宫颈癌术后容积旋转调强放疗技术的应用研究  

Study on the application of volume-modulated arc radiotherapy after cervical cancer surgery

作　　者：王艳洁 梁长华[2] WANG Yan-jie;LIANG Chang-hua(Tumor Radiotherapy Center,First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院放射治疗技术科,453100 [2]新乡医学院第一附属医院放射科,453100

出　　处：《中国实用医药》2023年第7期7-11,共5页China Practical Medicine

摘　　要：目的对比宫颈癌术后容积旋转调强放疗(VMAT)技术与和固定野动态调强放疗(DMLC-IMRT)技术的治疗剂量学差异。方法22例宫颈癌术后患者,术后均进行辅助放疗,设定相同的照射剂量参数分别行VMAT计划与DMLC-IMRT计划设计。比较VMAT和DMLC-IMRT技术计划靶区剂量、危及器官(OAR)剂量、体积参数及机器跳数、照射时间。结果VMAT技术D_(50%)(4978.55±51.13)cGy、均匀性指数(HI)值(0.06±0.01)均高于DMLC-IMRT技术的(4774.15±40.85)cGy、(0.05±0.01),差异有统计学意义(P<0.05);VMAT技术D_(2%)、D_(98%)、PTV_(100%)与DMLC-IMRT技术比较,差异无统计学意义(P>0.05)。VMAT技术膀胱体积V_(40)50.67(44.18,60.16)%及右股骨头体积V_(30)(24.05±9.72)%、平均剂量(D_(mean))(2547.68±207.04)cGy均低于DMLC-IMRT技术的52.61(45.88,59.06)%、(34.40±9.17)%、(2691.60±206.10)cGy,膀胱体积V_(30)(79.02±20.40)%高于DMLC-IMRT技术的(73.43±19.51)%,差异有统计学意义(P<0.05);VMAT技术小肠体积V_(30)、D_(mean)、D_(2%),直肠体积V_(30)、V_(40)、D_(mean)、最大剂量(D_(max)),膀胱体积V_(20)、D_(mean),左股骨头体积V_(20)、V_(30)、D_(mean)、D_(max),右股骨头体积V_(20)、D_(max)与DMLC-IMRT技术比较,差异无统计学意义(P>0.05)。VMAT技术机器跳数601.70(576.20,718.93)MU少于DMLC-IMRT技术的844.55(800.27,902.81)MU,照射时间128.23(119.05,144.52)s短于DMLC-IMRT技术的268.87(253.06,310.59)s,差异有统计学意义(P<0.05)。结论宫颈癌术后患者应用VMAT技术能提高靶区剂量并降低危及器官照射剂量,减少照射时间和机器跳数。Objective To compare the dosimetric differences between volume-modulated arc radiotherapy(VMAT)and dynamic multileaf collimator-intensity modulated radiotherapy(DMLC-IMRT)after cervical cancer surgery.Methods 22 patients after cervical cancer surgery all received adjuvant radiotherapy after surgery,and the same dose parameters were set for VMAT plan and DMLC-IMRT plan.The planning target volume dose,organ at risk(OAR)dose,volume parameters and machine unit,and exposure time of VMAT and DMLC-IMRT were compared.Results VMAT had D_(50%)of(4978.55±51.13)cGy and homogeneity index(HI)values of(0.06±0.01),which were higher than those of(4774.15±40.85)cGy and(0.05±0.01)for DMLC-IMRT,and the difference was statistically significant(P<0.05).There was no statistically significant difference between VMAT and DMLC-IMRT in the comparison of D_(2%),D_(98%),PTV_(100%)(P>0.05).VMAT had bladder V_(40) of 50.67(44.18,60.16)and right femoral head V_(30) of(24.05±9.72)% and mean dose(D_(mean))of(2547.68±207.04)cGy,which were lower than those of 52.61(45.88,59.06),(34.40±9.17)% and(2691.60±206.10)cGy for DMLC-IMRT;VMAT had higher bladder V_(30) of(79.02±20.40)% than(73.43±19.51)%for DMLC-IMRT;the differences were statistically significant(P<0.05).Small intestine[V_(30),D_(mean),D_(2%)],rectum[V_(30),V_(40),D_(mean),maximum dose(D_(max))],bladder[V_(20),D_(mean)],left femoral head[V_(20),V_(30),D_(mean),D_(max)],and right femoral head[volume V_(20),D_(max)]of VMAT and DMLC-IMRT were compared,and the differences were not statistically significant(P>0.05).Machine unit of 601.70(576.20,718.93)MU for VMAT was less than that of 844.55(800.27,902.81)MU for DMLCIMRT;exposure time of 128.23(119.05,144.52)s for VMAT was shorter than that of 268.87(253.06,310.59)s for DMLC-IMRT;the differences were statistically significant(P<0.05).Conclusion Compared with DMLC-IMRT,VMAT can increase the dose in target volume,reduce the dose to organs at risk,and reduce the exposure time and machine unit.

关 键 词：宫颈癌 容积旋转调强放疗 固定野动态调强放疗 靶区剂量 器官照射剂量 

分 类 号：R730.55[医药卫生—肿瘤] R737.33[医药卫生—临床医学]