容积调强弧形治疗与射波刀六维颅骨追踪技术对头颈部肿瘤晶格空间分割放疗的剂量学研究  

Dosimetric study of volumetric modulated arc therapy and cyberknife six-dimensional skull tracking in spatially fractionated lattice radiotherapy for head and neck tumors

作　　者：袁珂[1,2] 廖雄飞 王先良[1] 郎锦义[1] 应微[1] YUAN Ke;LIAO Xiongfei;WANG Xianliang;LANG Jinyi;YING Wei(Radiation Oncology Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital and Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China;School of Physics,University of Electronic Science and Technology)

机构地区：[1]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院放射肿瘤学四川省重点实验室,成都610041 [2]电子科技大学物理学院

出　　处：《国际医学放射学杂志》2025年第1期53-58,共6页International Journal of Medical Radiology

基　　金：四川省卫生健康委员会科技项目(24QNMP037);四川大学辐射物理及技术教育部重点实验室开放课题(2023SCURPT05)。

摘　　要：目的对比容积调强弧形治疗(VMAT)和射波刀六维(CK-6D)颅骨追踪技术在头颈部肿瘤晶格放射治疗(LRT)的剂量学和治疗效率的差异,并分析技术优势。方法回顾性选取接受基于VMAT技术(VMAT方案)完成LRT治疗的头颈部肿瘤病人7例,并将病人的CT影像及相关放射治疗结构集导入CK-6D计划系统(CK-6D方案),选择可变(Iris)准直器进行治疗计划设计。2种方案采用相同的处方剂量,比较2种方案下病人的肿瘤靶区(GTV)和晶格肿瘤靶区(GTV-Lattice)的90%体积照射剂量(D_(90))、平均照射剂量(D_(mean))、剂量峰谷比(PVDR)以及消融剂量比(ADR)。测量危及器官的剂量学参数,包括脑干、脊髓、视交叉的D_(max),腮腺的D_(mean),0.05~1 cm^(3)体积的皮肤接受的照射剂量(D_(0.05 mL)-D_(1mL))和Dmean等。采用配对t检验比较2个方案的治疗时间、Gamma通过率、PVDR、ADR和跳数(MU)。结果与VMAT方案相比,CK-6D方案GTV的D_(mean)降低,而GTV-Lattice的D_(90)和D_(mean)升高(均P<0.05);其余剂量参数在2方案间的差异无统计学意义(均P>0.05)。CK-6D方案的治疗时间、PVDR和MU均高于VMAT方案(均P<0.05)。2个方案间的Gamma通过率和ADR差异无统计学意义(均P>0.05)。结论头颈部肿瘤LRT治疗中,CK-6D相比VMAT技术,在肿瘤靶区内可实现更高的PVDR和更大的剂量梯度。但需要结合治疗时间的因素来权衡选取合适的技术以优化治疗效果和效率。Objective To compare the dosimetric and treatment efficiency differences between volumetric modulated arc therapy(VMAT)and cyberknife six-dimensional(CK-6D)skull tracking technology in lattice radiotherapy(LRT)for head and neck tumors and analyze their respective advantages.Methods This retrospective study selected seven patients with head and neck tumor who received LRT based on the VMAT technique(VMAT plan).The patients’CT images and related radiotherapy structure sets were imported into the CK-6D planning system(CK-6D plan),and treatment plans were designed using a variable(Iris)collimator.Both plans employed the same prescription dose.The tumor target area(GTV)and lattice tumor target area(GTV-Lattice)were compared for 90%volume irradiation dose(D_(90)),mean dose(D_(mean)),peak-to-valley dose ratio(PVDR),and ablation dose ratio(ADR).Dosimetric parameters for organs at risk were measured,including the maximum dose(Dmax)to the brainstem,spinal cord,and optic chiasm;D_(mean) to the parotid glands;and the doses received by 0.05-1 cm^(3) of skin(D0.05 mL-D1 mL)and their D_(mean).Paired t-tests were used to compare treatment time,Gamma passing rate,PVDR,ADR,and monitor units(MU)between the two plans.Results Compared to the VMAT plan,the CK-6D plan showed a reduced D_(mean) for the GTV and increased D_(90) and Dmean for the GTV-Lattice(all P<0.05).Other dosimetric parameters showed no statistically significant differences between the two plans(all P>0.05).The CK-6D plan required longer treatment time,higher PVDR,and more MUs than the VMAT plan(all P<0.05).The Gamma passing rate and ADR showed no significant differences between the two plans(both P>0.05).Conclusion For LRT in head and neck tumors,CK-6D achieves higher PVDR and greater dose gradients within the tumor target area compared with VMAT.However,considering treatment time,it is essential to balance the choice of technique to optimize therapeutic outcomes and efficiency.

关 键 词：调强放疗 射波刀 空间分割放射治疗 晶格放射治疗 峰谷剂量比 头颈部肿瘤 

分 类 号：R730.55[医药卫生—肿瘤]