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Dosimetric Comparison of Different Pattern of Intensity-modulated Radiotherapy for Pancreatic Carcinoma
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摘要:
目的 比较胰腺癌术后患者固定野调强放疗(fixed-field intensity-modulated radiotherapy, FF-IMRT)与容积调强放疗(volumetric modulated arc therapy, VMAT)的剂量学差异, 为临床选择合适的照射技术提供参考。 方法 2011年6月至12月在北京协和医院行放疗的10例胰腺癌术后患者, 分别根据其同一CT模拟定位图像设计FF-IMRT计划和VMAT计划, 处方剂量50 Gy/25次。分析剂量体积直方图曲线, 评估靶区、危及器官和正常组织的剂量分布, 并比较二者机器跳数(monitor units, MU)和治疗时间的差别。 结果 FF-IMRT计划和VMAT计划的靶区剂量分布差异无统计学意义(P > 0.05)。与FF-IMRT计划相比, VMAT计划中肝脏、胃、小肠、全身的V5明显升高(P均 < 0.05), 而肝脏的V10和V20, 胃的V10, 小肠的V10、V20、V50, 左肾的V20, 右肾的V20、V30、Dmean、Dmax, 以及全身的V10、V20有不同程度下降(P均 < 0.05), 脊髓的Dmax升高1.85 Gy(P=0.04)。FF-IMRT计划与VMAT计划的MU分别为619.60±117.18和492.70±51.56(t=3.18, P=0.01)。VMAT计划的MU较FF-IMRT计划减少了20.48%。 结论 胰腺癌患者选择VMAT计划, 可以在不降低计划水平上的剂量分布的前提下, 大大减少MU, 缩短治疗时间。 Abstract:Objective To analyze the dosimetric differences between fixed-field intensity-modulated radiotherapy (FF-IMRT) and volumetric modulated arc therapy (VMAT) in treating pancreatic carcinoma, aiming to facilitate the clinical decision upon appropriate radiation technique. Methods From June to December 2011, 10 postoperative patients of pancreatic carcinoma who received radiotherapy in Peking Union Medical College Hospital were selected for this comparison. FF-IMRT and VMAT plans were developed based on the same CT simulation image for each patient. The prescription dose was 50 Gy in 25 fractions. The doses distributions in planning target volume (PTV), organs at risk (OARs), and normal tissue were evaluated based on dose-volume histograms (DVH). The two plans were also compared in terms of monitor unit (MU) and length of treatment. Results The dose distributions in PTV showed no significant difference between FF-IMRT and VMAT plans(P > 0.05). Compared with FF-IMRT plan, VMAT plan significantly increased V5 of the liver, stomach, small intestine, and whole body(all P < 0.05), while reduced V10 and V20 of the liver, V10 of the stomach, V10, V20, and V50 of the small intestine, V20 of the left kidney, V20, V30, Dmean, Dmax of the right kidney, and V10, V20 of the whole body (all P < 0.05). The Dmax of the spinal cord decreased by 1.85 Gy in VMAT plan (P=0.04). MU of VMAT plan was significantly lower than that of FF-IMRT plan (492.70±51.56 vs. 619±117.18, t=3.18, P=0.01), with a 20.48% reduction from the MU level of the latter one. Conclusion For patients with pancreatic carcinoma, VMAT plan could reduce MU and shorten length of treatment while maintaining the dosimetric parameters at levels similar to or even better than those of FF-IMRT plan. -
