TCP/NTCP生物模型在胸中上段食管癌调强放疗中的应用  

Application of TCP/NTCP biological models in intensity-modulated radiotherapy for middle and upper esophageal carcinoma

作　　者：来凯建 巩贯忠[2] 吴慧[3] 全红[1] 尹勇[2] LAI Kaijian;GONG Guanzhong;WU Hui;QUAN Hong;YIN Yong(School of Physics and Technology,Wuhan University,Wuhan 430072,China;Department of Medical Physics and Technology,Shandong Cancer Hospital,Ji'nan 250117,China;Department of Radiation Oncology,He’nan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]武汉大学物理科学与技术学院,湖北武汉430072 [2]山东省肿瘤医院放射物理技术科,山东济南250117 [3]河南省肿瘤医院放疗科,河南郑州450008

出　　处：《中国医学物理学杂志》2022年第3期265-271,共7页Chinese Journal of Medical Physics

基　　金：国家自然科学基金(82072094);山东省自然科学基金(ZR2019LZL017);山东省泰山学者项目(ts201712098);河南省医学科技攻关计划省部共建项目(SB201901112)。

摘　　要：目的:探究TCP/NTCP生物模型在胸中上段食管癌放疗计划优化中的应用及剂量学特点。方法:回顾性分析47例胸中上段食管癌患者,为每位患者制定基于剂量体积(DV)限制的IMRT计划,在DV计划基础上添加对计划靶区(PTV)的TCP(限值90%、95%)生物模型以及危及器官的NTCP(限值10%、5%)模型优化,依次生成Plan_(TCP90%)、Plan_(TCP95%)、Plan_(NTCP10%)、Plan_(NTCP5%)4组计划。从剂量学及生物学参数方面评估计划间差异。结果:Plan_(TCP90%)、Plan_(TCP95%)相比于DV计划,靶区剂量参数均提高(P<0.05),其中D_(mean)、D_(2%)、D_(98%)分别提高(2.1%、9.8%)、(1.9%、9.8%)和(1.7%、9.3%),CI分别降低5%、20%,HI相近,TCP值分别提高2%、7%;危及器官受照剂量均有不同程度提高,Plan_(TCP95%)增加更显著(P<0.05)。经TCP优化后的计划仅Plan_(TCP90%)满足临床要求;Plan_(NTCP5%)与DV计划相比,靶区、心脏相关剂量参数间差异没有统计学意义(P>0.05),但双肺D_(mean)、V_(5 Gy)、V_(10 Gy)、V_(20 Gy)、NTCP值降低4.4%、1.6%、2.6%、6.2%、0.52%(P<0.05)。Plan_(NTCP10%)与DV计划相比,PTV及危及器官相关剂量学参数间差异没有统计学意义(P>0.05)。结论:TCP/NTCP生物学优化可以使靶区及危及器官剂量更符合生物学要求,建议在胸中上段食管癌放疗DV计划优化后引入TCP/NTCP的评估,进而进行选择性的靶向深入优化。Objective To explore the application of tumor control probability/normal tissue complication probability (TCP/NTCP) biological models in the optimization of radiotherapy plans for middle and upper thoracic esophageal cancer,and to analyze the dosimetric characteristics.Methods A total of 47 patients with middle and upper thoracic esophageal cancer were selected retrospectively,and the intensity-modulated radiotherapy plan based on dose-volume (DV) limits was developed for each patient.Based on the DV plan,the TCP biological models (with limit values of 90%and 95%) for the planning target volume (PTV) and the NTCP biological models (with limit values of 10%and 5%) for the organs-at-risk (OAR) were added to generate 4 sets of plans,namely Plan_(TCP90%),Plan_(TCP95%),Plan_(NTCP10%)and Plan_(NTCP5%).The differences in dosimetric and biological parameters between different plans were evaluated.Results Compared with those in DV plans,the dosimetric parameters of PTV in Plan_(TCP90%) and Plan_(TCP95%) were increased(P<0.05),in which the D_(mean)、D_(2%) and D_(98%) were increased by (2.1%,9.8%),(1.9%,9.8%) and (1.7%9.3%),respectively,and the TCP was increased by 2%and 7%,respectively,but conformity index was decreased by 5%and 20%,and homogeneity index was similar in the 3 sets of plans.The radiation doses to OAR were increased in different degrees,and the increase in Plan_(TCP95%)was more significant (P<0.05).After TCP optimization,only Plan_(TCP90%)could meet the clinical requirements.The dosimetric parameters of PTV and heart in Plan_(NTCP5%) and DV plan were basically the same(P>0.05),but the D_(mean)、V_(5 Gy)、V_(10 Gy)、V_(20 Gy) and NTCP for both lungs in Plan_(NTCP5%) were decreased by 4.4%,1.6%,2.6%,6.2%and 0.52%as compared with DV plan (P<0.05).The differences in the dose parameters of PTV and OAR between Plan_(NTCP10%) and DV plan were trivial (P>0.05).Conclusion TCP/NTCP biological optimization can make the dose to the target areas and OAR more in line with the biological requirements.It is suggested th

关 键 词：食管癌 计划优化 生物模型 剂量学 

分 类 号：R318[医药卫生—生物医学工程] R815.6[医药卫生—基础医学]