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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
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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

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

    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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