非共面容积调强和非共面固定野调强在脑转移瘤脑海马体保护全脑放射治疗联合同步推量的剂量学研究  

A dosimetric study of non-coplanar VMAT and non-coplanar IMRT in HA-WBRT+SIB for brain metastases

作　　者：曾华驱 陈宗友[2] 汤树奎 温尊北[2] 吴齐兵[1,3] Zeng Huaqu;Chen Zongyou;Tang Shukui;Wen Zunbei;Wu Qibin(School of Biomedical Engineering,Anhui Medical University,Hefei 230032,China;Department of Radiotherapy,Gaozhou People's Hospital,Gaozhou 525200,China;Department of Oncology Radiotherapy,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学生物医学工程学院,合肥230032 [2]高州市人民医院放射治疗科,高州525200 [3]安徽医科大学第一附属医院肿瘤放疗科,合肥230032

出　　处：《中国医学装备》2024年第12期25-31,共7页China Medical Equipment

基　　金：茂名市科技专项(2022S010)。

摘　　要：目的:探讨Monaco治疗计划系统非共面容积旋转调强治疗(VMAT)和非共面固定野调强放射治疗(IMRT)在脑转移瘤海马保护全脑放射治疗(HA-WBRT)联合同步推量(SIB)的剂量学差异,为临床提供切实可行的治疗方案。方法:回顾性选择2022年6月至2023年10月在高州市人民医院接受放射治疗的22例脑转移瘤患者病历资料,每例患者均采用HA-WBRT联合SIB(HA-WBRT+SIB)的非共面VMAT和非共面IMRT两种放射治疗计划,在满足靶区处方剂量要求的情况下比较两种计划的靶区和危及器官剂量分布、计划的机器跳数和治疗前计划验证。结果:两种计划的计划肿瘤靶区(PGTV)的50、55 Gy剂量覆盖的体积(V_(50)、V_(55))、最大剂量(D_(max))、异质性指数(HI)和适形性指数(CI)比较差异均无统计学意义(P>0.05)。对于全脑计划靶区(PTV-brain-SIB)的98%体积覆盖的剂量(D98%),IMRT与VMAT比较差异无统计学意义(P>0.05);VMAT计划可显著提高PTV-brain-SIB的30 Gy剂量覆盖的体积(V30)、降低HI值和提高CI值,与IMRT计划比较,差异有统计学意义(t=-6.366、3.289、-8.343,P<0.05)。VMAT计划左眼和右眼的D_(max)显著低于IMRT计划,差异均有统计学意义(t=5.784、5.351,P<0.05);VMAT计划右内耳的D_(max)高于IMRT计划,差异均有统计学意义(t=-2.848,P<0.05)。VMAT会显著增加左、右脑海马的D_(100%)高于IMRT计划,差异均有统计学意义(t=-2.564、-6.578,P<0.05)。IMRT计划的机器跳数为(1174±168)MU,显著低于VMAT计划,差异有统计学意义(t=-6.249,P<0.05);VMAT计划治疗时间为(294.1±16.4)s,少于IMRT计划,差异有统计学意义(t=-7.400,P<0.05)。在γ分析3%/2 mm和2%/2 mm标准下,IMRT计划的γ通过率分别为(99.1±0.6)%和(97.6±1.0)%,显著高于VMAT计划,差异有统计学意义(t=-2.733、5.780,P<0.05)。结论:基于Monaco放射治疗计划系统的非共面VMAT和非共面固定野IMRT两种治疗计划对脑转移瘤患者的海马保护全脑放射治疗联合同步推量照射Objective:To investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy(VMAT)and non-coplanar fixed-field intensity-modulated radiotherapy(IMRT)of Monaco treatment planning system(TPS)in hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost(HAWBRT+SIB)for brain metastases,so as to provide a practical and feasible treatment plan for clinical work.Methods:A total of 22 patients with brain metastases were retrospectively selected.Two radiotherapy plans,which included non-coplanar VMAT and non-coplanar fixed field IMRT of HA-WBRT+SIB,were designed for each patient.The dose distribution,the machine units(MU)of plan,and verification of pre-treatment plan in target area and organs at risk(OARs)between two plans were compared under meeting the prescribed dose requirements of target volume.Results:There were no significant differences in covered volumes(V_(50) and V_(55))of 50 and 55 Gy dose,maximum dose(D_(max)),heterogeneity index(HI)and conformity index(CI)of planning gross tumor volume(PGTV)between the two plans(P>0.05).For whole-brain planning target volume(PTV-brain-SIB),there was no significant difference in the dose that was covered by 98%volume(D98%)between IMRT and VMAT(P<0.05).VMAT plan could significantly improve the covered volume of 30 Gy dose(V30)of PTV-brain-SIB,and decrease HI value and increase CI value,and the differences of them between VMAT and IMRT were significant(t=-6.366,3.289,-8.343,P<0.05),respectively.The D_(max) values of left and right eyes of VMAT plan were significantly lower than those of IMRT plan,and the differences were significant(t=5.784,5.351,P<0.05),respectively.The D_(max) value of right inner ear of VMAT plan was higher than that of IMRT plan,and the difference was significant(t=-2.848,P<0.05).VMAT could significantly increase D_(100%)value of left and right hippocampus,which was higher than that of IMRT plan,and the differences of them between two plans were significant(t=-2.564,-6.578,P<0.05),respectively.The MU

关 键 词：海马保护 脑转移瘤 同步推量(SIB) 全脑放射治疗(WBRT) 容积旋转调强治疗(VMAT) 调强放射治疗(IMRT) 

分 类 号：R814.42[医药卫生—影像医学与核医学]