基于MR/CT融合图像精确分段勾画咽缩肌优化头颈部肿瘤调强放疗计划的物理和生物剂量学研究  

Physical and biological dosimetry studies on the optimization of intensity modulated radiotherapy plan for head and neck tumors based on precise segmentation and delineation of pharyngeal constrictor muscles using MR/CT fusion images

作　　者：张典刚[1] 曹耀峰[1] 韩潇 黄莉[1] 刘凯[1] ZHANG Diangang;CAO Yaofeng;HAN Xiao;HUANG Li;LIU Kai(Radiotherapy Center,Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院放疗中心,新疆乌鲁木齐830011

出　　处：《中华肿瘤防治杂志》2023年第16期972-977,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：新疆维吾尔自治区自然科学基金(2019D01C248)。

摘　　要：目的 探讨头颈部肿瘤调强放射治疗(IMRT)不限制咽缩肌剂量和保护咽缩肌的2种计划间靶区覆盖、咽缩肌剂量、肿瘤控制概率(TCP)和正常组织并发症概率(NTCP)的差异。方法 选取2019-01-01-2021-12-31新疆医科大学附属肿瘤医院收治的240例头颈部肿瘤患者,在CT模拟定位图像上勾画靶区并制定IMRT计划,命名为Plan1。同时基于MRI与CT融合图像勾画上、中、下咽缩肌并对咽缩肌进行剂量限值,制定保护咽缩肌的IMRT计划,命名为Plan2。通过剂量体积直方图(DVH)比较2种计划间靶区覆盖和咽缩肌剂量的差异,并以Poisson-LQ模型预测TCP和NTCP。2种计划数据差异比较采用配对t检验。结果 Plan1的计划靶区体积D_(98)为6 445.7 cGy,Plan2为6 497.8 cGy,t=4.944,P<0.001;Plan1的V_(100)为98.4%,Plan2为98.9%,t=4.300,P<0.001。Plan2的适形度指数比Plan1高0.02,差异有统计学意义,t=2.628,P=0.016。Plan2上、中、下咽缩肌V_(50)分别比Plan1低4.3%、17.4%和18.6%,差异均有统计学意义,均P<0.05。Plan2咽缩肌NTCP比Plan1低5.69%,t=-4.222,P<0.001;Plan2左、右侧腮腺NTCP分别比Plan1高1.29%和1.60%,t值分别为2.475和2.402,P值分别为0.021和0.025。2种计划间TCP差异无统计学意义,t=0.536,P=0.597。结论 保护咽缩肌的头颈部肿瘤IMRT计划可以满足临床剂量学要求,与常规IMRT计划相比降低了咽缩肌的V_(50)和NTCP,但增加了腮腺的NTCP。Objective To investigate the differences in target coverage,dose of pharyngeal constrictor,tumor control probability(TCP) and normal tissue complication probability(NTCP) between the plan without limiting pharyngeal constrictor dose and the one protecting the pharyngeal constrictor in intensity modulated radiotherapy(IMRT) for head and neck tumors.Methods A total of 240 patients with head and neck cancer admitted to the Affiliated Cancer Hospital of Xinjiang Medical University were selected.The target area was delineated on CT simulated localization images and a routine IMRT plan was developed,named Plan 1.In addition,based on MRI and CT fusion images,the upper,middle and lower pharyngeal constrictor muscles were delineated and dose limits were applied to the pharyngeal constrictor muscles.The IMRT plan for protecting pharyngeal constrictor muscles was developed and named Plan 2.Dose volume histogram(DVH) was used to compare the dosimetric differences of target coverage and pharyngeal constrictor dose between the two groups,and Poisson-LQ model was used to predict TCP and NTCP.Paired t-tests were used to compare the differences in data between the two plans.Results The planning target volume D_(98) of Planl was 6 445.7 cGy and that of Plan 2 was 6 497.8 cGy,t=4.944,P<0.001.The V_(100) of Plan1 was 98.4%,and the V_(100) of Plan2 was 98.9%,t=4.300,P<0.001.The conformity index of Plan2 was 0.02 higher than that of Plan1,and the difference was statistically significant,t=2.628,P=0.016.The V_(50) of the upper,middle,and lower pharyngeal constrictor muscles in Plan2 were 4.3%,17.4% and 18.6%,lower than those in Plan1,respectively,with statistically significant differences(all P<0.05).The NTCP of pharyngeal constrictor muscle in Plan2 was 5.69%,lower than that in Plan1,t=4.222,P<0.001.The NTCP of the left and right parotid glands in Plan2 were 1.29% and 1.60%,higher than those in Plan1,with t values of 2.475 and 2.402,and P values of 0.021 and 0.025,respectively.There was no statistically significant difference in TCP b

关 键 词：头颈部肿瘤 调强放疗 肿瘤控制概率 正常组织并发症概率 剂量学 

分 类 号：R739.91[医药卫生—肿瘤] R730.55[医药卫生—临床医学]