深吸气屏气技术在肺癌立体定向放射治疗中的应用  

Application of DIBH at the Stereotactic Body Radiotherapy of Lung Cancer

作　　者：单书灿 周晖 王玉洁 贺晓东 SHAN Shucan;ZHOU Hui;WANG Yujie;HE Xiaodong(Department of Radiation Oncology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201801,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射治疗科,上海201801

出　　处：《中国医疗设备》2022年第10期56-59,78,共5页China Medical Devices

基　　金：国家自然科学基金青年项目(81702601)。

摘　　要：目的对肺癌立体定向放射治疗(Stereotactic Body Radiation Therapy,SBRT)的患者分别在深吸气屏气(Deep Inspiration Breath-Hold,DIBH)的CT和常规自由呼吸状态下的四维CT(Four-Dimensional Computed Tomography,4D-CT)进行计划设计,比较两组计划的剂量学差异。方法选取10例进行SBRT治疗的非小细胞肺癌患者,分别进行DIBH和4D-CT采集,并在DIBH和4D-CT图像上勾画靶区和危及器官,分别在DIBH和4D-CT平均时相(Average Phase Image,AVG)的CT上进行计划设计,选择容积旋转调强技术,比较两组患者靶区和危及器官的体积,并分析两组患者计划的靶区和危及器官体积剂量的差异。结果DIBH组的计划靶体积相对4D-CT组减少48%,心脏的体积减少18.0%,而患侧肺的体积增大56%,健侧肺的体积增大64%。DIBH组相对于4D-CT组计划的患侧肺V_(5)、V_(10)、V_(20)分别降低了10.4%、10.3%和4.2%,心脏的平均剂量降低了34.6%,胸壁和大血管的热点剂量也显著降低(P<0.05)。两组计划的靶区适形度指数、梯度指数和机器跳数均无统计学差异(P>0.05),而DIBH组的D_(2 cm)的结果优于4D-CT组,差异具有统计学意义(P<0.05)。结论两组计划均能满足临床要求,DIBH技术可以很大程度上减少靶区体积照射;DIBH技术同时增加肺的体积,减少了心脏的体积,且使心脏远离胸壁,从而减少心脏和肺等正常组织的照射剂量。DIBH技术将为肺癌SBRT的患者提供更优的治疗选择。Objective The patients with lung cancer undergoing stereotactic body radiation therapy(SBRT)were planned with deep inspiration breath hold(DIBH)CT and conventional free breathing four-dimensional computed tomography(4D-CT)respectively,and the dosimetric differences between the two groups were compared.Methods A total of ten patients with non-cell lung cancer were enrolled.Two CT scans were acquired for each patient with and without breath hold(DIBH-CT and 4D-CT).Target and organ at risk were contoured on DIBH-CT and 4D-CT.The plan design was carried out on the CT of DIBH and 4D-CT average phase image(AVG)respectively,and the VMAT was selected to compare the volume of target area and organ at risk in the two groups,and to analyze the difference of planned volume dose of target volume and organ at risk in the two groups.Results For all patients,compared with the 4D-CT group,the planned target volume of the DIBH group decreased by 48%,the volume of the heart decreased by 18.0%.While the volume of lung-tumor and the normal lung were increased 56%and 64%,respectively.Compared with the 4DCT group,the V_(5),V_(10),V_(20) with the lung-tumor were reduced by 10.4%,10.3%,4.2%with DIBH plan,and the mean dose of heart decreased by 34.6%,and the hot spot dose to the chest wall and artery was also significantly decreased(P<0.05).For the CI,GI and MU,the DIBH plan had no significantly better plan quality(P>0.05).While for the D_(2 cm),the DIBH plan was significantly better than the 4D-CT plan,and the difference was statistically significant(P<0.05).Conclusion Both plans can meet the clinical requirements.DIBH can greatly reduce the target volume irradiation.The DIBH simultaneously increases the volume of the lung,reduces the volume of the heart,and moves the heart away from the chest wall,thereby reducing the dose to normal tissues such as the heart and lungs.DIBH will provide better treatment options for lung cancer patients with SBRT.

关 键 词：肺癌 立体定向放射治疗 深吸气屏气 四维CT 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]