新型动态适形弧技术在周围型肺癌立体定向放射治疗中的应用  

Application of Modern Dynamic Conformal Arc Technique for Stereotactic Body Radiation Therapy of Peripheral Lung Cancer

作　　者：魏鹏 张爱平 陈其超 杨君东[1] 刘卫东 叶书成[1] WEI Peng(The Affiliated Hospital of Jining Medical College,Shangdong Jining 272000, China)

机构地区：[1]济宁医学院附属医院肿瘤科,山东济宁272000 [2]济宁肿瘤医院放射治疗中心,山东济宁272011

出　　处：《河北医学》2022年第6期946-950,共5页Hebei Medicine

基　　金：中华国际医学交流基金立体定向放疗联合系统治疗与单纯系统治疗寡转移IV非小细胞肺癌的随机对比研究,(编号:2019-N-11-22);济宁医学院附属医院“苗圃”科研计划项目COMPASS系统在NSCLC体部立体定向放疗三维剂量验证中的应用研究,(编号:MP-MS-2019-019)。

摘　　要：目的:对比2种动态适形弧技术在周围型肺癌体部立体定向放射治疗(SBRT)中的剂量学差异,为临床中选取更优的放射治疗计划提供参考。方法:选取15例周围型肺癌病例,分别使用传统动态适形弧技术(CDCA)和新型动态适形弧技术(MDCA)进行SBRT计划设计和评估,比较2种计划靶区的Dmax、Dmean、Dmin、适形度指数(CI)、均匀性指数(HI)、梯度指数(GI)、危及器官的受照剂量、机器跳数和出束时间。结果:2种计划相比靶区的Dmean、Dmin、CI和GI等参数均有统计学意义(t=-2.766、4.774、15.791、-12.055,P<0.05)。MDCA计划与CDCA计划相比,靶区的Dmax、心脏、食管、脊髓的Dmax和机器跳数差异无统计学意义(P>0.05),但MDCA计划的双肺Dmean、V13.5、V12.5、肋骨、大血管的Dmax、正常组织的Dmean均低于CDCA计划,差异有统计学意义(t=-4.712、-3.604、-2.923、-5.799、-3.943、-4.774,P<0.05)。MDCA计划出束时间高于CDCA计划(t=8.824,P<0.05)。结论:MDCA计划在靶区适形度、剂量梯度以及危及器官保护方法明显优于CDCA计划,推荐使用MDCA计划。Objective:To compare the dosimetric differences of two dynamic conformal arc technologies in stereotactic body radiation therapy(SBRT)for peripheral lung cancer so as to provide reference for better selection.Methods:A total of fifteen patients with peripheral lung cancer were evaluated respectively for classical dynamic conformal arc(CDCA)technique and modern dynamic conformal arc(MDCA)technique during SBRT plan optimization.The dosimetric differences in Dmax,Dmean,Dmin,conformity index(CI),heterogeneity index(HI),gradient index(GI)of targets,dose volume histogram(DVH)of organs at risk,monitor unit(MU),and beam on time were compared.Results:There showed significant differences in Dmean,Dmin,CI and GI of targets among plans optimized with MDCA and CDCA technique(t=-2.766,4.774,15.791,-12.055,P<0.05).Compared with CDCA plans,there were no significant differences in Dmax of targets,heart,esophagus and spinal cord,and MU(P>0.05).Plans with MDCA technique achieved less Dmean,V13.5 and V12.5 of the lung,Dmax of ribs,great vessel,and Dmean of healthy tissues(t=-4.712,-3.604,-2.923,-5.799,-3.943,-4.774,P<0.05),but increased beam on time(t=8.824,P<0.05).Conclusion:MDCA plans significantly improved target conformity and gradient and reduced the doses to organs at risk.Therefore,it is recommended to choose MDCA plan for peripheral lung cancer.

关 键 词：动态适形弧放射治疗 非小细胞肺癌 子野形状优化 可变剂量率 

分 类 号：R73[医药卫生—肿瘤]