多重标准计划质量评价系统在直肠癌中的应用  

Application of multi-criteria plan quality assessment system in rectal cancer

作　　者：贺睿敏 邱小平[1] 杨振[2] 曹瑛 杨晓喻[2] 肖浩 HE Ruimin;QIU Xiaoping;YANG Zhen;CAO Ying;YANG Xiaoyu;XIAO Hao(Nanhua University,Hengyang 421001,China;Department of Oncology,Xiangya Hospital,Central South University,Changsha 410008,China;Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China)

机构地区：[1]南华大学,湖南衡阳421001 [2]中南大学湘雅医院肿瘤科,湖南长沙410008 [3]中山大学孙逸仙纪念医院,广东广州510000

出　　处：《中国医学物理学杂志》2018年第9期1017-1021,共5页Chinese Journal of Medical Physics

摘　　要：目的:使用一种自动计划评估软件系统,以该评估系统分析两种技术在直肠癌病例中的剂量学差异,为完善自动计划流程建立基础。方法:选取20例已批准的临床直肠癌计划,其中10例应用调强放射治疗(IMRT)技术,10例应用旋转调强放射治疗(Rapid arc)技术。将病人计划数据导入PlanIQ软件,将RTOG协议和TG报告文件作为参考,创建多重计划质量度量标准,标准包括靶区覆盖率,均匀性指数,适形度指数,股骨头、小肠、膀胱等危及器官的剂量学指标,将计划质量度量标准整合建立一个直肠癌计划质量评价系统。利用建立好的评估评价系统分别对两组病例进行评价打分,并进行相应的剂量学参数对比。结果:对比两种技术的剂量学参数,Rapid arc病例组靶区覆盖率和剂量热点要优于IMRT组,剂量学差异均有统计学意义。Rapid arc组除小肠外的危及器官受量要优于IMRT组,其中小肠V_(45)、D_(max),股骨头V_(40)、D_(max),膀胱V_(40)、V_(45)差异有统计学意义(P<0.05)。两组靶区均匀性指数和适形度指数差异无统计学意义(P>0.05)。最终通过质量评估系统得出的总分数,Rapid arc优于IMRT,且得分差异具有统计学意义(P<0.05)。结论:多重标准计划质量评估系统能有效地对计划进行评价,减少计划审查的工作量,可为自动计划的数据库提供优质的数据源。Objective To analyze the dosimetric differences between two techniques for rectal cancer with an automatic plan assessment system,and to establish a basis for refining the automatic planning process.Methods Twenty cases of rectal cancer were selected.Intensity-modulated radiotherapy(IMRT)technique was applied in 10 cases and Rapid Arc technique in the other 10 cases.The planning data of patients were imported into PlanIQ software to create plan quality metrics based on RTOG protocol and TG report files.The criterions included target coverage,homogeneity index,conformity index,and the dosimetric indicators of femoral head,small intestine,bladder and other organs-at-risk.After the integration of plan quality metrics,a rectal cancer plan quality assessment system was established.The established assessment system was used to score each criterion and compare the corresponding dosimetric parameters.Results The target coverage and hot spot in Rapid arc group were better than those in IMRT group,with statistical significance.The organs-at-risk sparing in Rapid arc group was superior to IMRT group except small intestine,and the differences in the V45,Dmaxof small intestine,the V40,Dmax of femoral head,and the V40,V45 of bladder were statistically significant(P<0.05).No significant differences were found between the two groups in homogeneity index and conformity index(P>0.05).According to the final scores obtained by quality assessment system,Rapid arc was proved to be better than IMRT,and the differences in scores were statistically significant(P<0.05).Conclusion Multi-criteria plan quality assessment system can effectively evaluate programs,reduce the workload of program reviews,and provide a good source of data for the databases of automatic planning.

关 键 词：直肠癌 调强放射治疗 旋转调强放射治疗 计划质量度量标准 

分 类 号：R735.37[医药卫生—肿瘤]