Monaco两种优化模式对非小细胞肺癌体部立体定向放射治疗计划的影响  

Effect of two optimal modes of Monaco on stereotactic radiation therapy planning for non-small cell lung cancer

作　　者：袁美芳 蒲琴 赵彪[1] 马立双 孙朝细 杨思原 YUAN Mei-fang;PU Qin;ZHAO Biao;MA Li-shuang;SUN Chao-xi;YANG Si-yuan(Department of Radiation Oncology,Yunnan Cancer Hospital·The Third Affiliated Hospital of Kunming Medical University Peking University Cancer Hospital Yunnan,Kunming 650118,Yunnan,China;Intensive Care Unit,Yunnan Cancer Hospital·The Third Affiliated Hospital of Kunming Medical University Peking University Cancer Hospital Yunnan,Kunming 650118,Yunnan,China;Department of Third Mammary Surgery,Yunnan Cancer Hospital·The Third Affiliated Hospital of Kunming Medical University Peking University Cancer Hospital Yunnan,Kunming 650118,Yunnan,China)

机构地区：[1]云南省肿瘤医院·昆明医科大学第三附属医院·北京大学肿瘤医院云南医院放射治疗科,云南昆明650118 [2]云南省肿瘤医院·昆明医科大学第三附属医院·北京大学肿瘤医院云南医院ICU,云南昆明650118 [3]云南省肿瘤医院·昆明医科大学第三附属医院·北京大学肿瘤医院云南医院乳腺外三科,云南昆明650118

出　　处：《生物医学工程与临床》2025年第2期184-190,共7页Biomedical Engineering and Clinical Medicine

基　　金：云南省教育厅科学研究基金项目(2024J0256);昆明医科大学2024年度大学生创新训练计划项目(2024CYD390)。

摘　　要：目的探讨Monaco 6.00.11计划系统中两种优化模式对早期非小细胞肺癌(NSCLC)在体部立体定向放射治疗(SBRT)中产生的物理剂量学和放射生物学参数的差异。方法选择2022年12月1日至2023年12月1日于云南省肿瘤医院行SBRT的NSCLC患者20例,其中男性13例,女性7例,年龄42~65岁,平均年龄56.70岁;TNM分期,T1N0M012例,T2N0M08例;肿瘤直径均≤5 cm且均为周围型NSCLC;经病理诊断为腺癌14例,鳞状细胞癌6例。在其他优化条件相同的情况下,为每例患者分别设计Pareto模式优先和Constrained模式优先两种放射治疗计划。分析比较两种模式在靶区、危及器官(OAR)的物理剂量学参数和放射生物学参数。结果对靶区而言,Pareto计划靶区(PTV)的Dmean(5358.24 cGy±43.42 cGy vs 5435.02 cGy±181.17 cGy)、D50%(5383.50 cGy±52.25 cGy vs 5473.39 cGy±215.14 cGy)、Dmin(4608.85 cGy±152.25 cGy vs 4485.91 cGy±355.75 cGy)、D98%(4917.72 cGy±20.11 cGy vs 4890.41 cGy±60.50 cGy)、适形度指数(CI)(0.87±0.04 vs 0.85±0.04)、梯度指数(GI)(6.36±2.04 vs 7.20±2.45)和机器跳数(MU)(2869.74 MU±471.32 MU vs 3144.67 MU±676.14 MU)均明显优于Constrained模式,且差异均具有统计学意义(P<0.05);对OAR而言,Constrained模式双肺的V20[(3.14±1.99)%vs(3.26±2.17)%]、V13.5[(167.95±85.43)cm3 vs(174.44±93.20)cm3],心脏的D2%[(302.18±130.20)cGy vs(313.23±129.76)cGy]、Dmean[(62.50±50.22)cGy vs(64.20±51.55)cGy]、等效均匀剂量(EUD)[(31.85±20.77)cGy vs(33.15±20.99)cGy]和胸壁的Dmax[(4742.12±1157.16)cGy vs(4813.11±1130.48)cGy]、Dmean[(328.60±128.51)cGy vs(337.57±138.51)cGy]略低于Pareto模式,且差异均具有统计学意义(P<0.05)。结论两种优化模式下靶区和OAR均能满足临床要求,选择Pareto模式优先可获得更好的靶区剂量分布和更低的MU,采用Constrained模式优先则胸壁等OAR的受照剂量略低,考虑计划的整体获益,推荐在早期NSCLC的SBRT计划设计中选择Pareto模式优先,但如须对胸壁等OAR进行特�Objective To investigate the differences of physical dosimetric and radiobiological parameters between two optimization modes of Monaco 6.0.11 planning system for stereotactic body radiotherapy(SBRT)in patients with early non-small cell lung cancer(NSCLC).Methods From December 1,2022 to December 1,2023,a total of 20 patients with NSCLC performed SBRT were enrolled,which included 13 males and 7 females,aged 42-65 years old with mean age of 56.70 years old;12 cases of T1N0M0 and 8 of T2N0M0 in TNM stage;tumor diameter was≤5 cm and all tumors were peripheral NSCLC;pathological diagnosis showed 14 cases of adenocarcinoma and 6 of squamous cell carcinoma.The Pareto priority and Constrained priority radiotherapy plans were designed for each patient under the same other optimization conditions.The physical dosimetric parameters and radiobiological parameters of target area and organs at risk(OAR)were analyzed and compared between 2 modes.Results For target volume,the planned target area Dmean(PTV)(5358.24 cGy±43.42 cGy vs 5435.02 cGy±181.17 cGy),D50%(5383.50 cGy±52.25 cGy vs 5473.39 cGy±215.14 cGy),Dmin(4608.85 cGy±152.25 cGy vs 4485.91 cGy±355.75 cGy),D98%(4917.72 cGy±20.11 cGy vs 4890.41 cGy±60.50 cGy),conformance index(CI)(0.87±0.04 vs 0.85±0.04),gradient index(GI)(6.36±2.04 vs 7.20±2.45)and machine unit(MU)(2869.74 MU±471.32 MU vs 3144.67 MU±676.14 MU)of Pareto mode were statistically significantly better than those of Constrained mode(P<0.05).For OAR,bilateral lung V20[(3.14±1.99)%vs(3.26±2.17)%],V13.5[(167.95±85.43)cm3 vs(174.44±93.20)cm3],heart D2%[(302.18±130.20)cGy vs(313.23±129.76)cGy],Dmean[(62.50±50.22)cGy vs(64.20±51.55)cGy],equivalent uniform dose(EUD)[(31.85±20.77)cGy vs(33.15±20.99)cGy]and thoracic wall Dmax[(4742.12±1157.16)cGy vs(4813.11±1130.48)cGy],Dmean[(328.60±128.51)cGy vs(337.57±138.51)cGy]in Constrained mode were statistically significantly lower than those in Pareto mode,and the differences were statistically significant(P<0.05).Conclusion It is demonstrated that t

关 键 词：优化模式 非小细胞肺癌 Monaco计划系统 放射治疗剂量 

分 类 号：R730.55[医药卫生—肿瘤] R734.2[医药卫生—临床医学]