有无均整器下肺癌立体定向放疗的差异性研究  

Difference in Stereotactic Body Radiation Therapy in Lung Cancer with or without Flattening Filter

作　　者：杨鹏 王伟生 徐成[2] 宋宏昌 黎杰 康盛伟 吴骏翔 Yang Peng;Wang Weisheng;Xu Cheng;Song Hongchang;Li Jie;Kang Shengwei;Wu Junxiang(Sichuan Key Laboratory of Radiation Oncology,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Department of Oncology,Guangyuan Central Hospital,Guangyuan 628000,Sichuan,China;Department of Oncology,Xichang People’s Hospital,Xichang 615000,Sichuan,China)

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院放射肿瘤学四川省重点实验室,成都610041 [2]广元市中心医院肿瘤科,四川广元628000 [3]西昌市人民医院肿瘤科,四川凉山州615000

出　　处：《肿瘤预防与治疗》2022年第10期939-944,共6页Journal of Cancer Control And Treatment

基　　金：四川省重点研发项目(编号:2021YFG0168、2021YFG0320)。

摘　　要：目的:探讨在均整模式(flattening filter,FF)和非均整模式(flattening filter free,FFF)下,肺癌立体定向放射治疗(stereotactic body radiation therapy,SBRT)中物理剂量和生物剂量的差异。方法:对84例肺癌患者放疗计划做回顾性分析,选用Pinnacle39.10计划系统,处方剂量为50 Gy/5 F。分别在FF模式(VMATFF)和FFF模式(VMATFFF)下设计容积旋转调强放疗(volumetric modulated arc therapy,VMAT)计划,采用配对t检验比较两种模式下靶区的D90、D2、覆盖率、适形指数、梯度指数等剂量学参数以及危及器官的物理剂量。同时,还比较了两种模式下正常组织并发症概率(normal tissue complication probability,NTCP)。结果:两种模式下,靶区的剂量学参数的差异均无统计学意义(P>0.05);VMATFFF组的脊髓D0.25cc、D0.5cc,食管D5cc,肺D1500cc的结果均优于VMATFF组的结果,差异具有统计学意义(P<0.05),两种模式在气管D4cc、肺D1000cc、心脏D1500cc的差异无统计学意义(P>0.05);VMATFFF组肺平均剂量和V5的NTCP优于VMATFF组(P<0.05)。结论:FFF模式对危及器官的保护更好,并且有效降低了放疗并发症的概率。建议对于肺癌SBRT技术选择FFF模式。Objective:To discuss the differences in physical and biological doses on stereotactic body radiation therapy(SBRT)in lung cancer with flattening filter free(FFF)and flattening filter(FF)modes.Methods:A retrospective analysis was made for the radiotherapy plans of 84 lung cancer patients.The planning system was Pinnacle39.10,and the prescription dose was 50Gy/5F.Volumetric modulated arc therapy(VMAT)plan was designed in FF mode(VMATFF group)and FFF mode(VMATFFF),respectively.D90,D2,coverage rate,conformity index,gradient index and physical dose of organs at risk(OARs)in two modes were compared by paired t test.Besides,normal tissue complication probability(NTCP)was also compared between the two modes.Results:There were no significant differences between two modes in dosimetric parameters of the target area(P>0.05).The results of D0.25cc and D0.5cc to spinal cord,D5cc to esophagus and D1500cc to lung in the VMATFFF group were significantly better than those in the VMATFF group(P<0.05).There was no significant differences between the two modes in D4cc to trachea,D1000cc to lung and D1500cc to heart(P>0.05).NTCP in mean lung dose and that in V5 in VMATFFF group were better than those in VMATFF group(P<0.05).Conclusion:The use of the FFF mode can protect OARs better and effectively reduce the probability of radiotherapy complications.It is recommended to choose FFF mode for lung cancer SBRT.

关 键 词：肺癌 立体定向放射治疗(SBRT) 非均整器 正常组织并发症概率(NTCP) 

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