多弧VMAT技术在多发脑转移瘤放疗中的应用价值研究  

Dosimetric study of multiple brain metastases radiation therapy using VMAT with multiple coplanar arcs

作　　者：刘博宇[1] 杨筑春 常艺 杨金磊[1] LIU Bo-yu;YANG Zhu-chun;CHANG Yi;YANG Jin-lei(Department of Radiotherapy,Jilin Provinical Cancer Hospital,Changchun,Jilin 130012,China)

机构地区：[1]吉林省肿瘤医院放射治疗科,吉林长春130012

出　　处：《中国卫生工程学》2023年第2期171-174,178,共5页Chinese Journal of Public Health Engineering

基　　金：吉林省卫生健康委项目(2021LC134)。

摘　　要：目的探索多弧VMAT(M-VMAT)技术在多发脑转移瘤放疗中的应用价值。方法选取2020年11月至2022年1月本院放疗科收治接受调强放疗的多发脑转移瘤患者21例,患者脑部转移灶均经MRI确诊。分别设计IMRT计划、双弧VMAT(D-VMAT)计划及M-VMAT计划,比较各计划间的剂量学结果。结果与D-VMAT比较,M-VMAT计划肿瘤区的适形度更好,预防照射区的最大剂量减少,平均剂量也减少,均匀性明显更优,上述差异均有统计学意义(均P<0.05)。与IMRT比较,M-VMAT计划肿瘤区适形度和均匀性指数均明显改善,肿瘤区最大剂量和平均剂量减少,上述差异均有统计学意义(均P<0.05);在预防照射区,除最小剂量外M-VMAT计划均明显更优,差异均有统计学意义(均P<0.05)。由图可知,M-VMAT计划预防照射区域接受33Gy照射的体积明显少于D-VMAT计划和IMRT计划,M-VMAT计划肿瘤区的适形度也明显优于D-VMAT计划和IMRT计划。M-VMAT计划的MUs数量和治疗时间均介于D-VMAT计划和IMRT计划之间。M-VMAT计划的Mus数分别比D-VMAT计划多约65.2%,比IMRT计划少约39.8%;M-VMAT计划的治疗时间分别比D-VMAT计划多约9.4%,比IMRT少约22.4%,上述差异均有统计学意义(均P<0.05)。与D-VMAT计划比较,M-VMAT计划对视神经、视交叉、脑干、垂体保护略优,差异均有统计学意义(均P<0.05)。与IMRT计划比较,除视交叉外,M-VMAT计划对其他危及器官的保护均略优,差异均有统计学意义(均P<0.05)。结论M-VMAT计划治疗多发脑转移瘤的剂量学结果明显优于D-VMAT计划和IMRT计划,治疗时间少于IMRT计划,具有较高的应用价值。Objective To explore the utility of the multi arc M-VMAT technique for radiotherapy of multiple brain metas-tases.Methods A total of 21 patients with multiple brain metastases who received intensity-modulated radiotherapy in the Department of radiotherapy of our hospital from November 2020 to January 2022 were selected,and they were diagnosed with brain metastases by MRI.An IMRT plan,a dual arc VMAT(d-vmat)plan,and an m-vmat plan were designed to compare dosimetric results between plans.Results Compared with d-vmat,the conformality of the tumor area was better and the maximum dose of preventive irradiation area was reduced,and the average dose was also reduced and the uniformity was significantly better,all of the above differences were statistically significant(all P<0.05).Compared with IMRT,the uniformity and homogeneity indexes of the tumor area in M-VMAT plan were significantly improved,the maximum and aver-age doses of the tumor area were reduced,and all of the differences were statistically significant(all P<0.05);In the pre-ventive irradiation area,the M-VMAT plan was significantly better except for the minimum dose,and the differences were statistically significant(all P<0.05).It is known from the figure that the volume of the preventive irradiation area receiving 33 Gy irradiation in M-VMAT plan was significantly less than that in D-VMAT and IMRT,and the conformality of the tumor area in M-VMAT plan was significantly better than that in D-VMAT and IMRT.Both the number of mus and treat-ment time for the m-vmat plan were intermediate between the d-vmat plan and the IMRT plan.The number of mus was ap-proximately 65.2%longer for the m-vmat plan than for the d-vmat plan and 39.8%shorter than the IMRT plan,respec-tively;The treatment time of m-vmat plan was approximately 9.4%more than d-vmat plan and 22.4%less than IMRT,re-spectively,and the above differences were all statistically significant(all P<0.05).Compared with the d-vmat plan,the m-vmat plan resulted in slightly superior preservation of the optic nerv

关 键 词：多弧VMAT 双弧VMAT 剂量学 多发脑转移瘤 

分 类 号：R73[医药卫生—肿瘤]