螺旋断层调强放疗技术的临床应用

刘志凯; 杨波; 胡克; 侯晓荣; 邱杰; 张福泉

doi:10.3969/j.issn.1674-9081.2013.04.011

螺旋断层调强放疗技术的临床应用

Clinical Application of Helical Tomotherapy in Peking Union Medical College Hospital

摘要

摘要:
目的总结应用螺旋断层调强放疗技术治疗多种良恶性肿瘤的初步经验。
方法 2012年9月至2013年7月北京协和医院放射治疗科采用螺旋断层调强放疗方案治疗前列腺癌33例、多发脑转移癌23例、生殖细胞瘤15例、乳腺癌24例、胰腺癌19例及侵袭性垂体瘤19例, 总结螺旋断层调强放疗相较于传统加速器调强放疗的优势。
结果螺旋断层调强放疗对于多种肿瘤在靶区均匀性及适形度、剂量分级给予、危及器官受量、射野衔接方面较传统加速器调强放疗具有优势。靶区内无低于处方剂量95%及高于处方剂量105%的区域, 80%处方剂量等剂量曲线能够与靶区高度适形; 靶区内根据临床需要能够实现3~5个不同剂量级别同步给予; 危及器官受量较传统调强放疗下降10%~20%;无需射野衔接, 克服了传统放疗射野衔接时出现的冷区/热区问题。
结论螺旋断层调强放疗在治疗复杂靶区、超长靶区、瘤区同步加量及重要危及器官保护等方面具有比传统加速器明显的放射物理学优势, 并可能提高疗效、降低不良反应。螺旋断层调强放疗针对不同病种的临床优势尚需进一步研究。

Abstract:
Objective To summarize the experience of using helical tomotherapy (HT) in treating a variety of benign and malignant tumors.
Methods HT was applied in 33 prostate cancer patients, 23 multiple brain metastases patients, 15 germ cell tumor patients, 24 breast cancer patients, 19 pancreatic cancer patients, and 19 invasive pituitary adenoma patients from September 2012 to July 2013 in Peking Union Medical College Hospital. The results were compared with that of fixed-field intensity-modulated radiotherapy (FF-IMRT).
Results HT showed remarkable advantaged over the FF-IMRT in terms of the homogeneity and conformity of target, simultaneous integrated boost for different dose levels, protection of risk organs, and radiation field convergence. There was no region of dose below 95% or over 105% of prescription dose in the planning target volume. Isodose line of 80% prescription dose had good conformity. Three to five different dose levels could be achieved for simultaneous integrated boost. Doses of organs-at-risk decreased by 10%-20%. No field convergence was needed, and therefore hot or cold region was eliminated.
Conclusions HT is remarkably superior to FF-IMRT in the treatment of complex and long targets, simultaneous integrated boost of target, and protection of organs-at-risk. Its roles in treating different diseases need further study.

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