胸中段食管癌3种调强放疗计划及心肺保护比较研究  

Dosimetric comparison of three differentradiation treatment plans and cardio-pulmonary protection for middle thoracic esophageal carcinoma

作　　者：张洪波 闫冰 薛旭东 汪琳 张朋 沈琦 钱立庭 Zhang Hongbo;Yan Bing;Xue Xudong(Dept of Radiation Oncology,The First Affliated Hospital of Unwversity of Science and Technology of China,Hefei 230001)

机构地区：[1]中国科学技术大学附属第一医院放疗科,合肥230001 [2]安徽医科大学生命科学学院生物医学工程系,合肥230032

出　　处：《安徽医科大学学报》2020年第8期1232-1236,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家癌症中心攀登基金(编号:NCC201812B034)。

摘　　要：目的比较并探讨胸中段食管癌3种调强放疗计划及心肺保护比较研究。方法选取24例胸中段食管癌的患者,分别设计常规固定野调强放疗(IMRT)、容积旋转调强(VMAT)、螺旋断层放疗(TOMO)计划,比较3种计划的计划靶区适形度指数(CI)、均匀性指数(HI)、危及器官的剂量学参数以及平均治疗时间和机器跳数(MU)的差异。结果相比VMAT和IMRT计划,TOMO计划拥有较优的HI(P=0.01),CI在3种计划之间差异无统计学意义(P=0.34),TOMO计划比VMAT、IMRT计划能更好降低双肺的V(30)、V(20)(P<0.05);TOMO和VMAT计划之间双肺的V(10)、V5、D(mean)差异无统计学意义(P>0.05),VMAT相比于IMRT计划在V(20)和V5差异有统计学意义(P<0.05);3种计划在心脏V(30)、V(40)、D(mean)和脊髓最大量D(max)差异无统计学意义(P>0.05);TOMO计划时间最长,机器跳数最多,VMAT计划的执行速度最快,相比TOMO时间平均缩短66%。结论在中段食管癌放疗中,TOMO计划比VMAT和IMRT计划在均匀性和双肺保护方面都更有优势,在靶区适形度和心脏、脊髓差异无统计学意义。TOMO需要较长的治疗时间和较多的机器跳数;VMAT时间最短,计划质量也优于普通IMRT,因而是性价比最高的治疗方式。Objective To compare and explore dosimetric parameters of three differentradiation treatment plans and cardio-pulmonary protection for middle thoracic esophageal carcinoma.Methods A total of twenty-four patients with middle thoracicesophageal cancer were included and three radiation treatment plansfor fixed filed intensity modulated radiotherapy(IMRT),volumetric modulated arc therapy(VMAT)and tomotherapy(TOMO)were designed for each patient.Conformity index(CI),homogeneity index(HI),dosimetric parameters of organs at risk,the mean treatment time and the number of monitor units(MU)of the three plans were compared.Results Compared with VMAT and IMRT,TOMO showed better HI(P=0.01),and there was no significant difference in CI(P=0.34)among three differentradiation treatment plans,TOMO was significantly better than those of VMAT and IMRT in lung V30 and V20(P<0.05);There was no statistically significant difference between TOMO and VAMT in lung V10、V5 and Dmean(P>0.05),VMAT was significantly better than IMRT in lung V20、V5(P<0.05);There was no significant difference in heart V30,V40,Dmean(P>0.05)and the highest dose of spinal cord(Dmax)(P>0.05)among three plans;TOMO had the longest treatment time and the most number of MU,VMAT was the fastest to execute,with an average time reduction of 66%compared to TOMO.Conclusion In radiotherapy for middle thoracic esophageal cancer,TOMO is more advantageous than VMAT and IMRT in terms of HI and lung protection,and there is no significant difference in CI and dosimetric parameters of heart and spinal cord.TOMO requires longer treatment time and more number of MU;VMAT has the shortest treatment time and better plan quality than IMRT,so it is the most cost-effective treatment.

关 键 词：食管癌 调强放射治疗 容积旋转调强放疗 螺旋断层放射治疗 

分 类 号：R735.1[医药卫生—肿瘤]