螺旋断层放疗、静态调强放疗和容积旋转调强放疗技术在宫颈癌放疗的剂量学对比分析  

Dosimetric comparison of tomotherapy,static IMRT and VMAT techniques in radiotherapy for cervical cancer

作　　者：苟亮倩 吴书裕 廖华英 杨玉善 张国前 余辉 王晓慧 张书旭 GOU Liangqian;WU Shuyu;LIAO Huaying;YANG Yushan;ZHANG Guoqian;YU Hui;WANG Xiaohui;ZHANG Shuxu(Radiotherapy Center,Affiliated Cancer Hospital and Institute of Guangzhou Medical University,Guangzhou 510095,China)

机构地区：[1]广州医科大学附属肿瘤医院放疗中心,广东广州510095

出　　处：《中国医学物理学杂志》2025年第4期429-434,共6页Chinese Journal of Medical Physics

基　　金：广州市科技计划项目(2023B03J1295);广东省普通高校特色创新类项目(2024KTSCX122)。

摘　　要：目的:量化评估静态调强放疗(IMRT)、容积旋转调强放疗(VMAT)和螺旋断层放疗(TOMO)3种技术在宫颈癌放疗中的剂量学差异,为临床医生的放疗决策提供数据支持,以优化放疗方案的选择。方法:选取2024年2月~5月在广州医科大学附属肿瘤医院收治的19例宫颈癌放疗患者的临床数据,对每个病例制定IMRT、VMAT、TOMO 3种计划,并进行剂量评估,评估指标包括靶区和危及器官(OARs)的剂量体积参数、均匀性指数(HI)、适形度指数(CI)及机器出束时间等。结果:所有治疗计划靶区均达到临床处方要求。在靶区剂量方面,TOMO组的D_(mean)和D_(max)均显著低于IMRT和VMAT组。对于OARs,TOMO组在降低膀胱D_(mean)、直肠D_(mean)、D_(max)、V_(30)、V_(40),以及左、右股骨头D_(mean)、D_(max)、V_(20)、V_(30)和骨盆D_(mean)、V_(20)、V_(50)等方面表现出显著优势,与IMRT和VMAT组相比,差异有统计学意义(P<0.05)。此外,TOMO组靶区的CI显著高于IMRT和VMAT组,而PGTVnd HI显著低于IMRT组,差异均有统计学意义(P<0.05)。虽然3组在PCTV HI方面的差异无统计学意义,但TOMO组的表现略优于其他两组。值得注意的是,VMAT技术治疗时间最短。结论:在宫颈癌的不同治疗模式中,TOMO技术显示出在靶区剂量覆盖率、OARs的剂量分布、CI和HI方面优于IMRT和VMAT技术。VMAT治疗效率最高。Objective To compare the dosimetric disparities among static intensity-modulated radiotherapy(IMRT),volumetric modulated arc therapy(VMAT),and tomotherapy(TOMO)techniques in cervical cancer radiotherapy for providing data support for clinical decision-making scheme of radiotherapy.Methods The clinical data of 19 cervical cancer patients,treated at the Affiliated Cancer Hospital and Institute of Guangzhou Medical University from February to May in 2024,were analyzed.Three plans were devised for each case using IMRT,VMAT,and TOMO techniques,followed by dosimetric evaluation in terms of various metrics such as dose volume parameters of the target areas as well as organs-at-risk(OAR),conformity index(CI),homogeneity index(HI),and delivery time.Results All 3 plans met the clinical prescription requirements for the target areas.Compared with static IMRT and VMAT,TOMO had significantly lower D_(mean) and D_(max)of PCTV and PGTVnd.For OAR,TOMO demonstrated significant advantages over IMRT and VMAT in the D_(mean) of the bladder,the D_(mean),D_(max),V_(30),V_(40)of the rectum,the D_(mean),D_(max),V_(20),V_(30)of left and right femoral heads,and the D_(mean),V_(20),V_(50)of the pelvis(P<0.05).In addition,the TOMO group showed significantly higher CI for both PCTV and PGTVnd as compared with IMRT and VMAT groups,and lower PGTVnd HI than IMRT group(all P<0.05).Although there was trivial difference among 3 groups in term of PCTV HI,TOMO group performed slightly better than the other two groups.Notably,VMAT technique had the shortest treatment time.Conclusion In various treatment modalities for cervical cancer,TOMO is superior to IMRT and VMAT in terms of target dose coverage,OAR dose distribution,CI,and HI.However,VMAT has the highest efficiency.

关 键 词：宫颈癌 螺旋断层放疗 容积旋转调强放疗 静态调强放疗 剂量学 

分 类 号：R737.33[医药卫生—肿瘤] R811.1[医药卫生—临床医学]