四维CT对肺癌患者立体定向放射治疗中正常组织受照射剂量的影响  

The Effect of Four Dimensional CT on the Radiation Dose of Normal Tissues in Lung Cancer Patients with Stereotactic Radiotherapy

作　　者：靳怀志 王学涛 杨耕 李飞 Jin Huaizhi;Wang Xuetao;Yang Geng;Li Fei(The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou Guangdong 510006,China)

机构地区：[1]广州中医药大学第二附属医院,广东广州510006

出　　处：《医疗装备》2024年第21期29-33,共5页Medical Equipment

基　　金：教育部产学合作协同育人项目(230806071142911)。

摘　　要：目的探讨肺癌立体定向放射治疗中四维CT(4DCT)对患者正常组织受照射剂量的影响。方法回顾性分析2020年2月至2023年11月于医院行立体定向放射治疗的32例肺癌患者的临床资料,均设计图像引导放射治疗(IGRT)计划和非图像引导的调强放射治疗(IMRT)计划。其中,IGRT计划设计中采用4DCT。在满足靶区处方剂量要求的前提下,比较两种计划头脚、前后、左右方向误差,原计划、IGRT计划、IMRT计划的吸气末和呼气末图像正常组织受照射剂量(食管D_(mean)、脊髓D_(mean)和D_(max)、心脏D_(mean)及肺V_(5)、V_(10)、V_(20)、D_(mean)),以及正常组织受照射剂量与头脚、前后、左右方向误差的相关性。比较两种计划不同方位的误差值及对食管、脊髓、心脏、肺等正常组织受照射剂量的影响。结果IGRT计划的头脚、前后、左右方向误差分别为(1.32±0.25)mm、(0.68±0.11)mm、(0.41±0.10)mm,均低于IMRT计划的(5.46±2.31)mm、(2.65±0.32)mm、(1.79±0.32)mm,差异有统计学意义(P<0.05)。原计划、IGRT计划、IMRT计划吸气末和呼气末图像的食管D_(mean)、脊髓D_(mean)、脊髓D_(max)、心脏D_(mean)及肺V_(5)比较,差异无统计学意义(P>0.05);原计划、IGRT计划吸气末和呼气末图像的肺V_(10)、V_(20)、D_(mean)均低于IMRT计划,差异有统计学意义(P<0.05);原计划与IGRT计划吸气末和呼气末图像的肺V_(10)、V_(20)、D_(mean)比较,差异无统计学意义(P>0.05)。Pearson相关性分析结果显示,吸气末和呼气末图像的食管D_(mean)、脊髓D_(mean)、脊髓D_(max)、心脏D_(mean)仅与头脚方向误差呈正相关(P<0.05);吸气末和呼气末图像的肺V_(5)、V_(10)、V_(20)、D_(mean)与头脚、前后、左右方向误差均呈正相关(P<0.05)。结论4DCT能够准确评估肺癌病灶随呼吸运动的位移,降低立体定向放射治疗患者的正常组织受照射剂量,减少误差,为减轻放射治疗不良反应提供质量保证。Objective To investigate the effect of four dimensional CT(4DCT)on the radiation dose of normal tissues in patients with stereotactic radiotherapy for lung cancer.Methods With the retrospective analysis of clinical data from 32 lung cancer patients with stereotactic radiotherapy in hospitals from February 2020 to November 2023,and the design of image-guided radiotherapy(IGRT)plans and non image-guided intensity modulated radiation therapy(IMRT)plans,among them,4DCT was adopted in the design of the IGRT plan.On the premise of meeting the prescription dose requirements for the target area,the errors in the head and foot,front and back,left and right directions of the two plans,as well as the normal tissue exposure doses(esophageal D_(mean),spinal cord D_(mean),spinal cord D_(max),cardiac D_(mean) and lung V_(5),V_(10),V_(20),D_(mean))in end-inspiratory and end-expiratory images of the original plan,IGRT plan and IMRT plan,and the correlation between the radiation dose of normal tissue and the errors of head and foot,front and back,left and right direction were compared.In addition,the error values of two plans in different directions and their effects on the radiation dose for normal tissues such as esophagus,spinal cord,heart,and lungs were compared.Results The errors of head and foot,front and back,and left and right directions in the IGRT plan were(1.32±0.25)mm,(0.68±0.11)mm,and(0.41±0.10)mm,respectively,all lower than the IMRT plan's(5.46±2.31)mm,(2.65±0.32)mm,and(1.79±0.32)mm,with statistically significant differences(P<0.05).There were no significant differences between esophageal D_(mean),spinal cord D_(mean),spinal cord D_(max),cardiac D_(mean) and pulmonary V_(5) in end-inspiratory and end-expiratory images of original plan,IGRT plan and IMRT plan(P>0.05).The lung V_(10),V_(20),and D_(mean) of the endinspiratory and end-expiratory images of the original plan and IGRT plan were significantly lower than those of the IMRT plan(P<0.05).There were no significant differences in lung V_(10),V_(20),and D_(me

关 键 词：四维CT 肺癌 立体定向放射治疗 误差 受照射剂量 

分 类 号：R730.5[医药卫生—肿瘤]