共面IMRT和非共面IMRT在食管癌大范围淋巴结预防性照射中的剂量学差异  

Dosimetric Comparison Between Coplanar and Non-Coplanar IMRT in Prophylactic Extended-Field Nodal Irradiation for Esophageal Cancer

作　　者：邹乐乐[1] 车国强 景娟娟[1] ZOU Lele;CHE Guoqiang;JING Juanjuan(Nanyang Second People's Hospital,Nanyang,473000)

机构地区：[1]河南省南阳市第二人民医院,473000

出　　处：《实用癌症杂志》2022年第9期1469-1473,共5页The Practical Journal of Cancer

摘　　要：目的研究共面调强放射(IMRT)与非共面IMRT在食管癌大范围淋巴结预防性照射中的剂量差异。方法将92例食管癌患者纳为研究对象,将其均分为共面IMRT组与非共面IMRT组治疗。比较两种放射计划的近期疗效、放射性反应,放射性指标[计划靶区(PVT)剂量参数、适形指数(CI)、剂量不均匀性指数(HI)、危及器官]、随访1年比较两组肿瘤局部控制率。结果两组近期疗效比较差异无统计学意义(P>0.05)。共面组患者放射性肺炎分级较非共面组严重,差异具有统计学意义(P<0.05)。两组PTV剂量参数Dmax、Dmin及Dmean水平、CI及HI指数比较,差异均无统计学意义(P>0.05)。非共面组双肺受照剂量V5、V10、V20、V30及MLD水平均较共面组下降,心脏受照剂量V30、V40、V45、V55及Dmean水平均较共面组上升,差异均具有统计学意义(P<0.05)。两组脊髓D1cc受照剂量比较,差异无统计学意义(P>0.05)。全部病例随访1年,采用Kaplan-Meier法分析其局部控制率,结果提示,共面组1年局部控制率为64.1%,非共面组为72.6%,差异具有统计学差异(P<0.05)。结论非共面IMRT能更为有效地保护胸中段食管癌患者正常肺组织,减少放射性肺炎发生率,并提高患者1年局部控制率,但非共面IMRT可能增加心脏受照剂量,造成心脏损伤,对合并心肌病、瓣膜病变等患者应慎重。Objective To compared the dosimetric difference between coplanar and non-coplanar intensity-modulated radiotherapy(IMRT)in prophylactic extended-field nodal irradiation for esophageal cancer.Methods 92 patients with esophageal cancer were enrolled,and were equally classified into coplanar IMRT group and non-coplanar IMRT group.Then the short-term efficacy,radiation response,radiation indexes[planning target volume(PVT)related parameters,conformity index(CI),heterogeneity index(HI),organs at risk]and tumor local control rate during 1-year follow-up were compared.Results The short-term efficacy had no statistical difference between the 2 groups(P>0.05).The radiation pneumonitis was more severe in coplanar IMRT group than in non-coplanar IMRT group(P<0.05).PTV parameters including mean dose(Dmean),maximum dose(Dmax)and minimum dose(Dmin),CI and HI showed no significant difference between groups(P>0.05).The dosimetric parameters V5,V10,V20,V30 and mean lung dose(MLD)of the bilateral lung of non-coplanar IMRT group were significantly lower than those of coplanar IMRT group(P<0.05),and the V30,V40,V45,V55 and Dmean of heart non-coplanar IMRT group were significantly higher than those of coplanar IMRT group(P<0.05).The dose to 1 cubic centimeter(D1cc)of spinal cord demonstrated no statistical difference(P>0.05).All cases were followed up for 1 year.Kaplan-Meier analysis showed that the 1-year local control rate was 64.1%in coplanar IMRT group and 72.6%in non-coplanar IMRT group,with statistical difference(P<0.05).Conclusion Compared with coplanar IMRT,non-coplanar IMRT can more effectively protect the normal lung tissue of patients with middle thoracic esophageal cancer,reduce the incidence of radiation pneumonitis,and improve the one-year local control rate.However,non-coplanar IMRT may increase the cardiac radiation dose and cause cardiac injury,so patients with cardiomyopathy and valvular lesions should be avoided.

关 键 词：调强放射治疗 共面 非共面 食管癌 剂量学 

分 类 号：R735.1[医药卫生—肿瘤]