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宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较

杨波,  庞廷田,  刘峡,  孙显松,  李文博,  胡克,  邱杰,  张福泉

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文章导航 > 协和医学杂志  > 2013 >  4(4): 392-396
杨波, 庞廷田, 刘峡, 孙显松, 李文博, 胡克, 邱杰, 张福泉. 宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较[J]. 协和医学杂志, 2013, 4(4): 392-396. doi: 10.3969/j.issn.1674-9081.2013.04.010
引用本文: 杨波, 庞廷田, 刘峡, 孙显松, 李文博, 胡克, 邱杰, 张福泉. 宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较[J]. 协和医学杂志, 2013, 4(4): 392-396. doi: 10.3969/j.issn.1674-9081.2013.04.010
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Bo YANG, Ting-tian PANG, Xia LIU, Xian-song SUN, Wen-bo LI, Ke HU, Jie QIU, Fu-quan ZHANG. Comparison of the Radiation Doses Used in Helical Tomotherapy and Fixed-field Intensity-modulated Radiotherapy for Cervical Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 392-396. doi: 10.3969/j.issn.1674-9081.2013.04.010
Citation: Bo YANG, Ting-tian PANG, Xia LIU, Xian-song SUN, Wen-bo LI, Ke HU, Jie QIU, Fu-quan ZHANG. Comparison of the Radiation Doses Used in Helical Tomotherapy and Fixed-field Intensity-modulated Radiotherapy for Cervical Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 392-396. doi: 10.3969/j.issn.1674-9081.2013.04.010
shu

宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较

doi: 10.3969/j.issn.1674-9081.2013.04.010

  • 中国医学科学院 北京协和医学院 北京协和医院放射治疗科, 北京 100730

详细信息
    通讯作者:

    邱杰 电话:010-69155481, E-mail:qiujie819@aliyun.com

  • 中图分类号: R737.33

Comparison of the Radiation Doses Used in Helical Tomotherapy and Fixed-field Intensity-modulated Radiotherapy for Cervical Cancer

  • Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

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    摘要
  • 摘要:   目的  比较对宫颈癌术后患者应用螺旋断层调强放疗(helical tomotherapy, HT)和固定野调强放疗(fixed-field intensity-modulated radiotherapy, FF-IMRT)两种计划方式进行放射治疗的剂量学差异。  方法  选择10例宫颈癌术后进行调强放疗的患者行CT模拟定位, 勾画靶区及危及器官, 对同一CT图像设计HT计划和FF-IMRT计划。评估靶区及危及器官的剂量分布。  结果  HT计划组和FF-IMRT计划组靶区覆盖度均满足临床处方剂量要求。与FF-IMRT计划组相比, HT组的计划靶区(planning target volume, PTV)95%、PTV100%覆盖度增加, PTV105%覆盖度降低、Dmean及Dmax均明显降低(P=0.000), 适形度指数和均匀性指数均优于FF-IMRT计划组(P=0.000)。与FF-IMRT计划组相比, HT计划组的膀胱V40降低约7%(P=0.000), Dmax平均值降低1.7 Gy(P=0.000);直肠V40降低约8%(P=0.000);小肠V30、V40分别降低4%、3%(P=0.002, P=0.000), Dmax平均值降低2 Gy(P=0.000);骨髓V30增加约5%(P=0.001), 左右股骨头D5差异无统计学意义; 马尾神经Dmax的平均值降低约2 Gy(P=0.030)。全身V20、V30、V40分别降低2%、1.3%、0.6%(P < 0.01)。  结论  宫颈癌患者采用HT技术, 靶区均匀性指数及适形度指数均较FF-IMRT技术明显提高, 膀胱、直肠、小肠中高剂量区的体积进一步降低。HT技术在宫颈癌术后的临床应用中具有可行性, 可作为一种新的照射方式推广。
    Abstract:   Objective  To compare the radiation doses applied in helical tomotherapy (HT) and fixed-field intensity-modulated radiotherapy (FF-IMRT) for cervical cancer.  Methods  The computed tomography (CT) images of 10 patients with cervical cancer were transferred into the Eclipse planning system. HT and FF-IMRT plans were performed on a TomoTherapy treatment planning system(TPS) and an Eclipse TPS, respectively. Institutional dose-volume constraints used in cervical cancer were kept the same for both techniques. The targets and the organs-at-risk were evaluated.  Results  The coverage of HT planning group and FF-IMRT planning group met the clinical requirements of the prescribed dose. Compared with the FF-IMRT planning group, planning target volume(PTV)95% and PTV100% of HT planning group coverage increased, PTV105% became lower, Dmax and Dmean decreased, conformity index (CI) and homogeneity index (HI) improved(P=0.000). Compared with the FF-IMRT planning group, V40 and Dmax of the bladder reduced by about 7% and 1.7 Gy, respectively(P=0.000); V40 of the rectum reduced by about 8%(P=0.000), V30 and V40 of the small intestine reduced by 4%(P=0.002) and 3%(P=0.000), Dmax reduced by 2 Gy(P=0.000), V30 of the bone marrow increased by 5%(P=0.001), D5 of the femoral heads showed no difference; Dmax of the cauda equine reduced by 2 Gy(P=0.030); V20, V30, and V40 of the body reduced by 2%, 1.3%, 0.6%, respectively(P < 0.01).  Conclusions  HT has superior target HI and CI to the FF-IMRT in patients with cervical cancer, along with decreased high-dose regions in the bladder, rectum, and small intestine. Therefore, HT is feasible for the postoperative treatment of cervical cancer patients.
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  • 表  1  FF-IMRT计划和HT计划PTV的剂量分布(x±s)

