磁共振引导分次立体定向放射治疗脑肿瘤的初步临床应用  

Preliminary clinical application of magnetic resonance-guided fractionated stereotactic radiation in the treatment of brain tumors

作　　者：饶乐 蔡博宁[1] 解传滨[1] 刘彦立 王海洋 俞伟[1] 曲宝林[1] Rao Le;Cai Boning;Xie Chuanbin;Liu Yanli;Wang Haiyang;Yu Wei;Qu Baolin(Department of Radiation Oncology,the First Medical Center of PLA General Hospital,Beijing100853,China)

机构地区：[1]解放军总医院第一医学中心放射治疗科,北京100853

出　　处：《中华放射肿瘤学杂志》2024年第12期1091-1097,共7页Chinese Journal of Radiation Oncology

基　　金：国家重点研发计划(2022YFC2409503)。

摘　　要：目的评价磁共振引导分次立体定向放射治疗(FSRT)脑肿瘤的剂量学特点及安全性、有效性。方法回顾性分析2023年7月—2024年2月解放军总医院第一医学中心放射治疗科收治的8例使用Unity加速器行磁共振引导FSRT治疗脑肿瘤的患者资料。患者的每次放疗均使用在线自适应流程,由放疗科医师选择自适应方案为位置自适应(ATP)或形状自适应(ATS),每次自适应均需重新审核放疗计划后开始治疗,分割方案为21~30 Gy分3~5次。使用统计描述重点分析其临床特征、放疗计划及计划参数。连续变量用M(Q_(1),Q_(3))表示,分类变量用例数(百分数)表示。结果本研究中9个病灶共治疗41次,其中ATP计划20次(49%),ATS计划21次(51%)。中位靶区覆盖率为95.1%(95%,99.8%),中位靶区最大剂量率为1.15(1.07,1.31);中位适形性指数(CI)为0.75(0.69,0.86),中位均匀性指数(HI)为1.09(1.06,1.21),中位梯度指数(GI)为4.73(3.36,8.45)。通过ATS计划后大体肿瘤体积(GTV)缩小中位值为8.22(1.2,10.1)cm^(3),脑组织V_(12 Gy)下降中位值为30.46(8.34~31.13)cm^(3)。中位随访3.2(1.4,6.1)个月,所有患者未见放射性脑坏死,放疗期间急性脑水肿2例(均为轻度),除1例因全身疾病进展出现死亡,其余患者局部未复发,生活质量良好。结论通过磁共振引导行FSRT的治疗计划参数整体尚可,自适应计划可有效降低正常脑组织受量,使用磁共振引导FSRT治疗脑肿瘤可行安全。Objective To evaluate the dosimetric characteristics,safety and effectiveness of magnetic resonance-guided fractionated stereotactic radiotherapy(FSRT)for brain tumors.Methods Clinical data of 8 brain tumor patients treated with magnetic resonance-guided FSRT in the Radiotherapy Department of the First Medical Center of the PLA General Hospital from July 2023 to February 2024 were retrospectively analyzed.Online adaptive radiotherapy was adopted for all patients.Adapt-to-position(ATP)or adapt-to-shape(ATS)radiotherapy was chosen by radiologists.Each adaptation was initiated after the radiotherapy plan was re-examined.The radiotherapy fractionation plan was 21-30 Gy/3-5 F.Clinical characteristics,radiotherapy plans and plan parameters were analyzed by statistical description.Median(Q_(1),Q_(3))was used to describe continuous data and percentage was used to describe categorical data.Results In this study,9 lesions were treated a total of 41 times,including 20 times(49%)of ATP plan and 21 times(51%)of ATS plan.The median target area coverage rate was 95.1%(95%,99.8%),the median target area maximum dose rate was 1.15(1.07,1.31),the median conformity index(CI)was 0.75(0.69,0.86),the median homogeneity index(HI)was 1.09(1.06,1.21),and the median gradient index(GI)was 4.73(3.36,8.45),respectively.After ATS plan,the median reduction in gross target volume(GTV)was 8.22 cm^(3)(1.2,10.1 cm^(3)),and the median reduction in brain tissue V_(12 Gy)was 30.46 cm^(3)(8.34,31.13 cm^(3)).The median follow-up was 3.2 months(1.4,6.1 months).No radiation necrosis was found in any patient.There were 2 cases of acute brain edema during radiotherapy(both were mild).Except for 1 case who died due to systemic disease progression,the remaining patients had no local recurrence,and achieved good quality of life.Conclusions The parameters of the treatment plan of magnetic resonance-guided FSRT are generally acceptable.The adaptive plan can effectively reduce the dose of normal brain tissues.It is safe and feasible to use the magnetic resonance-

关 键 词：脑肿瘤 分次立体定向放射疗法 放射疗法 自适应 磁共振引导加速器 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]