通量平滑度在胸中上段食管癌容积弧形调强中的剂量学比较  

Dosimetric comparison among volumetric modulate arc therapy plans with different fluence smoothing in the treatment of patients with middle and upper thoracic esophageal carcinoma

作　　者：吴凡 刘敏 康盛伟 王培 黎杰 唐斌 吴骏翔 Wu Fan;Liu Min;Kang Shengwei;Wang Pei;Li Jie;Tang Bin;Wu Junxiang(Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Radiation Oncology Key Laboratory of Sichuan Province,Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院,放射肿瘤学四川省重点实验室,成都610041

出　　处：《中华放射医学与防护杂志》2020年第1期32-35,共4页Chinese Journal of Radiological Medicine and Protection

基　　金：国家重点研发计划项目(2017YFC0113100);四川省科技重点研发项目(2018GZ0197)。

摘　　要：目的对比Monaco计划系统中3种通量平滑度参数在胸中上段食管癌容积弧形调强(VMAT)中的剂量学差异。方法选取15例胸中上段食管癌病例,相同优化条件下分别使用高、中和低3种通量平滑度(高组、中组、低组)进行VMAT计划设计和评估。比较3组计划靶区的D95、Dmean、适形度指数(CI)、均匀性指数(HI)、危及器官的受量和机器跳数。结果3组计划相比靶区的D95、Dmean、CI和HI等参数差异均无统计学意义(P>0.05)。高组与中和低组相比,心脏的V40、Dmean、双肺的V10、V20、Dmean和子野数差异无统计学意义(P>0.05);与中组和低组相比,高组心脏的V30和脊髓危及器官的计划体积(PRV)Dmax均降低(t=-2.167、-0.999,P<0.05);高组双肺的V5高于中和低组(t=1.306、-2.027、P<0.05);与中组和低组相比,高组的机器跳数降低(t=-3.148、-6.692、P<0.05)。与中组相比,低组的心脏V30和Dmean,脊髓PRV Dmax均增加(t=0.411、0.589、0.013,P<0.05),而肺的V5降低(t=0.423,P<0.05)。结论3组计划均能满足临床要求。综合考虑计划质量和执行效率,建议采用高通量平滑度用于中上段食管癌容积弧形调强放疗。Objective To compare the dosimetric differences of volumetric modulated arc therapy(VMAT)plans optimized with 3 different fluence smoothing parameters using Monaco treatment planning system.Methods A total of 15 patients with middle and upper esophageal carcinoma were planned with Low fluence smoothing(Low),Medium fluence smoothing(Medium)and High fluence smoothing(High)during VMAT optimization.The dosimetric differences in D95,Dmean,conformity index(CI),homogeneity index(HI)of targets,dose volume histogram(DVH)of organs at risk(OARs),and monitor unit(MU)were compared.Results There were no significant differences in D95,Dmean,CI and HI of targets,as well as in V40 and Dmean of the heart,V10,V20 and Dmean of the lung,and segment number among plans optimized with different fluence smoothing techniques(P>0.05).Plans with high fluence smoothing achieved less V30 of heart,Dmax of cord PRV(t=-2.167,-0.999,P<0.05),lower MU(t=-3.148,-6.692,P<0.05),but increased V5 of both lungs(t=1.306,-2.027,P<0.05)compared with plans with Medium and Low fluence smoothing.Plans with low fluence smoothing irradiated higher dose to the V30 and Dmean to heart(t=0.411,0.589,0.013,P<0.05),but less V5 of the lungs(t=0.423,P<0.05)compared with plans with medium fluence smoothing.Conclusions All VMAT plans with 3 different fluence smoothing can meet the clinical requirements.VMAT plans optimized with high fluence smoothing are recommended in the treatment of patients middle and upper thoracic esophageal carcinoma.

关 键 词：危及器官 临床要求 胸中上段食管癌 容积弧形调强 平滑度 计划靶区 均匀性指数 机器跳数 

分 类 号：R735[医药卫生—肿瘤]