胸中段食管癌sIMRT、VMAT、TOMO三种放疗技术靶区和危及器官剂量学研究  

Target area and organ at risk dosimetry study of sIMRT,VMAT and TOMO for middle thoracic esophageal cancer

作　　者：赵彪 袁美芳 马立双 孙朝细 安义均 汤可维 杨毅 ZHAO Biao;YUAN Meifang;MA Lishuang;SUN Chaoxi;AN Yijun;TANG Kewei;YANG Yi(Department of Radiotherapy,Yunnan Cancer Hospital/the Third Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650118,China;Department of Neurosurgery,Yunnan Cancer Hospital/the Third Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650118,China;Department of Oncology,the First People's Hospital of Zhaotong,Yunnan Zhaotong 657099,China;Department of Oncology,the First People's Hospital of Yueyang,Hunan Yueyang 414000,China)

机构地区：[1]云南省肿瘤医院/昆明医科大学第三附属医院放射治疗科,云南昆明650118 [2]云南省肿瘤医院/昆明医科大学第三附属医院神经外科,云南昆明650118 [3]昭通市第一人民院肿瘤科,云南昭通657099 [4]岳阳市第一人民医院肿瘤科,湖南岳阳414000

出　　处：《现代肿瘤医学》2022年第13期2424-2428,共5页Journal of Modern Oncology

摘　　要：目的:探讨胸中段食管癌sIMRT、VMAT、TOMO三种放疗计划剂量学特点,为临床治疗提供剂量学参考。方法:选取我科2016年9月至2020年1月的25例胸中段食管癌放疗患者资料,采用Pinnacle10.0和Tomotherapy TPS分别设计sIMRT、VMAT、TOMO三组计划,对三组计划的靶区和危及器官剂量学参数进行比较。结果:胸中段食管癌sIMRT、VMAT、TOMO三种放疗技术靶区和危及器官剂量学比较;靶区适形度CI(0.638±0.043 vs 0.686±0.052 vs 0.762±0.045)和均匀性HI(0.247±0.025 vs 0.231±0.013 vs 0.211±0.023)TOMO最佳,VMAT优于sIMRT(P<0.05)。双肺V_(5)(%)(68.23±6.03 vs 65.51±5.21 vs 76.75±8.03)、V_(10)(%)(47.48±3.53 vs 45.04±2.07 vs 52.54±2.65)和D_(mean)(cGy)(1310.57±76.76 vs 1250.44±70.39 vs 1250.44±70.39)VAMT最低、sIMRT低于TOMO(P<0.05);双肺V_(20)(%)(22.87±2.02 vs 20.57±1.53 vs 20.01±2.08)TOMO略低于VMAT、VMAT略低于sIMRT(P<0.05)。心脏V_(25)(%)(30.57±8.59 vs 24.46±8.44 vs 19.86±6.92)、V_(30)(%)(18.55±5.08 vs 15.08±5.57 vs 11.69±4.74)、D_(mean)(cGy)(1742.23±485.63 vs 1680.33±510.33 vs 1651.36±521.33)TOMO低于VMAT,VMAT低于sIMRT(P<0.05)。脊髓最大剂量D_(2%)(4045.46±168.57 vs 4010.65±210.32 vs 3740.56±185.58),TOMO低于VMAT,VMAT略低于sIMRT(P<0.05)。结论:胸中段食管癌根治性放疗靶区适形度和均匀性TOMO最佳,VMAT优于sIMRT;危及器官剂量三种放疗技术各有特点,但综合来看对肺的保护VMAT最优,心脏和脊髓的保护TOMO最优,sIMRT在肺的低剂量区较TOMO有一定优势。Objective:To investigate the dosiological characteristics of sIMRT,VMAT and TOMO radiotherapy plans for middle thoracic esophageal cancer,and to provide dosiological reference for clinical treatment.Methods:Data of 25 patients with middle thoracic esophageal cancer treated with radiotherapy in our department from September 2016 to January 2020 were selected to design sIMRT,VMAT and TOMO groups using Pinnacle 10.0 and TomTOMotherapy TPS respectively,and to compare the dosiological parameters of the target area and organs at risk of the three groups.Results:A dosiological comparison of sIMRT,VMAT and TOMO radiotherapy techniques in target areas and organs at risk for middle thoracic esophageal cancer.CI(0.638±0.043 vs 0.686±0.052 vs 0.762±0.045)and HI(0.247±0.025 vs 0.231±0.013 vs 0.211±0.023)were the best TOMO,VMAT was better than sIMRT(P<0.05).Double lung V_(5)(%)(68.23±6.03 vs 65.51±5.21 vs 76.75±8.03),V_(10)(%)(47.48±3.53 vs 45.04±2.07 vs 52.54±2.65)and D_(mean)(cGy)(1310.57±76.76 vs 1250.44±70.39 vs 1250.44±70.39)VAMT was the lowest and sIMRT was lower than TOMO(P<0.05).Double lung V_(20)(%)(22.87±2.02 vs 20.57±1.53 vs 20.01±2.08)TOMO was slightly lower than VMAT,VMAT was slightly lower than sIMRT(P<0.05).Cardiac V_(25)(%)(30.57±8.59 vs 24.46±8.44 vs 19.86±6.92),V_(30)(%)(18.55±5.08 vs 15.08±5.57 vs 11.69±4.74),D_(mean)(cGy)(1742.23±485.63 vs 1680.33±510.33 vs 1651.36±521.33)TOMO was lower than VMAT and VMAT was lower than sIMRT(P<0.05).The maximum spinal cord dose D_(2%)(4045.46±168.57 vs 4010.65±210.32 vs 3740.56±185.58),TOMO was lower than VMAT,and VMAT was slightly lower than sIMRT(P<0.05).Conclusion:TOMO is the best target conformal and uniformity of radical radiotherapy for middle thoracic esophageal cancer,and VMAT is better than sIMRT.The three radiotherapy techniques have their own characteristics,but in general,VMAT is the best for lung protection,TOMO is the best for heart and spinal cord protection,and sIMRT has certain advantages over TOMO in the low-dose region of lu

关 键 词：胸中段食管癌 剂量学 静态调强放疗 容积旋转调强放疗 螺旋断层放疗 

分 类 号：R735.1[医药卫生—肿瘤]