脑转移性癌IMRT与3D-CRT剂量学对比分析研究  

Dosimetric comparison of IMRT and 3D-CRT in brain metastasis tumors

作　　者：王树超[1] 田楠楠 李宏[1] 李琨[1] 李爱菊[1] 刘文健[1] WANG Shu-Chao;TIAN Nan-nan;LI Hong;LI Kun;LI Ai-ju;LIU Wen-jian(Department of Radiotherapy, The Affliated Hospital of Taishan Medical College, Shandong,2 71000 China)

机构地区：[1]泰山医学院附属医院放疗二病区,山东泰安271000

出　　处：《社区医学杂志》2018年第2期15-18,共4页Journal Of Community Medicine

摘　　要：目的比较脑转移性癌调强放疗(IMRT)与三维适形放疗(3D-CRT)靶区剂量学差异,为临床应用提供参考。方法选择2014年6月—2015年12月接受放射治疗的脑转移性癌患者共20例(其中10例单发,10例多发转移患者),每例患者分别设计三维适形放疗(全脑2野对穿+3野局部加量)及5野IMRT计划。分析两组分别运用两种放疗方法的等剂量曲线及剂量体积直方图(DVH),评价两种治疗计划对靶区剂量分布及周围正常组织的影响。计量资料比较采用配对t检验和单因素方差分析,P<0.05为差异有统计学意义。结果 (1)单发转移病灶组:IMRT计划显著提高了靶区适形度,但均匀度无明显优势。显著降低了脑干、视交叉和脑垂体的最大受照射剂量(均P<0.05);视交叉和脑垂体的最小受照射剂量和平均受照剂量、左右视神经的平均剂量与3D-CRT比较,差异有统计学意义(均P<0.05)。(2)多发转移病灶组:IMRT计划与3D-CRT相比较,靶区适行度及均匀度均在可接受范围。IMRT计划中左右晶体的受照剂量显著增大(均P<0.05),其他危及器官无明显差异(P>0.05)。结论两种放疗计划均能达到满意的靶区覆盖率。IMRT与3D-CRT都有更好的靶区适形性但都表现出了较大的靶区异质性。多发脑转移病灶组中IMRT放疗方式对危及器官的保护没有表现出优势。Objective To compare the dose distribution and volume histogram（DVH）of intensity-modulated radiation therapy-（IMRT）and three-dimensional conformal radiation therapy of the planning target volum（PTV）.Methods Twenty patients（ineluding 10 cases with single lesion,10 cases with multiple lesions）with brain metastases cancer accepted radiation therapy were selected.The three-dimensional conformal radiation therapy（2 fields for the whole brain ＋ 3 fields as a boost treatment for the GTV）and 5 fields intensity-modulated radiation therapy（IMRT）plans were designed respectively for each patient.Count data were compared by paired t test and single factor analysis of variance.P〈0.05 was considered statistically significant.Results（1）single metastatic lesions group：The IMRT program significantly improved the conformability of the target area,but there was no obvious advantage in uniformity,at the same time,it reduced the maximum exposure dose of the brain stem,the optic chiasma,and the pituitary gland.（all P〈0.05）.The minimum irradiated dose and average dose of the optic chiasma and the pituitary gland,the average dose of the left and right optic nerve were significantly different from those of 3D-CRT（P〈0.05）.（2）multiple lesions group：Compared with 3D-CRT,the IMRT plan is acceptable in target area and uniformity.The irradiated dose of the left and right crystals in the IMRT program increased significantly（P〈0.05）,and there was no significant difference in other jeopard organs（P〉0.05）.Conclusions The two kinds of radiotherapy plan can achieve satisfactory target coverage.Both IMRT and 3D-CRT have better target area conformability,but both show large target heterogeneity.In the multiple brain metastases group,IMRT radiotherapy has no advantage in the protection of jeopard organs.

关 键 词：脑转移性癌 调强放疗 三维适形放疗 

分 类 号：R739.41[医药卫生—肿瘤]