螺旋断层调强放射治疗系统对局部晚期非小细胞肺癌患者危及器官受照剂量参数的影响  

Effect of TOMO therapy on the parameters of exposure dose of organs at risk in locally advanced NSCLC patients

作　　者：陈莹 黄文涛 徐志勇 Chen Ying;Huang Wentao;Xu Zhiyong(Department of Radiotherapy,General Hospital of PLA Southern Theatre Command,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院放射治疗科,广州510010

出　　处：《中国医学装备》2025年第4期13-17,共5页China Medical Equipment

基　　金：广东省医学科研基金(C2022134)。

摘　　要：目的:分析螺旋断层放射治疗(TOMO)系统对局部晚期非小细胞肺癌(NSCLC)患者危及器官(OAR)受照射剂量及体积的影响,从而分析TOMO的优势。方法:选择2019年1月至2024年3月在解放军南部战区总医院接受TOMO治疗的98例局部晚期NSCLC患者,分别对54例患者设计TOMO计划,对44例患者设计容积弧形调强放射治疗(VMAT)计划,对比分析两种计划对OAR受照射剂量参数的影响。结果:TOMO计划的计划靶体积(PTV)适形指数(CI)和计划肿瘤靶区体积(PGTV-T)的CI分别为(0.769±0.012)和(0.756±0.011),高于VMAT计划,PTV均匀指数(HI)为(0.138±0.014),低于VMAT计划,差异均有统计学意义(t=4.457、6.993、7.245,P<0.05)。所有NSCLC患者中TOMO计划在全肺接受5 Gy剂量照射体积(V_(5 Gy))和心脏V_(30 Gy)分别为(45.251±1.652)%和(21.002±1.265)%,优于VMAT计划,差异有统计学意义(t=3.931、6.169,P<0.05);而VMAT计划全肺V_(20 Gy)优于TOMO计划,差异有统计学意义(t=4.346,P<0.05)。NSCLC患者左肺TOMO计划全肺V_(20 Gy)、心脏V_(30 Gy)分别为(24.278±1.456)%和(21.365±1.687)%,均优于VMAT计划,差异有统计学意义(t=9.140、4.992,P<0.05);VMAT计划的心脏V_(40 Gy)优于TOMO计划,差异有统计学意义(t=1.422,P<0.05)。NSCLC患者右肺中,TOMO计划全肺V_(5 Gy)和心脏V_(40 Gy)优于VMAT计划,差异均有统计学意义(t=7.460,6.201,P<0.05)。两种计划的OAR全肺V_(20 Gy)、心脏V_(30 Gy)、V_(40 Gy)、食道V50 Gy、脊髓最大剂量(Dmax)比较,差异均无统计学意义(P>0.05)。结论:TOMO计划在局部晚期NSCLC患者中PTV靶区放射适形度最佳,该技术更适合右肺和左肺的局部晚期NSCLC。Objective:To analyze the effect of the TOMO therapy on the exposure dose and volume of organs at risk(OAR)in patients with locally advanced non-small cell lung cancer(NSCLC),so as to analyze the TOMO’s advantages.Methods:A total of ninety-eight patients with locally advanced NSCLC who received TOMO treatment at the General Hospital of PLA Southern Theatre Command from January 2019 to March 2024 were selected.The TOMO plan was designed for 54 patients,and the volumetric modulated arc therapy(VMAT)plan was designed for 44 patients.The effect of the two plans on the parameters of exposure dose in OAR was compared and analyzed.Results:The conformity index(CI)values of planning target volume(PTV)and planning gross tumor volume-T(PGTV-T)in the TOMO plan were respectively(0.769±0.012)and(0.756±0.011),which were higher than those in the VMAT plan.The homogeneity index(HI)value of PTV in the TOMO plan was(0.138±0.014),which was lower than that in the VMAT plan.The differences of the above indicators between TOMO plan and VMAT plan were statistically significant(t=4.457,6.993,7.245,P<0.05).In all NSCLC patients,the exposure volume(V_(5 Gy))of receiving 5Gy dose on whole lung and the V_(30 Gy) on heart in OAR in the TOMO plan were respectively(45.251±1.652)%and(21.002±1.265)%,which were better than those in the VMAT plan,with statistically significant differences(t=3.931,6.169,P<0.05).However,the V_(20 Gy) of the whole lung in the VMAT plan was better than that in the TOMO plan,with statistically significant difference(t=4.346,P<0.05).In the left lung of NSCLC patients,the V_(20 Gy) of the whole lung and the V_(30 Gy) of the heart of OAR in the TOMO plan were respectively(24.278±1.456)%and(21.365±1.687)%,which were better than those in the VMAT plan,with statistically significant differences(t=9.140,4.992,P<0.05).The V40Gy of the heart in the VMAT plan was better than that in the TOMO plan,with statistically significant difference(t=1.422,P<0.05).In the right lung of NSCLC patients,the V50 Gy of the whole lung and

关 键 词：螺旋断层放射治疗(TOMO)系统 非小细胞肺癌(NSCLC) 容积弧形调强放射治疗(VMAT) 危及器官(OAR) 

分 类 号：R816.41[医药卫生—放射医学]