不可手术食管癌患者序贯加量IMRT与同步推量IMRT的剂量学比较分析  

Dosimetric analysis of sequential boost intensity-modulated radiotherapy and simultaneous integrated boost intensitymodulated radiotherapy in patients with inoperable esophagus carcinoma

作　　者：李玉锋[1] 沈莲 孟令新[1] 厉兵城 王海燕 汪运鹏 苏娜 宋海涛 LI Yu-feng;SHEN Lian;MENG Lingxin;LI Bing-cheng;WANG Hai-yan;WANG Yun-peng;SU Na;SONG Hai-tao(Department of Oncology,Rizhao People’s Hospital,Key Laboratory of Medicine and Health of Shandong,Rizhao 276826,Shandong,China;Department of Oncology,The Second People's Hospital of Rizhao,Rizhao 276800,Shandong,China)

机构地区：[1]日照市人民医院肿瘤科,山东省医药卫生重点实验室,山东日照276826 [2]日照市第二人民医院肿瘤科,山东日照276800

出　　处：《生物医学工程与临床》2023年第5期580-586,共7页Biomedical Engineering and Clinical Medicine

基　　金：山东省医药卫生科技发展计划项目(2019WS160);山东省医学会临床科研专项资金项目(YXH2022ZX03224)。

摘　　要：目的对比不可手术食管癌序贯加量调强放射治疗(SB-IMRT)计划与同步推量调强放射治疗(SIB-IMRT)计划在靶区参数上的区别,以及对正常器官的影响程度。方法选择日照市人民医院2018年10月至2022年5月拟行放射治疗的不可手术食管癌患者30例,其中男性25例,女性5例;年龄60~88岁,中位年龄68.2岁;病变长度4.0~17.6 cm,平均病变长度6.37 cm(标准差2.76 cm);临床分期为c Tx N1-2M0-1期。分别制定SB-IMRT与SIB-IMRT两种放射治疗计划,并采用靶区勾画、射束设野、靶区覆盖、剂量均匀性、危及器官(OAR)、处方剂量(CB-CHOP)审核通过放射治疗计划。SIB-IMRT给予剂量方法为在一个计划中临床计划靶区(PCTV)50.4 Gy,肿瘤计划靶区(PGTV)剂量同步给予59.92 Gy,共28次完成。SB-IMRT剂量要求为PCTV 50 Gy,均分25次完成;完成后修改照射野局部加照至10 Gy,均分5次完成。SB-IMRT放射治疗需设计前后两套计划,再做计划叠加处理,合成一套计划后根据处方剂量要求优化计划并记录靶区参数和OAR限量。采用均匀性指数(HI)、适形性指数(CI)、靶区覆盖度(TC)及剂量分布、OAR限量等参数分别评估。结果两组计划的PCTV-Dmax、PGTV-Dmax和PCTV-Dmin剂量差异无统计学意义(均P>0.05),但SIB-IMRT组PCTV-Dmean、PGTV-Dmin、PGTV-Dmean均低于SB-IMRT组,差异有统计学意义[(57.38±1.73)Gy vs(58.13±2.38)Gy、(51.41±4.90)Gy vs(54.76±6.31)Gy、(61.22±2.10)Gy vs(62.86±2.03)Gy。P>0.05]。两组计划的PCTV-TC值比较,差异无统计学意义(P>0.05)。SB-IMRT组CI优于SIB-IMRT组,而HI次于SB-IMRT组,两组间CI、HI值比较,差异有统计学意义(0.55±0.10 vs 0.60±0.11、1.20±0.38 vs 1.24±0.39。P<0.05)。SIB-IMRT组PGTV和PCTV的生物效应剂量(BED)分别为72.74 Gy、59.47 Gy;SB-IMRT组PGTV和PCTV的BED分别为72 Gy、60 Gy。SIB-IMRT组脊髓Dmax、双肺V5和心脏的平均心脏剂量(MHD)低于SB-IMRT组,差异均有统计学意义[(41.83±2.48)Gy vs(43.27±1.99)Gy、(41.06±Objective To compare the difference of dose distribution in target area and organs at risk between sequential boost intensity-modulated radiotherapy(SB-IMRT)and simultaneous integrated boost intensity-modulated radiotherapy(SIBIMRT)for inoperable esophageal carcinoma.Methods From October 2018 to May 2022,a total of 30 inoperable patients with esophagus carcinoma performed radiotherapy were enrolled,which included 25 males and 5 females,aged 60-88 years old with median age of 68.2 years old;lesion length was 4.0-17.6 cm with mean of 6.37 cm(standard deviation 2.76 cm);clinical stage was cTxN1-2M0-1.The SB-IMRT and SIB-IMRT plans were developed respectively,and the radiotherapy plan was approved by target delineation,beam field setting,target coverage(TC),dose uniformity,organ at risk(OAR),and prescription dose(CB-CHOP).The dose method of SIB-IMRT was 50.4 Gy for clinical planning target volume(PCTV)and 59.92 Gy for tumor planning gross target volume(PGTV)in one plan,28 times in total.The dose requirement of SB-IMRT was PCTV 50 Gy with mean of 25 times.Then,the radiation field was modified and locally irradiated to 10 Gy with mean of 5 times.The SB-IMRT was designed 2 sets of plan,and then the plans were superimposed.After integration of a set of plan,it was optimized according to prescription dose requirements,and the target area parameters and OAR limits were recorded.The homogeneity index(HI),conformity index(CI),TC,dose distribution and OAR limits were evaluated respectively.Results There was no significant difference in dosage parameters of PCTV-Dmax,PGTV-Dmax and PCTV-Dmin between 2 groups(all P>0.05),while PCTV-Dmean,PGTV-Dmin and PGTV-Dmean values of SIB-IMRT group were lower than those of SB-IMRT group,and difference was statistically significant[(57.38±1.73)Gy vs(58.13±2.38)Gy,(51.41±4.90)Gy vs(54.76±6.31)Gy,(61.22±2.10)Gy vs(62.86±2.03)Gy.P>0.05].There was no significant difference in PCTV-TC values between 2 groups(P>0.05).The CI of SB-IMRT group was better than that of SIB-IMRT group,while HI was

关 键 词：食管癌 调强放射治疗 同步推量调强放疗 序贯加量调强放疗 

分 类 号：R735.1[医药卫生—肿瘤]