表 1 FF-IMRT计划和VMAT计划危及器官的剂量体积限值
危及器官 剂量体积限值 肝脏 50%的体积接受的剂量小于30 Gy 胃 50%的体积接受的剂量小于20 Gy 小肠 50%的体积接受的剂量小于30 Gy，2 cm3的体积接受的剂量小于56 Gy 肾脏 30%的体积接受的剂量小于20 Gy 脊髓 0.1 cm3的体积接受的剂量小于45 Gy FF-IMRT：固定野调强放疗；VMAT：容积调强放疗 
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表 2 FF-IMRT计划和VMAT计划的靶区剂量分布(x±s，n=10)
计划方式 PTV95(%) PTV105(%) PTV110(%) Dmean(Gy) Dmax(Gy) HI CI 固定野调强 99.90±0.13 21.95±14.43 0.00±0.00 51.69±0.35 54.35±0.69 1.06±0.01 0.92±0.03 容积调强 99.94±0.06 27.79±20.40 0.00±0.00 52.26±1.14 53.01±0.65 1.06±0.01 0.93±0.01 t -1.20 -0.67 1.00 -1.41 2.27 0.35 -1.70 P 0.26 0.52 0.34 0.19 0.05 0.74 0.12 FF-IMRT、VMAT：同表 1；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
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表 3 FF-IMRT计划与VMAT计划肝脏、胃、小肠、左肾、右肾、全身的剂量分布(x ±s，n=10)
部位 计划方式 V5(%) V10(%) V20(%) V30(%) V40(%) V50(%) Dmean(Gy) Dmax(Gy) 肝脏 固定野调强 24.89±14.86 17.53±13.18 8.60±8.47 2.35±2.71 0.96±1.00 0.34±0.36 5.23±3.28 48.10±11.20 容积调强 26.75±16.62 16.11±13.69 7.43±8.53 2.43±2.94 0.92±1.13 0.38±0.50 5.30±3.42 48.36±11.20 t -0.27 3.14 3.41 -0.42 0.58 -0.89 -0.70 -0.32 P 0.03 0.01 0.01 0.69 0.57 0.40 0.50 0.76 胃 固定野调强 42.23±26.17 36.57±25.22 21.44±18.76 8.18±10.91 2.95±5.32 1.13±2.56 9.98±6.78 43.00±13.36 容积调强 44.94±25.82 35.01±24.83 17.97±13.82 7.71±9.32 3.38±5.58 1.14±2.60 9.85±6.16 42.68±13.46 t -4.03 2.27 1.61 0.52 -0.72 -0.22 0.47 0.71 P 0.03 0.05 1.14 0.62 0.50 0.83 0.65 0.50 小肠 固定野调强 67.65±9.80 61.72±9.07 41.71±12.91 13.48±5.78 4.03±2.07 1.10±0.79 16.14±3.24 52.59±2.12 容积调强 70.36±9.01 58.65±7.93 36.57±9.26 14.49±6.53 3.76±2.19 0.97±0.77 15.72±2.68 52.16±2.75 t -4.53 3.12 2.65 -0.88 1.16 3.88 1.38 1.65 P 0.00 0.01 0.03 0.40 0.28 0.00 0.20 0.13 左肾 固定野调强 79.02±22.15 43.47±18.89 15.41±12.05 3.96±5.74 0.33±0.75 1.01±3.10 11.12±4.19 36.28±9.81 容积调强 78.07±20.18 41.82±24.61 8.11±8.19 1.41±2.51 0.31±0.80 0.02±0.05 13.60±13.58 30.16±11.06 t 0.61 0.37 3.65 1.84 0.40 1.01 -0.67 1.71 P 0.56 0.72 0.01 0.10 0.70 0.34 0.52 0.12 右肾 固定野调强 86.36±18.26 45.41±16.48 14.63±10.97 2.19±2.15 0.03±0.05 0.00±0.00 11.40±3.38 34.10±8.10 容积调强 83.29±19.00 41.91±20.93 6.66±6.66 0.66±1.41 0.00±0.00 0.00±0.00 10.01±2.87 31.11±7.04 t 2.05 1.01 3.40 2.41 1.56 - 4.00 3.35 P 0.07 0.34 0.01 0.04 0.15 - 0.00 0.01 全身 固定野调强 29.62±9.22 22.37±7.37 12.14±5.29 5.46±2.34 3.26±1.35 2.11±0.91 6.66±2.24 54.35±0.69 容积调强 31.31±9.82 21.90±7.59 11.41±4.70 5.70±2.52 3.15±1.33 2.08±0.90 6.79±2.26 53.89±0.83 t -4.91 3.69 2.87 -1.92 2.03 1.79 -4.61 2.15 P 0.00 0.01 0.02 0.09 0.07 0.11 0.00 0.06
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