不同放疗方案治疗多发脑转移瘤的剂量学和效果差异分析  

Dosimetric and efficacy difference analysis of different radiotherapy regimens for multiple brain metastases

作　　者：张卫恒 邹炳 赵学会[1] 李正 左明 ZHANG Weiheng;ZOU Bing;ZHAO Xuehui;LI Zheng;ZUO Ming(Department of Oncology,The Second Affiliated Hospital of Nanchang University,Nanchang 330000,China)

机构地区：[1]南昌大学第二附属医院肿瘤科,南昌330000

出　　处：《国际医学放射学杂志》2025年第2期159-163,202,共6页International Journal of Medical Radiology

摘　　要：目的比较超弧刀(Hyperarc)、容积调强弧形治疗(VMAT)、调强放射治疗(IMRT)、三维适形放射治疗(3DCRT)治疗多发脑转移瘤的剂量学和效果差异。方法前瞻性选取168例多发脑转移瘤病人,随机分为4组(n=42),分别采用Hyperarc、VMAT、IMRT和3DCRT技术设计治疗计划。采用单因素方差分析、Kruskal-Wallis检验、卡方检验比较4组病人的临床资料及治疗有效率,并比较4组间计划靶区剂量学参数[均匀性指数(HI)、适形度指数(CI)、梯度指数(GI)],危及器官剂量[双侧晶体及脑干的最大剂量(Dmax)和平均剂量(Dmean)]、机器跳数和出束时间。结果Hyperarc组的治疗有效率高于VMAT组、IMRT组和3DCRT组(P<0.05);与其他3组相比,Hyperarc组病人计划靶区HI、GI以及双侧晶体及脑干Dmax、Dmean均较低,计划靶区的Dmean和CI均更高(均P<0.05);VMAT组和IMRT组病人计划靶区HI、GI,以及双侧晶体及脑干Dmax、Dmean均低于3DCRT组(均P<0.05),计划靶区Dmean和CI高于3DCRT组(P<0.05);Hyperarc组机器跳数和出束时间均低于VMAT组、IMRT组,但高于3DCRT组(均P<0.05)。结论在多发脑转移瘤病人的放射治疗中,Hyperarc技术的靶区剂量学分布以及对危及器官的保护具有优势。Objective To compare the dosimetry and efficacy differences among Hyperarc,volume modulated arc therapy(VMAT),intensity modulated radiation therapy(IMRT),and three-dimensional conformal radiation therapy(3DCRT)for the treatment of multiple brain metastases.Methods A total of 168 patients with multiple brain metastases were prospectively selected and randomly divided into 4 groups(n=42),each receiving treatment plans designed using Hyperarc,VMAT,IMRT,or 3DCRT.One-way ANOVA,Kruskal Wallis test,and chi-square test were used to compare the clinical data and treatment efficacy,as well as the dosimetric parameters of the planning target volume[homogeneity index(HI),conformity index(CI),gradient index(GI)],organ at risk dose[maximum dose(Dmax)and average dose(Dmean)to bilateral crystals and brainstem],and monitor units and beam delivery time,among the 4 groups.Results The treatment efficacy of the Hyperarc group was significantly higher than that of the VMAT,IMRT,and 3DCRT groups(P<0.05).Compared with the other three groups,the Hyperarc group had lower HI,GI,and Dmax/Dmean for the bilateral lenses and brainstem,while Dmean and CI of target volume were higher(all P<0.05).The VMAT and IMRT groups exhibited lower HI,GI,and Dmax/Dmean for the bilateral lenses and brainstem compared to the 3DCRT group(all P<0.05),while their target volume Dmean and CI were higher(P<0.05).The Hyperarc group had fewer monitor units and a shorter beam-on time than the VMAT and IMRT groups,but higher than the 3DCRT group(all P<0.05).Conclusion In the radiotherapy of multiple brain metastases,Hyperarc technology demonstrates advantages in target volume dosimetric distribution and organ-at-risk protection.

关 键 词：脑转移瘤 超弧刀 容积调强弧形治疗 调强放射治疗 三维适形放射治疗 剂量学 

分 类 号：R739.41[医药卫生—肿瘤] R815[医药卫生—临床医学]