呼吸触发前瞻门控在早期非小细胞肺癌立体定向放射治疗中剂量学优势  

Dosimetric advantages of respiratory-triggered prospective gating in stereotactic body radiation therapy for early stage non-small-cell lung cancer

作　　者：钱涵 汪红艳[1] 王凡[1] QIAN Han;WANG Hongyan;WANG Fan(Department of Radiation Oncology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院放疗科,合肥230022

出　　处：《实用医学杂志》2023年第1期86-91,共6页The Journal of Practical Medicine

基　　金：安徽高校自然科学研究项目(编号:KJ2021A0303)。

摘　　要：目的探讨呼吸触发前瞻门控在早期非小细胞肺癌(NSCLC)立体定向放射治疗(SBRT)中剂量学优势。方法选取21例经病理证实的早期NSCLC患者,分别行自由呼吸下3D-CT、4D-CT电影模式和呼气末前瞻性呼吸触发轴向-R模式扫描,同等条件下分别设计前瞻门控(Plan_(pro))、30%~70%时相回顾门控(Plan_(30-70))、运动包络法(Plan_(all))及传统基于人群边际的3D-CT(Plan_(3D))4组无均整器模式容积旋转调强SBRT计划。统计分析计划靶体积(PTV)、患侧肺和全肺的V_(5)、V_(20)、V_(14.4)、平均肺剂量(MLD)、全肺正常组织并发症概率(NTCP)、心脏D_(max)、食管D_(max)、食管NTCP、脊髓D_(max)和近端支气管树D_(max)等指标。结果Plan_(all)与Plan_(3D)相比,除脊髓D_(max)的所有剂量学参数均下降差异有统计学意义(P<0.05)。与Plan_(all)相比,Plan_(pro)的PTV、患侧肺V_(5)、V_(20)、V_(14.4)、MLD、全肺V_(5)、V_(20)、V_(14.4)、MLD、NTCP、心脏D_(max)和食管NTCP较Plan_(30-70)分别进一步减少了8.42 cc、2.06%、1.02%、26.67 cc、0.58 Gy、2.35%、0.63%、32.89 cc、0.43 Gy、0.1%、1.72 Gy及0.09%,差异有统计学意义(P值分别为0.004、<0.010、0.006、0.010、0.006、0.004、<0.001、0.010、<0.001、0.005、<0.001、0.026)。结论早期NSCLC SBRT中,传统基于人群边际的3D-CT计划高估PTV并增加危及器官受量;采用呼吸运动管理技术,尤其是前瞻门控更好保护胸部正常组织器官,减少患者放疗不良反应。Objective To investigate the dosimetric advantages of respiratory-triggered prospective gating in stereotactic body radiation therapy(SBRT)for early-stage non-small-cell lung cancer(NSCLC).Methods A total of 21 patients with pathologically confirmed early-stage NSCLC were selected and received free-breathing 3DCT,4D-CT cine mode and end-expiratory prospective respiratory-triggered axial-R mode scans,respectively.With FFF,VMAT and SBRT technology under the same condition,four corresponding plans,prospective gating(Plan_(pro)),30%~70%temporal retrospective gating(Plan_(30-70)),motion enveloped method(Plan_(all))and conventional population margin-based 3D-CT(Plan_(3D))were designed,respectively.The planning target volume(PTV),the V_(5),V_(20),V_(14.4),MLD of both ipsilateral lung and bilateral lung,the normal tissue complication probability(NTCP)of the bilateral lung,heart D_(max),esophagus D_(max),the NTCP of the esophagus,spinal cord D_(max)and proximal bronchial tree D_(max)were compared.Results Statistically significant differences were found between Plan_(all)and Plan_(3D)for all dosimetric parameters except spinal cord D_(max)(P<0.05).Compared with Plan_(all),Plan_(pro)showed further reductions in PTV,ipsilateral lung V_(5),V_(20),V_(14.4),MLD,bilateral lung V_(5),V_(20),V_(14.4),MLD,NTCP,heart D_(max)and esophagus NTCP compared to Plan_(30-70)by 8.42 cc,2.06%,1.02%,26.67 cc,0.58 Gy,2.35%,0.63%,32.89 cc,0.43 Gy,0.1%,1.72 Gy and0.09%(P=0.004,<0.010,0.006,<0.001,0.006,0.004,<0.001,0.010,<0.001,0.005,<0.001,0.026).Conclusion In SBRT for early-stage NSCLC,conventional population margin-based 3D-CT plans overestimated PTV and increased the exposure dose to organs at risk;respiratory motion management technologies,especially prospective gating,could better protect normal tissues and organs in the chest and reduce adverse effects of radiotherapy.

关 键 词：非小细胞肺癌 呼吸门控成像技术 立体定向放射治疗 容积旋转调强治疗 无均整器 

分 类 号：R734.2[医药卫生—肿瘤]