不同调强放疗技术在局部晚期非小细胞肺癌根治性放疗中的剂量参数比较  

Comparison of dose parameters of three different intensity modulated radiotherapy techniques in local advanced NSCLC radical radiotherapy

作　　者：关明丽 雷亚楠 李贺 GUAN Mingli;LEI Yanan;LI He(Department of Tumor Radiotherapy,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院肿瘤放疗科,河南洛阳471000

出　　处：《现代医药卫生》2023年第22期3848-3854,共7页Journal of Modern Medicine & Health

摘　　要：目的比较固定野调强放射治疗(放疗)(IMRT)、容积弧形调强放疗(VMAT)和螺旋断层放疗系统(TOMO)3种不同调强放疗技术在局部晚期非小细胞肺癌(NSCLC)根治性放疗中的剂量参数。方法选取2020年9月至2022年9月该院收治的96例局部晚期NSCLC患者为研究对象,为每一例患者设计以上三套不同调强放疗计划。结果计划靶区(PTV)剂量参数对比显示,与IMRT和TOMO比较,VMAT的靶区剂量适形度指数(CI)显著更高,与TOMO比较,VMAT的不均匀度指数(HI)显著更低,差异均有统计学意义(P<0.05);与TOMO比较,IMRT的HI显著更低,差异有统计学意义(P<0.05);与IMRT和TOMO比较,VMAT的平均剂量(D_(mean))显著更低,差异有统计学意义(P<0.05);在高剂量区(D_(1)、D_(2))和低剂量区(D_(98)、D_(99))及V95、V105等方面,TOMO较IMRT、VMAT显著更低,差异均有统计学意义(P<0.05)。危及器官剂量对比显示,3种不同调强放疗技术下的全肺D_(mean)、V_(5)、V_(10)、V_(40)及V_(50)比较,差异均无统计学意义(P>0.05);与IMRT比较,TOMO的全肺V_(20)及V_(30)显著更低,差异均有统计学意义(P<0.05);与TOMO比较,IMRT的心脏D_(mean)、V_(5)、V_(10)及V_(20)显著更低,差异均有统计学意义(P<0.05);3种不同调强放疗技术下的脊髓、食管最大剂量和D_(mean)比较,差异均无统计学意义(P>0.05)。在右肺NSCLC患者中,与IMRT和TOMO比较,VMAT的CI和HI明显更优,差异均有统计学意义(P<0.05);与IMRT比较,TOMO的正常肺组织D_(mean)、心脏V_(5)及V_(10)均显著更高,差异均有统计学意义(P<0.05)。在纳入大靶区的患者中,VMAT的CI明显优于IMRT,HI明显优于TOMO,差异均有统计学意义(P<0.05);与TOMO比较,IMRT的心脏D_(mean)、V_(5)、V_(10)、V_(20)显著更低,差异均有统计学意义(P<0.05)。在中央型NSCLC患者中,与IMRT比较,TOMO的V_(20)显著更低,但V_(5)却显著更高,差异均有统计学意义(P<0.05)。结论VMAT可能最适合局部晚期NSCLC患者(尤其对中央型、大靶�Objective To compare the dose parameters of intensity modulated radiation therapy(IMRT),volumetric modulated arc therapy(VMAT)and spiral tomography radiotherapy system(TOMO)in radical radiotherapy for locally advanced non-small cell lung cancer(NSCLC).Methods A total of 96 patients with locally advanced NSCLC admitted to this hospital from September 2020 to September 2022 were selected as the study objects,and the above three different intensive-modulated radiotherapy plans were designed for each patient.Results The dose parameters of planning target volume(PTV)showed that compared with IMRT and TOMO,the dose conformity index(CI)of VMAT was significantly higher and the homogeneity index(HI)of VMAT was significantly lower,with statistical significance(P<0.05).Compared with TOMO,the HI of IMRT was significantly lower,the difference was statistically significant(P<0.05).Compared with IMRT and TOMO,the mean dose(D_(mean))of VMAT was significantly lower,the difference was statistically significant(P<0.05).In the high-dose zones(D_(1),D_(2))and low-dose zones(D_(98),D_(99)),and V_(95),V_(105),TOMO was significantly lower than IMRT and VMAT,and the differences were statistically significant(P<0.05).There was no significant difference in lung D_(mean),V_(5),V_(10),V_(40) and V_(50) under thr ee different IMRT techniques(P>0.05).Compared with IMRT,V_(20) and V_(30) of TOMO were significantly lower,the differences were statistically significant(P<0.05).Compared with TOMO,D_(mean),V_(5),V_(10) and V_(20) of IMRT were significantly lower,with statistical significance(P<0.05).There was no significant difference in maximum dose and D_(mean) of spinal cord and esophagus under three different IMRT techniques(P>0.05).In right lung NSCLC patients,CI and HI of VMAT were significantly better than those of IMRT and TOMO,with statistical significance(P<0.05).Compared with IMRT,D_(mean) in normal lung tissue and V_(5) and V_(10) in heart of TOMO were significantly higher,with statistical significance(P<0.05).In patients with large targ

关 键 词：调强放疗技术 非小细胞肺癌 放射治疗 剂量参数 

分 类 号：R734.2[医药卫生—肿瘤]