周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究

doi:10.3760/cma.j.issn.1004-4221.2017.03.015

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摘要目的回顾性设计周围型肺癌并纵隔淋巴结转移的分野锁定准直器调强计划,比较分野锁定准直器计划和准直器位置自动选择调强计划的剂量学特点,研究分野锁定准直器计划对正常肺组织保护。方法选取12例在本院行IMRT的周围型肺癌并纵隔淋巴结转移患者的治疗计划,计划全部为准直器位置自动选择调强计划,针对相同CT图像与靶区设计分野锁定准直器计划,同一角度射野分野后各准直器位置分别由各分离靶区形状决定。处方剂量60 Gy分30次,计划要求95%PTV达到100%处方剂量。通过DVH统计PTV相关剂量参数、CI、HI、机器跳数、肺组织及心脏剂量体积参数。对两种计划组间行配对样本t检验。结果两种计划均达到临床要求,两种计划靶区D₂、D₉₈、CI和HI均相近(P均>0.05)。分野锁定准直器计划机器跳数比准直器位置自动选择调强计划多15%~20%(P=0.010)。全肺V₅、V₁₀、V₂₀、V₃₀、D_mean均低于准直器位置自动选择调强计划(P=0.000、0.000、0.000、0.002、0.000);健侧肺V₅、V₂₀、D_mean同样低于准直器位置自动选择调强计划(P=0.000、0.017、0.000)。脊髓和心脏剂量体积参数两种计划剂量体积参数均相近(P均>0.05)。结论
对周围性肺癌并纵隔淋巴结转移的调强计划设计可考虑分野锁定准直器计划设计,可一定程度减小肺组织低剂量照射体积,降低放射性肺炎发生概率。

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	王昊
	陈华
	顾恒乐
	蔡旭伟
	郭金栋
	王常禄
	徐志勇

关键词 ：纵隔淋巴结转移, 周围型肺癌/放射疗法, 调强, 分野锁定准直器方法, 调强, 准直器位置自动选择方法, 剂量学

Abstract： Objective To retrospectively design an intensity-modulated radiotherapy (IMRT) plan with split field and fixed jaw techniques for peripheral lung cancer with mediastinal lymph node metastasis, to compare dosimetric characteristics between the IMRT plans with fixed jaw and dynamic jaw, and to study lung protection by the plan with split field and fixed jaw. Methods Treatment plans were collected from 12 patients with peripheral lung cancer and mediastinal lymph node metastasis who were treated with IMRT in our hospital. All plans used the dynamic jaw technique. The plans with split field and fixed jaw were designed based on the identical computed tomography images and planning target volume (PTV). Each jaw position in split field depended on each separate PTV. The prescription dose was 60 Gy in 30 fractions. 95% PTV was planned to receive 100% of the prescription dose. Dosimetric parameters of PTV, conformity index (CI), heterogeneity index (HI), number of monitor units (MUs), and dose-volume values of the lung and heart were obtained from dose-volume histogram. Comparison between the two plans was made by paired t test. Results Both plans met clinical requirements. There were no significant differences in D₂, D₉₈, CI, or HI of PTV between the two plans (all P>0.05). Compared with the dynamic jaw plan, the fixed jaw plan had MUs increased by 15%-20%(P=0.010). The V₅, V₁₀, V₂₀, V₃₀, and mean dose for the whole lungs were significantly lower in the fixed jaw plan than in the dynamic jaw plan (P=0.000,0.000,0.000,0.002,0.000). The V₅, V₂₀, and mean dose for the healthy lung were also significantly lower in the fixed jaw plan than in the dynamic jaw plan (P=0.000,0.017,0.000). There were no significant differences in dose-volume values for the spinal cord or heart between the two plans (all P>0.05). Conclusions IMRT with split field and fixed jaw is recommended for patients with peripheral lung cancer and mediastinal lymph node metastasis. The therapy to a certain extent reduces low-dose volume for the lung and the incidence of radiation-induced pneumonitis.

Key words： Lymph node metastasis of longitudinal hiccup,peripheral lung cancer/radiotherapy Intensity-modulated,fixed-jaw method in split fields Intensity-modulated,jaw position auto-chosen method Dosimetry

收稿日期: 2015-12-31

通讯作者: 徐志勇,Email:xzyong12@vip.sina.com

引用本文:

王昊,陈华,顾恒乐等. 周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究[J]. 中华放射肿瘤学杂志, 2017, 26(3): 320-323.

Wang Hao,Chen Hua,Gu Hengle et al. A study of lung protection in intensity-modulated radiotherapy with split field and fixed jaw techniques for peripheral lung cancer with mediastinal lymph node metastasis[J]. Chinese Journal of Radiation Oncology, 2017, 26(3): 320-323.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.03.015 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I3/320

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