局部晚期鼻咽癌静态调强、容积旋转调强和螺旋断层调强放射治疗的剂量学比较  

Dosimetric comparison of sIMRT,VMAT and HT for locally advanced nasopharyngeal carcinoma

作　　者：陈欣 李萌萌 陈如君 吴先想 方美芳 张亚军[2] 葛文洁[2] 张梦雨 江浩[2] 蔡汉飞[2] CHEN Xin;LI Meng-meng;CHEN Ru-jun(School of Graduate,Bengbu Medical College,Bengbu Anhui 233030,China;不详)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233030 [2]蚌埠医学院第一附属医院放疗科,安徽蚌埠233004

出　　处：《中国医学装备》2022年第3期17-22,共6页China Medical Equipment

基　　金：蚌埠市-蚌埠医学院联合科技攻关项目(BYLK201805)“多学科联合模式对头颈部鳞状细胞癌转移潜能探索的临床研究”。

摘　　要：目的:探讨静态调强放射治疗(sIMRT)、容积旋转调强放射治疗(VMAT)和螺旋断层放射治疗(HT)在局部晚期鼻咽癌放射治疗中的剂量学特点。方法:选取医院收治的12例局部晚期鼻咽癌患者,分别制定sIMRT、VMAT和HT计划。在满足相同处方剂量要求的情况下,评估靶区受量、危及器官(OAR)受量,并比较3种计划的正常组织剂量分布和总机器跳数(MU)。结果:3种计划剂量分布均可满足临床剂量要求。靶区受量中,HT、VMAT的近似最大剂量(D_(2))、均匀度(HI)和适形度(CI)优于sIMRT,差异有统计学意义(F=21.334,F=62.043,F=11.17;P<0.05);VMAT与HT在鼻咽部原发癌及颈转移淋巴结计划靶区(PGTV)和计划靶区1(PTV1)中差异较小并无统计学意义,而在计划靶区2(PTV2)中,HT计划的D_(2)、HI及CI要显著优于sIMRT和VMAT,差异有统计学意义(F=12.659,F=185.259,F=16.28;P<0.05)。OAR受量中,与sIMRT和VMAT相比,HT计划脑干1 cm^(3)体积剂量(D_(1cm^(3)))和眼晶状体的最大剂量(D_(max))有所降低,差异有统计学意义(F=12.306,F=12.271;P<0.05);视神经D_(max),口腔、耳蜗及甲状腺的平均剂量(D_(mean))均有所升高,差异有统计学(F=12.67,F=13.197,F=766.6,F=5.399;P<0.05);HT计划腮腺的D_(mean)相对于sIMRT和VMAT明显降低(F=4.36,F=8.205;P<0.05),且HT在保护腮腺的低剂量体积(V_(10)~V_(20))更有优势。对于正常组织(NT),HT的受量相对于sIMRT和VMAT明显升高,差异有统计学意义(F=5.316,F=21.846,F=31.706,F=13.335,P<0.05)。VMAT在机器跳数和治疗时间上明显优于sIMRT和HT,差异有统计学意义(F=315.2,F=79.301;P<0.05)。结论:HT在局部晚期鼻咽癌的治疗中对复杂靶区的调制能力更有优势,有更好的靶区适形度和均匀度;VMAT在提供较好剂量分布的同时,治疗效率最高;sIMRT仅在保护视神经、视交叉方面有着较好的优势,可根据临床实际情况选择合适的治疗计划。Objective:To explore the dosimetric characteristics of static intensity-modulated radiotherapy(sIMRT),volumetric modulated arc therapy(VMAT) and helical tomotherapy(HT) for locally advanced nasopharyngeal carcinoma.Methods:Twelve patients with locally advanced nasopharyngeal carcinoma admitted to hospital were selected,and the plans of sIMRT,VMAT and HT were respectively formulated for them.The received doses of target volume,organs at risk(OAR) were assessed under meeting the requirement of same prescription dose,and then,the dose distribution of normal tissue and total machine monitor unit(MU) of the three plans were compared.Results:The dose distributions of all three plans could meet the requirements of clinical dose.In the received dose of target region,the approximate maximum dose(D_(2)),homogeneity index(HI) and conformity index(CI) of HT and VMAT were significantly better than those of sIMRT(F=21.334,F=62.043,F=11.17,P<0.05),respectively.The differences between VMAT and HT in planning gross tumor volume(PGTV) and planning target volume 1(PTV1) of primary cancer of nasopharynx and cervical metastatic lymph nodes were not significant,while the D_(2),HI and CI of HT plan were significantly better than those of sIMRT and VMAT in PTV2(F=12.659,F=185.259,F=16.28,P<0.05).In OAR received doses,the 1 cm^(3) volume dose(D_(1 cm^(3))) of brainstem and the maximum dose(D_(max)) of eye lens in HT plan were significantly lower than those in sIMRT and VMAT(F=12.306,F=12.271,P<0.05),respectively.And the D_(max) of optic nerve,the average dose(D_(mean)) of oral cavity,cochlea and thyroid in HT plan were significantly higher than those in sIMRT and VMAT(F=12.67,F=13.197,F=766.6,F=5.399,P<0.05),respectively.The D_(mean) of parotid in HT plan was significantly lower than that in sIMRT and VMAT(F=4.36,F=8.205,P<0.05),respectively.And HT had more advantages in protecting the parotid gland at lower dose volumes(V_(10)-V_(20)).For normal tissue(NT),the received dose of HT was significantly higher than that of sIMRT and VMAT(F=5.

关 键 词：鼻咽癌 螺旋断层放射治疗(HT) 容积旋转调强放射治疗(VMAT) 静态调强放射治疗(sIMRT) 剂量学 

分 类 号：R814.2[医药卫生—影像医学与核医学]