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直肠癌术前容积调强与固定野调强技术的剂量学比较

杨波 庞廷田 孙显松 胡克 邱杰 张福泉

杨波, 庞廷田, 孙显松, 胡克, 邱杰, 张福泉. 直肠癌术前容积调强与固定野调强技术的剂量学比较[J]. 协和医学杂志, 2014, 5(2): 179-183. doi: 10.3969/j.issn.1674-9081.2014.02.011
引用本文: 杨波, 庞廷田, 孙显松, 胡克, 邱杰, 张福泉. 直肠癌术前容积调强与固定野调强技术的剂量学比较[J]. 协和医学杂志, 2014, 5(2): 179-183. doi: 10.3969/j.issn.1674-9081.2014.02.011
Bo YANG, Ting-tian PANG, Xian-song SUN, Ke HU, Jie QIU, Fu-quan ZHANG. Dosimetric Comparison between Preoperative Volumetric Modulated Arc Therapy and Fixed-field Intensity-modulated Radiotherapy for Rectal Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(2): 179-183. doi: 10.3969/j.issn.1674-9081.2014.02.011
Citation: Bo YANG, Ting-tian PANG, Xian-song SUN, Ke HU, Jie QIU, Fu-quan ZHANG. Dosimetric Comparison between Preoperative Volumetric Modulated Arc Therapy and Fixed-field Intensity-modulated Radiotherapy for Rectal Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(2): 179-183. doi: 10.3969/j.issn.1674-9081.2014.02.011

直肠癌术前容积调强与固定野调强技术的剂量学比较

doi: 10.3969/j.issn.1674-9081.2014.02.011
详细信息
    通讯作者:

    邱杰 电话:010-69155481, E-mail:qj_ww@139.com

  • 中图分类号: R735.3

Dosimetric Comparison between Preoperative Volumetric Modulated Arc Therapy and Fixed-field Intensity-modulated Radiotherapy for Rectal Cancer

More Information
    Corresponding author: QIU Jie Tel: 010-69155481, E-mail:qj_ww@139.com
  • 摘要:   目的  比较对直肠癌术前患者应用固定野调强(fixed-field intensity-modulated radiotherapy, FF-IMRT)和容积调强(volumetric modulated arc therapy, VMAT)两种计划方式进行术前放射治疗的剂量学差异。  方法  选择15例直肠癌术前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FF-IMRT计划和VMAT计划。评估靶区及危及器官的剂量分布。  结果  VMAT计划组和FF-IMRT计划组靶区覆盖度均能满足处方剂量要求。与FF-IMRT计划组相比, VMAT计划组计划靶区(planning target volume, PTV)105%覆盖度、Dmean及Dmax均增加(P=0.011, P=0.017, P=0.006), 适形度指数减低(P=0.008), 而均匀性指数差异无统计学意义(P=0.193)。与FF-IMRT计划组相比, VMAT计划组膀胱V50增加约15%(P=0.009), Dmax平均值增加0.7 Gy(P=0.003);小肠V30降低10%(P=0.004), Dmax平均值增加0.9 Gy(P=0.000);骨髓V10、V30、V40分别降低2%、10%、10%(P=0.000, P=0.000, P=0.000), Dmean平均值降低1.7 Gy(P=0.000);左右股骨头D5分别降低3.2 Gy、2.4 Gy(P=0.000, P=0.000);全身V10、V20、V30、V40也明显降低(P=0.003, P=0.000, P=0.000, P=0.004)。VMAT计划组较FF-IMRT计划组机器跳数(monitor units, MU)平均值减少50%(P=0.000)。  结论  直肠癌术前患者采用VMAT技术, 可以获得等同于或优于FF-IMRT计划的剂量分布, 患者治疗时间明显缩短, MU明显降低。
  • 表  1  FF-IMRT计划和VMAT计划PTV的剂量分布($\overline x \pm s $)

    计划方式 PTV95%(%) PTV105%(%) Dmean(Gy) Dmax(Gy) HI CI
    FF-IMRT 99.87±0.10 18.25±6.07 51.62±0.18 54.45±0.46 1.06±0.02 0.93±0.01
    VMAT 99.83±0.13 34.34±20.88 52.07±0.61 55.03±0.64 1.06±0.01 0.90±0.03
    t -0.845 2.926 2.741 3.235 1.367 -3.065
    P 0.412 0.011 0.017 0.006 0.193 0.008
    FF-IMRT:固定野调强放疗;VMAT:容积调强放疗;PTV:计划靶区;Dmean:平均剂量;Dmax:最大剂量;HI:均匀性指数;CI:适形度指数
    下载: 导出CSV

