三种放疗技术在腰椎转移瘤中的应用  

Application of three radiotherapy techniques in lumbar metastases

作　　者：王金鹏 王培合[2] 王益伟 刘洪明 WANG Jinpeng;WANG Peihe;WANG Yiwei;LIU Hongming(Department of Radiation Oncology,Changle Qicheng Traditional Chinese Medicine Hospital,Weifang 262400,China;Department of Radiation Oncology,Weifang People’s Hospital)

机构地区：[1]昌乐齐城中医院放疗科,山东潍坊262400 [2]潍坊市人民医院肿瘤放疗科

出　　处：《潍坊医学院学报》2022年第4期276-280,共5页Acta Academiae Medicinae Weifang

摘　　要：目的对比腰椎转移瘤放疗中三维适形放疗(3D-CRT)、正向调强放疗(fIMRT)和静态调强放疗(sIMRT)三种治疗技术的剂量学特点及治疗效率,探讨适用于基层医院的腰椎转移瘤放疗方式。方法回顾性选取29例腰椎转移瘤患者,处方剂量为40.5Gy/15f。采用雷泰治疗计划系统为每个病例重新设计3D-CRT、,fIMRT和sIMRT计划。对比分析3组放疗计划的靶区剂量参数、危及器官受量、机器跳数及治疗时间。结果在3D-CRT、fIMRT、sIMRT计划中,适形度指数(CI)分别为0.73±0.05,0.82±0.05,0.75±0.05(P=0.000,0.000,0.028);均匀度指数(HI)分别为0.181±0.048,0.101±0.015,0.099±0.020(P=0.000,0.587,0.000);机器跳数分别为(375.3±30.9)MU,(397.4±22.7)MU,(687.0±80.0)MU(P=0.000);单次治疗时间分别为(313.0±7.3)s,(391.8±23.3)s和(748.9±59.2)s(P=0.000)。靶区剂量D_(2)与D_(mean)对比结果均为3D-CRT>sIMRT>fIMRT;D_(98)对比结果sIMRT>3D-CRT>fIMRT;肾脏D_(mean)、与脊髓D_(max)对比结果均为3D-CRT>sIMRT>fIMRT;肾脏V_(12)、肝脏D_(mean)、胃D_(mean)与小肠V_(15)的对比结果均为3D-CRT>fIMRT>sIMRT。结论fIMRT计划相比3D-CRT计划有着较大剂量学优势,且相对sIMRT计划机器跳数少,治疗时间短,降低了运动误差的影响,可为患者带来一定获益,该技术可作为腰椎转移瘤放疗的选择。Objective To compare the dosimetric characteristics and radiotherapy efficiency of three-dimensional conformal radiation therapy(3D-CRT),forward intensity modulated radiation therapy(fIMRT)and static intensity modulated radiation therapy(sIMRT)in the radiotherapy of lumbar metastases,and explore the radiotherapy methods for lumbar metastases in primary hospitals.Methods A total of 29 patients with lumbar metastatic tumor were retrospectively selected with the prescribed dose of 40.5Gy/15f.3D-CRT,fIMRT and sIMRT plans were redesigned for each case using the Linatech treatment planning system.The dose parameters of target,dose of organs at risk,machine unit and treatment time of three radiotherapy plans were compared and analyzed.Results The conformal index(CI)of 3D-CRT,fIMRT and sIMRT was 0.73±0.05,0.82±0.05,0.75±0.05(P=0.000,0.000,0.028),respectively.Homogeneity index(HI)was 0.181±0.048,0.101±0.015,0.099±0.020(P=0.000,0.587,0.000).The machine units were(375.3±30.9)MU,(397.4±22.7)MU and(687.0±80.0)MU(P=0.000),respectively.The treatment time was(313.0±7.3)s,(391.8±23.3)s and(748.9±59.2)s(P=0.000),respectively.The comparison results of target dose D_(2) and D_(mean) showed 3D-CRT>sIMRT>fIMRT.D_(98) sIMRT>3D-CRT>fIMRT;D_(mean) of kidney and D_(max) of spinal cord were 3D-CRT>sIMRT>fIMRT.The comparison results of kidney V_(12),liver D_(mean),stomach D_(mean) and small intestine V_(15) were 3D-CRT>fIMRT>sIMRT.Conclusion Compared with 3D-CRT,fIMRT has a large dosimetric advantage.Compared with sIMRT plans, fIMRT has fewer MU and shorter treatment time,which reduces the impact of motion error and brings certain benefitsto patients. fIMRT can be used as the choice of radiotherapy for lumbar metastatic tumor in primary hospitals.

关 键 词：椎体转移瘤 三维适形放疗 正向调强 调强放射治疗 

分 类 号：R815[医药卫生—放射医学]