Monaco计划系统优化参数对非小细胞肺癌的剂量学影响  

Dosimetric impact of optimization parameters in Monaco treatment planning system on non-small cell lung cancer

作　　者：柴林 王慧驰 王延虎 洪梅[1] 常远 CHAI Lin;WANG Hui-chi;WANG Yan-hu;HONG Mei;CHANG Yuan(Department of Radiotherapy,Nanjing Brain Hospital,Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学附属南京脑科医院胸科院区放疗科,江苏南京210029

出　　处：《临床肺科杂志》2022年第11期1729-1734,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨Monaco计划系统参数中最小子野面积、最小子野宽度改变,对非小细胞肺癌剂量分布的影响。方法选取25例非小细胞肺癌患者,任意固定1个参数、改变另外1个参数对调强计划进行优化,观察参数改变对靶区、危及器官受量的影响趋势。结果1)最小子野面积改变组,相比于1 cm^(2),肺V_(5)、V_(20)、肺D_(mean)、心脏V_(30)、靶区CI和HI有统计学差异(P<0.05)。在2 cm^(2)时,肺V_(20)受量增加最大;3 cm^(2)时,肺V_(20)、V_(5)、心脏D_(mean)受量降低最大,肺D_(mean)、心脏V_(30)受量增加最大;5 cm^(2)时,肺V_(30)、V_(40)受量降低最大。2)最小子野宽度改变组,相比于0.5 cm,肺V_(20)、V_(30)、心脏D_(mean)、靶区CI和HI有统计学差异(P<0.05)。在0.8 cm时,肺V_(20)、V_(30)受量降低最大;0.7 cm时,肺V_(5)、肺D_(mean)、心脏V_(30)受量降低最大,肺V_(40)受量增加最大。结论最小子野面积在3~5 cm^(2)、最小子野宽度在0.7~0.8 cm范围内取值时,即满足临床剂量要求,又减少肺组织受照剂量,对降低放射性肺炎发生概率有一定帮助。此外,相比于最小子野面积,最小子野宽度改变对危及器官受量分布影响较大。Objective To investigate the effects of changes in the minimal segment andminimal segment width on the dosimetry distribution of non-small cell lung cancer(NSCLC)in the Monaco planning system.Methods Twenty-five patients with non-small cell lung cancer were selected,one parameter was arbitrarily fixed,and another parameter was changed to optimize the intensity modulation plan,and the influence trend of parameter changes on the target volume and organ at risk was observed.Results 1.In the minimal segment area group,compared with 1 cm^(2),V_(5),V_(20),mean dose(D_(mean))of the lung,V_(30) of heart,Conformal Index(CI),and Homogeneity Index(HI)of PTV were statistically different(P<0.05).In addition,at 2 cm^(2),the radiation dose of lung V_(20) increased the most.At 3 cm^(2),the radiation dose of lung V_(20),V_(5),and heart D_(mean) decreased the most,and the radiation dose of lungD_(mean),and heart V_(30) increased the most.At 5 cm^(2),the doses of lung V_(30) and V_(40) decreased the most.2.In the minimal segment width group,compared with 0.5 cm,lung V_(20),V_(30),and heart D_(mean),target CI and HI were statistically different(P<0.05).In addition,at 0.8 cm,the radiation dose of lung V_(20),and V_(30) decreased the most.At 0.7 cm,the radiation dose of lung V_(5),lung D_(mean),and heart V_(30) decreased the most,while the dose of lung V_(40) increased the most.Conclusion When the minimum segment area is 3 cm^(2)-5 cm^(2),the minimum segment width is within the range of 0.7 cm-0.8 cm,it not only meets the clinical dose requirements but also reduces the radiation dose to lung tissue,which is helpful to reduce the probability of radiation pneumonitis.In addition,compared with the minimum subfield area,the variation of the minimum subfield width had a greater impact on the distribution of organs at risk of exposure.

关 键 词：Monaco计划系统 非小细胞肺癌 调强放射治疗 剂量分布 

分 类 号：R734.2[医药卫生—肿瘤]