不同治疗计划系统在宫颈癌调强放射治疗中的剂量学比较  

Dosimetric comparison of different planning systems applied in intensity modulated radiation therapy in the treatment of cervical cancer

作　　者：杨健 刘颖 王胜利[2] 张勇 许新明 王静 杨红霞 董俊峰[2] 刘丹[3] YANG Jian;LIU Ying;WANG Shengli;ZHANG Yong;XU Xinming;WANG Jing;YANG Hongxia;DONG Junfeng;LIU Dan(Department of Radiotherapy,Cangzhou People’s Hospital,Cangzhou 061000,Hebei,China;Department of General Surgery,Huanghua Development Zone Boai Hospital,Cangzhou 061100,Hebei,China;Department of Radiotherapy,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China)

机构地区：[1]沧州市人民医院放疗科,河北沧州061000 [2]黄骅开发区博爱医院普外科,河北沧州061100 [3]河北医科大学第四医院放疗科,石家庄0500110

出　　处：《癌症进展》2019年第21期2561-2564,2596,共5页Oncology Progress

摘　　要：目的使用3种商用治疗计划系统制订宫颈癌调强放射治疗(IMRT)计划并进行剂量学分析,为临床选择治疗计划系统提供参考和依据。方法选择10例宫颈癌患者,由有经验的物理师分别使用Pinnacle 9.2计划系统、Oncentra 4.3计划系统、Eclipse 10.0计划系统制订3组IMRT计划。所有计划均采用7野共面照射(210°、260°、310°、0°、50°、100°、150°),在瓦里安23EX直线加速器上完成。计划靶体积(PTV)处方剂量为50.4 Gy/28 f,危及器官限量参考临床要求。比较3种计划系统的靶区和危及器官受照射剂量以及机器跳数和子野数。结果与Pinnacle和Oncentra系统相比,Eclipse系统计算的PTV的Dmean、D50在确保达到处方剂量要求的前提下均较低,且其均匀性指数(HI)、适形指数(CI)、正常组织受照指数(HCO)均较低,差异均有统计学意义(P﹤0.05)。Pinnacle系统和Eclipse系统计算的直肠V40、V45、V50、Dmean均低于Oncentra系统计算的结果(P﹤0.05),且Pinnacle系统计算的数值均最小。Pinnacle系统和Eclipse系统计算的膀胱V30、V35、V40均低于Oncentra系统计算的结果(P﹤0.05),且Pinnacle系统计算的数值均最小。3种计划系统计算的小肠Dmax比较,差异有统计学意义(P﹤0.05),其中Eclipse系统计算的结果最小。Pinnacle系统的机器跳数为(811.300±100.581)个,明显少于Oncentra系统的(945.549±65.001)个,差异有统计学意义(P﹤0.01)。结论就宫颈癌IMRT计划而言,在直肠和膀胱受量达到临床要求的前提下,Eclipse系统更具优势;当计划的难点在于降低直肠和膀胱受量时,Pinnacle系统更具优势;当需要提高靶区内低剂量区的剂量时,优先考虑使用Oncentra系统;当需要降低小肠受量时,优先考虑Eclipse系统。Objective To perform a dosimetric comparison of intensity modulated radiation therapy(IMRT)by using three commercial planning systems in the treatment of cervical cancer.Method Three IMRT treatment plans were optimally generated using Pinnacle 9.2,Oncentra 4.3 and Eclipse 10.0 by experienced physical therapist for each of 10 randomly selected patients with cervical cancer.All plans were generated as 7 fields coplanar irradiation(210°,260°,310°,0°,50°,100°,150°),which were delivered using the Varian 23EX system.The prescribed dosage of planning target volume(PTV)was 50.4 Gy/28 f,and the dosage constrains for organ at risk(OAR)were addressed following the clinical requirements.The three planning systems were compared for the radiation dose of target volume and OAR,as well as the monitor units and subfields were compared among the three groups.Result Compared with the Pinnacle and Oncentra system,the Dmean and D50 for PTV calculated using Eclipse consistently remained on a low level in the case of the requirements for prescribed dosage were met,besides,the homogeneity index(HI),conformal index(CI)and healthy tissue coverage index(HCO)were relatively low,with statistically significant differences observed(P<0.05).The rectum V40,V45,V50,and Dmean calculated by Pinnacle and Eclipse were all lower than those generated by Oncentra system(P<0.05),and those values obtained using Pinnacle system were the minimum ones.As to bladder V30,V35,and V40,lower values were calculated using Pinnacle and Eclipse compared to Oncentra system(P<0.05),also,Pinnacle system produced the minimum values.The three systems revealed significantly different small bowel Dmax(P<0.05),with Eclipse values being the lowest.The monitor units of Pinnacle system were(811.300±100.581),which was significantly less compared to the(945.549±65.001)observed in Oncentra system,with statistically significant differences noted(P<0.01).Conclusion In the context of IMRT planning for cervical cancer,as long as the exposure of rectum and bladder meet the cli

关 键 词：宫颈癌 调强放射治疗 剂量分布 计划靶体积 

分 类 号：R737.33[医药卫生—肿瘤]