IMRT、sIMRT及3DCRT在胸中段食管癌放疗中的应用比较  

Comparison among IMRT,sIMRT and 3DCRT in radiotherapy for middle thoracic esophageal cancer

作　　者：傅博[1] 吴建语[1] 沈佳鹏 阮必顺 许锦慧 龙泉先 何玉凤 彭志刚[2] FU Bo;WU Jianyu;SHEN Jiapeng;RUAN Bishun;XU Jinhui;LONG Quanxian;HE Yufeng;PENG Zhigang(Department of Oncology,The Second People's Hospital of Qinzhou,Qinzhou 535000,China;Department of Oncology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]钦州市第二人民医院肿瘤科,广西钦州535000 [2]广西医科大学第一附属医院肿瘤内科,广西南宁530021

出　　处：《中国医学物理学杂志》2022年第10期1208-1212,共5页Chinese Journal of Medical Physics

基　　金：中华国际科学交流基金会检验检测科技专项(Z2020LGX001)。

摘　　要：目的:探讨调强放疗(IMRT)、简化调强放疗(sIMRT)及三维适形放疗(3DCRT)在胸中段食管癌放疗中的应用比较。方法:回顾性选取胸中段食管癌患者105例,根据患者所接受的放疗方式分为IMRT组(n=33)、sIMRT组(n=40)及3DCRT组(n=32),比较各组靶区2%体积的器官所受照射剂量(D_(2))、D_(50)、D_(98)、均匀性指数(HI)和适形度指数(CI)差异,双肺接受5 Gy剂量照射的肺体积占全肺总体积的百分比(V_(5))、V_(10)、V_(20)、脊髓最大剂量(D_(max))和心脏平均剂量(D_(mean))等。结果:IMRT组和sIMRT组D_(2)、D_(50)、D_(98)和HI分别为(6659.43±161.15)cGy和(6603.55±145.54)cGy、(6312.26±132.20)cGy和(6289.94±121.17)cGy、(5815.43±114.41)cGy和(5801.16±120.03)cGy、(1.09±0.04)和(1.08±0.03),显著高于3DCRT组(P<0.05),CI分别为(0.71±0.02)和(0.72±0.03),显著低于3DCRT组(P<0.05);IMRT组、sIMRT组和3DCRT组双肺V_(5)、V_(10)、V_(20)和脊髓D_(max)比较差异无统计学意义(P>0.05);IMRT组和sIMRT组心脏D_(mean)分别为(784.69±101.16)cGy和(796.79±112.28)cGy,显著低于3DCRT组(P<0.05);sIMRT组机器跳数和子野数目分别为(432.24±71.19)MU和(18.03±5.56),显著低于IMRT组和3DCRT组(P<0.05);IMRT组机器跳数和子野数目分别为(501.16±78.98)MU和26.65±7.140,显著低于3DCRT组(P<0.05);IMRT组、sIMRT组和3DCRT组骨髓抑制、放射性肺炎、放射性食管炎和肺纤维化发生率比较差异无统计学意义(P>0.05);IMRT组、sIMRT组和3DCRT组放疗疗效比较差异无统计学意义(P>0.05)。结论:3DCRT、IMRT和sIMRT靶区剂量参数均可满足临床要求,其中sIMRT心脏受照剂量、机器跳数低,临床上可优先选择sIMRT计划。Objective To compare the dosimetric differences among intensity-modulated radiotherapy(IMRT),simplified intensity modulated radiotherapy(sIMRT)and three-dimensional conformal radiotherapy(3DCRT)for middle thoracic esophageal cancer.Methods According to the radiotherapy techniques,105 patients with middle thoracic esophageal cancer were divided into IMRT group(n=33),sIMRT group(n=40)and 3DCRT group(n=32).The D_(2),D_(50),D_(98),homogeneity index(HI)and conformity index(CI)of target areas,the V_(5),V_(10),V_(20) of both lungs,the maximum dose(D_(max))to spinal cord and the mean dose(D_(mean))to heart were compared among different groups.Results The D_(2),D_(50),D_(98) and HI in IMRT group and sIMRT group were(6659.43±161.15)cGy and(6603.55±145.54)cGy,(6312.26±132.20)cGy and(6289.94±121.17)cGy,(5815.43±114.41)cGy and(5801.16±120.03)CGy,(1.09±0.04)and(1.08±0.03),respectively,which were significantly higher than those in 3DCRT group(P<0.05).The CI was(0.71±0.02)in IMRT group and(0.72±0.03)in sIMRT group,significantly lower than that in 3DCRT group(P<0.05).There were no significant differences in the V_(5),V_(10),V_(20) of both lungs and the D_(max) to spinal cord among IMRT group,sIMRT group and 3DCRT group(P>0.05).The D_(mean) to heart was(784.69±101.16)cGy in IMRT group and(796.79±112.28)cGy in sIMRT group,significantly lower than that in 3DCRT group(P<0.05).The monitor units and number of subfields in sIMRT group were(432.24±71.19)MU and(18.03±5.56),which were significantly lower than those in IMRT group and 3DCRT group(P<0.05).The monitor units and number of subfields in IMRT group were(501.16±78.98)MU and(26.65±7.140),respectively,which were significantly lower than those in 3DCRT group(P<0.05).The differences in the incidences of bone marrow transplantation,radiation pneumonia,radiation esophagetis,pulmonary fibrosis among IMRT group,sIMRT group and 3DCRT group were trivial(P>0.05),and there was no significant difference in radiotherapy efficacy among IMRT group,sIMRT group and 3DCRT group(P>0.05

关 键 词：调强放疗 简化调强放疗 三维适形放疗 胸中段 食管癌 

分 类 号：R816.5[医药卫生—放射医学]