    计划方式 PTV95%(%) PTV100%(%) PTV105%(%) PTV110%(%) Dmean(Gy) Dmax(Gy) HI CI
    FF-IMRT 99.461±0.213 95.000±0.000 47.118±7.949 0.346±0.242 52.708±0.173 55.462±0.345 1.127±0.025 0.889±0.010
    HT 99.654±0.260 95.658±0.308 0.047±0.129 0.000±0.000 51.383±0.148 53.032±0.493 1.029±0.003 0.951±0.010
    t值 2.330 -7.717 9.775 2.121 14.019 12.693 45.521 -10.156
    P值 0.045 0.000 0.000 0.063 0.000 0.000 0.000 0.000
    下载: 导出CSV

    表  2  FF-IMRT计划和HT计划膀胱、直肠、小肠、骨髓和全身的剂量分布(x±s)

    部位 计划方式 V5(%) V10(%) V20(%) V30(%) V40(%) V50(%) Dmean(Gy) Dmax(Gy)
    膀胱 FF-IMRT 100.000±0.000 100.000±0.000 100.000±0.000 98.732±1.604 50.005±3.988 24.637±4.503 41.947±0.734 54.494±0.467
    HT 100.000±0.000 100.000±0.000 100.000±0.000 99.854±0.347 42.977±0.824 25.936±3.462 40.417±2.148 52.776±0.365
    t值 -2.209 6.181 -2.288 2.198 8.743
    P值 0.055 0.000 0.048 0.055 0.000
    直肠 FF-IMRT 98.234±2.032 94.942±4.853 92.993±5.848 90.631±6.227 54.606±4.591 14.444±3.548 39.807±1.931 52.224±0.615
    HT 99.589±0.917 98.049±2.560 94.793±4.468 91.480±5.800 46.783±2.003 18.317±2.713 39.413±1.267 52.685±0.578
    t值 -3.262 -3.462 -2.936 -1.956 6.035 -5.933 1.226 -2.084
    P值 0.010 0.007 0.017 0.082 0.000 0.000 0.251 0.067
    小肠 FF-IMRT 74.992±4.298 66.857±4.871 56.908±6.283 39.645±8.591 19.181±6.800 7.826±3.421 23.343±2.937 54.532±0.488
    HT 79.184±4.695 73.807±4.709 57.376±7.333 36.056±10.951 16.296±7.201 6.506±3.236 23.472±3.363 52.655±0.533
    t值 -14.933 -25.820 -0.888 4.287 7.202 7.382 -0.657 9.575
    P值 0.000 0.000 0.398 0.002 0.000 0.000 0.527 0.000
    骨髓 FF-IMRT 99.736±0.344 97.383±1.643 90.640±2.762 64.226±3.683 33.413±2.187 10.813±2.064 34.346±0.826 54.508±0.431
    HT 100.000±0.000 99.509±0.578 89.546±3.223 69.090±4.459 32.833±3.907 9.583±2.173 35.045±1.097 52.128±0.123
    t值 -2.428 -5.714 3.564 -5.200 0.728 3.207 -3.660 19.038
    P值 0.038 0.000 0.006 0.001 0.485 0.011 0.005 0.000
    全身 FF-IMRT 55.302±8.945 48.119±7.611 34.523±5.053 19.532±2.997 10.119±1.514 6.179±0.928 15.191±2.174 55.462±0.345
    HT 59.095±9.392 53.696±8.354 32.527±4.335 18.272±2.508 9.560±1.318 5.924±0.850 15.310±2.037 53.032±0.493
    t值 -13.609 -17.544 4.721 4.919 5.579 7.551 -1.487 12.693
    P值 0.000 0.000 0.001 0.001 0.000 0.000 0.171 0.000
    下载: 导出CSV

    表  3  FF-IMRT计划和HT计划股骨头、马尾神经的剂量分布(x±s)

    计划方式 左股骨头D5
    (Gy)    		 右股骨头D5
    (Gy)    		 马尾神经Dmax
    (Gy)
    FF-IMRT 43.174±3.306 44.255±2.038 28.471±2.698
    HT 41.946±4.216 41.674±3.836 26.596±1.309
    t值 -0.734 1.723 -2.569
    P值 0.482 0.119 0.030
    下载: 导出CSV
    • 参考文献(10)
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    [5] Mell LK, Tiryaki H, Ahn KH, et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 71:1504-1510. doi:  10.1016/j.ijrobp.2008.04.046
    [6] Schubert LK, Gondi V, Sengbusch E, et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy[J].Radiother Oncol, 2011, 100:241-246. doi:  10.1016/j.radonc.2011.01.004
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  • 收稿日期:  2013-08-19
  • 刊出日期:  2013-10-30

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