全骨髓照射中基于黏膜保护的HT-TMI计划参数选择研究  

Study on parameter selection of HT-TMI plan based on mucosal protection

作　　者：高露 李小凯 刁勇 蒋朝阳 段文越 张伶 GAO Lu;LI Xiaokai;DIAO Yong;JIANG Chaoyang;DUAN Wenyue;ZHANG Ling(Department of Oncology,the General Hospital of Western Theater Command,Sichuan Chengdu 610083,China;College of Medicine,Southwest Jiaotong University,Sichuan Chengdu 610031,China)

机构地区：[1]中国人民解放军西部战区总医院肿瘤科,四川成都610083 [2]西南交通大学医学院,四川成都610031

出　　处：《现代肿瘤医学》2023年第4期725-732,共8页Journal of Modern Oncology

摘　　要：目的:通过对比不同螺距、调制因子组合的螺旋断层放射治疗全骨髓照射(total marrow irradiation,TMI)计划,评估其剂量学参数,寻求黏膜保护的最优参数组合。方法:勾画全骨髓临床靶区(含上、下颌骨)及危及器官,放疗计划优化时将射野宽度、螺距及调制因子三种计划参数固定,并对黏膜相关器官限量,评估器官受量的降低程度及该方案对整体计划质量的影响。固定射野宽度为5 cm,采用不同螺距和不同调制因子制定计划,通过非参数检验比较不同计划的剂量学指标、出束时间,分析不同参数组合对改善黏膜剂量分布的差异,以获取最优组合。结果:黏膜相关器官限量后平均中位剂量较不限量减少52%~64%,且对整体计划质量无显著影响;螺距(0.287)和调制因子(3或3.5)改善黏膜相关器官剂量分布更具优势。结论:通过计划优化减低黏膜相关器官剂量是可行的。Objective:By comparing the total marrow irradiation(TMI)plans inhelical tomotherapy with different pitch and modulation factor combinations,the optimal parameter combination for mucosal protection was sought.Meth⁃ods:The clinical target area of the whole bone marrow(including the maxilla and mandible)and organs at risk were sketched.During the optimization of the radiotherapy plan,the three treatment planning parameters of the field width,pitch and modulation factor were fixed,and the dose of mucosa-related organswere limited.After the optimization,the degree of reduction of mucosa-related organs and their influence on the plan quality of TMI were evaluated.With a field width of 5 cm,different pitch and modulation factors were used to generate the TMI plans.The dosimetric indexes of target areas and organ at risk and beam-on time were compared using nonparametric test.And the differences of different parameter combinations in improving mucosal dose distribution were analyzed to obtain the optimal combina⁃tion.Results:The results showed that the mean median dose of mucosa-related organs was reduced by 52%~64%after dose limitation,and there had no significant effect on the quality of planning.What's more,pitch of 0.287 and modulation factor of 3.5 had more advantages in improving the mucosal dose distribution.Conclusion:It is feasible to reduce the dose of mucosa-related organs by planning optimization.

关 键 词：螺旋断层放疗 全骨髓照射 治疗计划参数 黏膜保护 

分 类 号：R730.5[医药卫生—肿瘤]