螺旋断层动态钨门技术在肺癌立体定向放疗中的应用  

Application of Dynamic Jaw Technique in Helical Tomotherapy During Stereotactic Body Radiotherapy for Lung Cancer

作　　者：吴骏翔 唐斌 康盛伟 王培 黎杰 吴凡 WU Junxiang;TANG Bin;KANG Shengwei;WANG Pei;LI Jie;WU Fan(Key Laboratory of Radiation Oncology of Sichuan Province,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,UESTC,Chengdu Sichuan 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,四川成都610041

出　　处：《中国医疗设备》2022年第4期43-46,共4页China Medical Devices

基　　金：四川省重点研发项目(2021YFG0168,2021YFG0320)。

摘　　要：目的通过评估动态钨门技术的计划质量和执行效率,探讨能否在螺旋断层调强放疗中使用射野宽度5.0 cm的动态钨门(Dynamic Jaw 5.0 cm,DJ5.0)代替2.5 cm固定钨门(Fixed Jaw 2.5 cm,FJ2.5)应用于肺癌立体定向放疗(Stereotactic Body Radiotherapy,SBRT)。方法选取10例肺癌患者,处方剂量40 Gy/5次,相同优化条件下分别使用FJ2.5、射野宽度2.5 cm的动态钨门(Dynamic Jaw 2.5 cm,DJ2.5)和DJ5.0进行计划设计和评估。比较3组计划靶区的D95、适形度指数、梯度指数(Gradient Index,GI)、危及器官的受照剂量、机器跳数和照射时间。结果DJ2.5组的靶区GI优于其他两组,差异有统计学意义(P<0.05)。DJ2.5组的患侧肺V_(5)、V_(10)、D_(mean)、健侧肺D_(mean)、脊髓D_(max)、心脏D_(mean)、食管D_(mean)与DJ5.0和FJ2.5组相比均降低,差异有统计学意义(P<0.05)。DJ5.0和FJ2.5组相比,患侧肺V_(5)、V_(10)和D_(mean)均降低,差异有统计学意义(P<0.05)。DJ5.0组与FJ2.5和DJ2.5组相比,机器跳数分别降低了37.0%、40.7%,照射时间分别降低了34.5%和37.9%,差异有统计学意义(P<0.05)。结论综合考虑计划质量和照射效率,建议采用DJ5.0代替传统的FJ2.5应用于肺癌SBRT,在满足临床要求的同时可以显著缩短照射时间,若只考虑计划质量则选择DJ2.5。Objective To evaluate the plan quality and execution efficiency of dynamic jaw and investigate the feasibility of replacing the fixed jaw 2.5 cm(FJ2.5)with dynamic jaw 5.0 cm(DJ5.0)in stereotactic body radiotherapy(SBRT)of lung cancer.Methods A total of 10 patients with lung cancer were selected with a prescription dose of 40 Gy/5 times.Under the same optimization conditions,FJ2.5,dynamic jaw 2.5 cm(DJ2.5)and DJ5.0 were used for plan design and evaluation,respectively.The difference for D95,conformity Index(CI),gradient Index(GI),dose to OARs,monitor unit and beam-on time were compared among these 3 techniques.Results DJ2.5 plan was better in the aspects of the GI(P<0.05).DJ2.5 plan were superior to DJ5.0 and FJ2.5 plans in the aspects of the V_(5),V_(10) and D_(mean) to the ipsilateral lung,the D_(mean) to the contralateral lung,the D_(max) to the spinal cord,the D_(mean) to heart and the D_(mean) to esophagus(P<0.05).Compared with FJ2.5 plan,the V_(5),V_(10) and D_(mean) to the ipsilateral lung of DJ5.0 plan were superior(P<0.05).Compared with FJ2.5 and DJ2.5,the monitor unit of DJ5.0 was decreased by 37.0%and 40.7%,and the beam-on time was decreased by 34.5%and 37.9%,respectively(P<0.05).Conclusion Taking the planning quality and irradiation efficiency into consideration,it is suggested to use DJ5.0 group instead of traditional FJ2.5 for SBRT of lung cancer,which can significantly shorten the irradiation time while meeting the clinical requirements.If only the planning quality is considered,the DJ2.5 group should be selected.

关 键 词：螺旋断层调强放疗 动态钨门技术 立体定向放疗 剂量学 肺癌 

分 类 号：R815.6[医药卫生—放射医学]