    表  2  FF-IMRT计划和VMAT计划膀胱、小肠、骨髓、全身的剂量分布($ \overline x \pm s $)

    部位 计划方式 V5(%) V10(%) V20(%) V30(%) V40(%) V50(%) Dmean(Gy) Dmax(Gy)
    膀胱 FF-IMRT 100.00±0 100.00±0 76.92±9.57 41.69±12.99 26.13±12.20 7.80±6.32 30.10±3.64 51.78±2.19
    VMAT 100.00±0 99.99±0 74.65±7.43 38.95±12.03 25.38±12.46 8.94±6.76 29.86±3.35 52.49±2.17
    t -1.000 -1.577 -1.637 -1.445 3.054 -1.094 3.596
    P 0.334 0.137 0.116 0.171 0.009 0.292 0.003
    小肠 FF-IMRT 69.93±10.66 61.39±11.32 39.23±15.66 21.27±12.11 12.11±7.74 4.81±3.91 18.52±5.37 53.08±0.67
    VMAT 70.53±10.15 61.77±10.08 36.01±14.39 19.10±10.08 12.04±6.60 5.44±3.84 17.92±4.21 53.94±0.51
    t 1.094 0.561 -1.463 -3.437 -0.129 2.293 -1.372 5.142
    P 0.292 0.583 0.165 0.004 0.900 0.038 0.192 0.000
    骨髓 FF-IMRT 90.0 ±18.53 89.54±5.70 76.24±15.05 61.23±5.87 31.32±5.68 7.10±3.22 31.91±1.99 53.95±0.76
    VMAT 95.70±3.95 88.13±5.79 72.80±5.95 55.26±4.98 28.26±6.04 8.17±4.12 30.21±2.01 54.42±0.64
    t 1.351 -7.551 -0.894 -7.584 -7.739 3.331 -12.087 2.499
    P 0.198 0.000 0.387 0.000 0.000 0.005 0.000 0.026
    全身 FF-IMRT 54.05±7.63 45.08±7.68 33.25±6.31 17.95±4.09 10.31±2.55 6.52±1.58 14.64±2.87 54.45±0.46
    VMAT 55.53±7.89 44.62±7.53 29.31±5.75 16.62±3.47 10.04±2.35 6.68±1.60 13.26±4.14 55.03±0.64
    t 10.830 -3.604 -14.355 -6.233 -3.489 2.738 -1.977 10.830
    P 0.000 0.003 0.000 0.000 0.004 0.016 0.068 0.000
    FF-IMRT、VMAT、Dmean、Dmax:同表 1
    下载: 导出CSV
  • [1] 胡克, 庞廷田, 杨波, 等.直肠癌术前放疗中三维适形放疗与调强适形放疗的剂量学比较分析[J].中华放射医学与防护杂志, 2010, 30:310-313. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfsyxyfhzz98201003020
    [2] Bakiu E, Telhaj E, Kozma E, et al. Comparison of 3D CRT and IMRT treatment plans[J]. Acta Inform Med, 2013, 21:211-212. doi:  10.5455/aim.2013.21.211-212
    [3] Studenski MT, Bar-Ad V, Siglin J, et al. Clinical experience treansitioning from IMRT to VMAT for head and neck cancer[J]. Med Dosim, 2013, 38:171-175. doi:  10.1016/j.meddos.2012.10.009
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    [5] Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy:a review of current literature and clinical use in practice[J]. Br J Radiol, 2011, 84:967-996. doi:  10.1259/bjr/22373346
    [6] Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers[J]. Int J Radiat Oncol Biol Phys, 2006, 65:1-7. doi:  10.1016/j.ijrobp.2006.01.027
    [7] Yoo S, Wu QJ, Lee WR, et al. Radiotherapy treatment plans with RapidArc for prostate cancer involving seminal vesicles and lymph nodes[J]. Int J Radiat Oncol Biol Phys, 2010, 76:935-942. doi:  10.1016/j.ijrobp.2009.07.1677
    [8] Vanetti E, Clivio A, Nicolini G, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx hypo-pharynx and larynx:a treatment planning comparison with fixed field IMRT[J]. Radiother Oncol, 2009, 92:111-117. doi:  10.1016/j.radonc.2008.12.008
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    [10] Moiseenko V, Duzenli C, Durand RE. In vitro study of cell survival following dynamic MLC intensity-modulated radiation therapy dose delivery[J]. Med Phys, 2007, 34:1514-1520. doi:  10.1118/1.2712044
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出版历程
  • 收稿日期:  2013-08-15
  • 刊出日期:  2014-04-30

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