不同治疗计划优化方式在听神经瘤伽马刀治疗中的剂量学比较  

Dosimetric comparison of different treatment plan optimization methods in Gamma Knife treatment of acoustic neuroma

作　　者：蔡俊涛 陈兢[1] 李鹏[1] 李杨[1] 张祝均[1] 徐云波 CAI Juntao;CHEN Jing;LI Peng;LI Yang;ZHANG Zhujun;XU Yunbo(Department of Neurosurgery,West China Hospital,Sichuan University,Sichuan Chengdu 610041,China)

机构地区：[1]四川大学华西医院神经外科,四川成都610041

出　　处：《现代肿瘤医学》2023年第18期3447-3450,共4页Journal of Modern Oncology

摘　　要：目的:比较手动的正向计划(manual forward plan,M-FP)、手动靶点的逆向计划(manual shot inverse plan,MS-IP)和自动靶点的逆向计划(automatic shot inverse plan,AS-IP)在听神经瘤靶区和危及器官(organ at risk,OAR)的剂量学差异。方法:回顾接受伽玛刀治疗的26例听神经瘤患者,分别重新设计M-FP、MS-IP和AS-IP。比较靶区剂量分布、照射时间和OAR剂量参数。结果:靶区剂量分布两种IP的覆盖率、选择性、Paddick适形度指数(PCI)均好于M-FP,差异有统计学意义(P<0.05),两种IP之间差异无统计学意义(P>0.05);AS-IP的梯度指数(GI)略高于其余两种计划,与M-FP比较差异无统计学意义(P>0.05),与MS-IP比较差异有统计学意义(P<0.05);三种计划的照射时间从高到低依次为M-FP、MS-IP、AS-IP,两两比较差异均有统计学意义(P<0.05)。OAR的剂量两种IP耳蜗的D_(max)、D_(mean)均低于M-FP,差异有统计学意义(P<0.05),两种IP之间差异无统计学意义(P>0.05);三种计划脑干的D_(max)、D_(0.1 cc)、D_(mean)差异均无统计学意义(P>0.05)。结论:Leksell伽玛刀GammaPlan中的IP在优化过程中可能是一种次优的计划,但与FP相比,IP的靶区剂量分布略优,对小体积OAR保护更好,治疗时间上也体现出明显优势。如果未来进一步完善优化模式,或许对临床患者个体化的治疗有重要意义。Objective:Dosimetric differences in acoustic neuroma target volume and organ at risk(OAR)were compared between manual forward plan(M-FP),manual shot inverse plan(MS-IP),automatic shot inverse plan(AS-IP).Methods:M-FP,MS-IP and AS-IP were redesigned respectively for twenty-six patients with acoustic neuroma.The target dose distribution,beam-on time(BOT)and OAR dose parameters were compared.Results:The coverage,selectivity and Paddick conformity index(PCI)of the two IP in the target dose distribution were better than those of M-FP,with a statistically significant difference(P<0.05).There was no statistically significant difference between the two IP(P>0.05).The gradient index(GI)of AS-IP was slightly higher than that of the other two plans.There was no significant difference between AS-IP and M-FP(P>0.05),but there was significant difference between AS-IP and MS-IP(P<0.05).The BOT of the three plans from high to low was M-FP,MS-IP,AS-IP,and the difference was statistically significant(P<0.05).In terms of dose of OAR,D_(max) and D_(mean) of cochlea in the two kinds of IP were lower than those of M-FP,the difference was statistically significant(P<0.05),and there was no significant difference between two kinds of IP(P>0.05).The D_(max),D_(0.1 cc) and D_(mean) of brainstem of the three plans were not statistically significant(P>0.05).Conclusion:The IP in the Leksell Gamma Knife GammaPlan may be a suboptimal plan during the optimization process,but compared to FP,the target dose distribution of IP is slightly better,providing better protection for small volume OAR,and demonstrating significant advantages in treatment time.If the optimization model is further improved in the future,it may have important significance for individualized treatment of clinical patients.

关 键 词：听神经瘤 正向计划 逆向计划 剂量 

分 类 号：R739.4[医药卫生—肿瘤]