中枢神经系统肿瘤患儿全脑全脊髓照射质子放疗计划与光子调强放疗计划的剂量学比较  

Dosimetric comparison of proton radiotherapy plan versus intensity-modulated photon radiotherapy plan for craniospinal irradiation in children with central nervous system tumors

作　　者：陈庆 孙磊[2] 毕斌[3] 王宇翔 徐锐 CHEN Qing;SUN Lei;BI Bin;WANG Yuxiang;XU Rui(Qingdao Medical College of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学青岛医学院,山东青岛266071 [2]淄博万杰肿瘤医院质子治疗中心 [3]四川省肿瘤医院(四川省肿瘤研究所) [4]中国科学技术大学附属第一医院离子医学中心 [5]青岛大学附属医院介入医学科

出　　处：《精准医学杂志》2025年第2期95-101,共7页Journal of Precision Medicine

摘　　要：目的比较四种不同放疗技术在儿童中枢神经系统(CNS)肿瘤全脑全脊髓照射(CSI)治疗中的剂量学差异。方法收集2005年5月—2023年5月在淄博万杰肿瘤医院接受全脑全脊髓质子被动散射放疗(PSPT)的33例CNS患儿的放疗前CT肿瘤定位图像,并且勾画出放疗靶区和危及器官(OAR)。将上述CT图像分别在Eclipse proton、Eclipse photon治疗计划系统中进行PSPT、质子调强放疗(IMPT)、光子静态调强放疗(IMRT)、光子容积旋转调强放疗(VMAT)计划设计及评估,并分别设为PSPT组、IMPT组、IMRT组及VMAT组。比较四组计划中放疗计划靶区(PTV)的适形度指数(CI)、均匀性指数(HI)、梯度指数(GI),及PTV、OAR、正常组织(NT)的95%靶体积照射剂量(D _(95))、5%靶体积照射剂量(D_(5))、平均照射剂量(D_(mean))和照射剂量体积百分比(V_(5),V_(10),V_(20))等指标。结果IMRT、VMAT组PTV的D_(95)、D_(mean)、CI、GI均显著高于IMPT、PSPT组(F=8.452~22.671,t=-20.352~9.779,P<0.05),PTV D_(5)、HI均显著低于IMPT、PSPT组(F=9.782~15.234,t=3.462~9.512,P<0.05)。IMPT、PSPT组OAR及NT的D_(mean)、V_(5)、V_(10)以及V_(20)均显著低于IMRT、VMAT组(F=15.189~899.507,H=100.583、483.825,t=-110.622~27.767,P<0.05),且PSPT组OAR中眼球D_(mean)、晶体D_(mean)、甲状腺D_(mean)均显著低于IMPT组(F=201.163,H=100.583、483.825,t=-21.536~27.767,P<0.05)。结论在儿童CNS肿瘤的CSI中,光子调强放疗计划(IMRT、VMAT)较质子放疗计划(IMPT、PSPT)具有更好的PTV适形度和均匀度;但与光子调强放疗计划(IMRT、VMAT)相比,质子放疗计划(IMPT、PSPT)能够更好地保护患儿PTV以外的NT和OAR。Objective To investigate the differences in dosimetry between four radiotherapy techniques in craniospinal irradiation(CSI)for central nervous system(CNS)tumors in children.Methods CT images for tumor localization before radiotherapy were collected from 33 children with CNS tumor who underwent CSI passive scattering proton therapy(PSPT)in Zibo Wanjie Tumor Hospital from May 2005 to May 2023,and the radiotherapy target volume and organ at risk(OAR)were contoured.These CT images were used to design and evaluate four treatment plans in the Eclipse proton and Eclipse photon treatment planning systems,i.e.,PSPT,intensity-modulated proton therapy(IMPT),photon static intensity-modulated radiotherapy(IMRT),and photon volumetric-modulated arc therapy(VMAT),which were designated as the PSPT,IMPT,IMRT,and VMAT groups,respectively.Related dosimetric parameters were compared between the four plans,including the conformity index(CI),homogeneity index(HI),and gradient index(GI)of the planning target volume(PTV),the dose to 95%of the volume(D 95),dose to 5%of the volume(D_(5)),and mean radiation dose(D_(mean))for PTV,OAR,and normal tissue(NT),and the percentage of volume receiving different doses(V_(5),V_(10),V_(20)).Results Compared with the IMPT and PSPT groups,the IMRT and VMAT groups had significantly higher D 95,D mean,CI,and GI of PTV(F=8.452-22.671,t=-20.352-9.779,P<0.05)and significantly lower D_(5) and HI of PTV(F=9.782-15.234,t=3.462-9.512,P<0.05).Compared with the IMRT and VMAT groups,the IMPT and PSPT groups had significantly lower D_(mean),V 5,V _(10),and V_(20) of OAR and NT(F=15.189-899.507,H=100.583,483.825,t=-110.622-27.767,P<0.05),and compared with the IMPT group in terms of OAR,the PSPT group had a significantly lower D_(mean )of the eyeballs,lenses,and thyroid(F=201.163,H=100.583,483.825,t=-21.536-27.767,P<0.05).Conclusion In CSI for pediatric CNS tumors,IMRT and VMAT plans have better PTV conformity and homogeneity than IMPT and PSPT plans,and compared with photon-based intensity-modulated radiotherapy plans

关 键 词：中枢神经系统肿瘤 颅脊柱照射 放射疗法 调强适形 质子疗法 光子放射治疗 放射治疗剂量 剂量学比较 儿童 

分 类 号：R318[医药卫生—生物医学工程] R815[医药卫生—基础医学]