动态调强和静态调强技术治疗中晚期宫颈癌剂量学比较  

Dosimetric comparison of dynamic IMRT and static IMRT for middle-terminal cervical cancer

作　　者：朱均强[1] 班卫华[2] 蒙富斌 谢源贵 苏善宁 王洪乾[1] ZHU Jun-qiang;BAN Wei-hua;MENG Fu-bin;XIE Yuan-gui;SU Shan-ning;Wang Hong-qian(Deparment of Radiation Oncology,Red Cross Hospital of Yulin City,Yulin 537000,P.R.China;Department of Radiation Oncology,People's Hospital of Baise,Baise 533000.P.R.China)

机构地区：[1]玉林市红十字会医院肿瘤放疗科,广西玉林537000 [2]百色市人民医院肿瘤放疗科,广西百色533000

出　　处：《中华肿瘤防治杂志》2020年第7期559-565,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西壮族自治区卫生与健康委员会自筹经费科研课题(Z20180445)。

摘　　要：目的宫颈癌严重威胁着妇女的健康,调强放射治疗(intensity modulated radiotherapy,IMRT)联合后装放疗成为中晚期(ⅡB~ⅢB期)宫颈癌治疗的主要方法。本研究旨在比较动态调强放射治疗(dynamic intensity modulated radiotherapy,dIMRT)技术和强度等级不同的静态调强放射治疗(static intensity modulated radiotherapy,sIMRT)技术治疗中晚期宫颈癌时的剂量学特点,为临床应用提供参考。方法回顾性选取玉林市红十字会医院2017-10-09-2019-03-24收治的中晚期(ⅡB~ⅢB期)宫颈癌患者50例(其中ⅡB期17例,ⅢA期15例,ⅢB期18例),在增强定位CT影像上勾画靶区和危及器官。在Eclipse 10.0计划系统中基于同一套CT图像设计5野调强计划,选取dIMRT技术中的滑窗技术(Sliding Window,SW)和强度等级分别为13(Ec13),10(Ec10),7(Ec7)和5(Ec5)的sIMRT技术,处方剂量均为50Gy/25次,要求计划靶区95%的体积达到处方剂量。通过分析剂量-体积直方图(dose volume histogram,DVH)及传输参数,比较5种调强放射治疗方式中计划靶区的靶区适形指数(conformity index,CI)、均匀指数(homogeneity index,HI)、危及器官(膀胱、小肠和直肠)剂量分布和机器参数的差异。数据经Shapiro-Wilk法检验符合正态分布后,组间均值差异进行单因素方差分析,两两多重比较采用LSD法。用Pearson法分析sIMRT强度等级与子野数量的关系。结果5种计划的靶区最大剂量Dmax、平均剂量Dmean、HI值和CI值差异有统计学意义。其中,对于SW、Ec13、Ec10、Ec7和Ec5计划,Dmax值分别为(55.27±1.29)、(55.54±1.18)、(55.83±1.10)、(57.51±1.05)和(59.90±1.08)Gy,差异有统计学意义,F=154.844,P<0.01;HI值分别为1.06±0.01、1.06±0.01、1.07±0.01、1.09±0.01和1.12±0.02,差异有统计学意义,F=452.442,P<0.01;CI值分别为0.89±0.01、0.88±0.01、0.88±0.01、0.86±0.01和0.83±0.01,差异有统计学意义,F=107.928,P<0.01。相对于sIMRT,SW组的Dmean、HI值和CI值差异有统计学意义,均P<OBJECTIVE Cervical cancer is a serious threat to women’s health,and intensity-modulated radiation therapy(IMRT)combined with brachytherapy becomes the principal means of cervical cancer treatment for middle and late stage cervical carcinoma.This paper aimed to compare the dosimetric characteristics of dynamic IMRT and static IMRT with different intensity levels for advanced cervical cancer and provides recommendations for clinical application.METHODS Fifty patients(17,15 and 18 forⅡB,ⅢA andⅢB stage,respectively)withⅡB-ⅢB stage cervical carcinoma between October 9 th,2017 and March 24 th,2019 in the Yulin Red Cross Hospital were enrolled retrospectively.The target areas and critical organs were contoured on the contrast-enhanced CT images.The fixed-five-fields IMRT plans were designed on the same set of CT images in Eclipse 10.0 treatment planning system(TPS),which were dynamic IMRT(Sliding Window,SW)and static IMRT with intensity levels 13(Ec13),10(Ec10),7(Ec7)and 5(Ec5),respectively.The prescription dose was 50 Gy/25 fractions,and 95%of the PTV was required to achieve the prescribed dose.By analyzing the dosevolume histogram(DVH)and delivery parameters,homogeneity index(HI)and conformity index(CI)for PTV,radiation in organs at risk(OARs),such as bladder,small intestine and rectum,and machine parameters was compared.After the data were tested by S-W method to conform to normal distribution,the mean difference between groups was analyzed by oneway anova,and the pair comparison was conducted by LSD method.The relationship between intensity levels and the number of segments was analyzed with Pearson method.RESULTS The differences of maximum dose Dmax,mean dose Dmean,HI and CI in PTV were statistically significant(P<0.05)for five groups.For SW,Ec13,Ec10,Ec7 and Ec5,Dmax,HI and CI values were(55.27±1.29),(55.54±1.18),(55.83±1.10),(57.51±1.05)and(59.90±1.08)Gy,F=154.844,P<0.01;1.06±0.01,1.06±0.01,1.07±0.01,1.09±0.01 and 1.12±0.02,F=452.442,P<0.01;0.89±0.01,0.88±0.01,0.88±0.01,0.86±0.01 and 0.8

关 键 词：宫颈癌 调强放射治疗 动态调强放射治疗 静态调强放射治疗 强度等级 子野 剂量学 

分 类 号：R730.55[医药卫生—肿瘤] R737.33[医药卫生—临床医学]