食管癌VMAT与IMRT剂量比较的<em>Meta</em>分析

doi:10.3760/cma.j.issn.1004-4221.2017.09.015

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摘要

目的对食管癌VMAT与IMRT靶区和OAR剂量比较行Meta分析。方法文献检索纳入相关研究,分析靶区和OAR剂量参数、机器跳数及治疗时间。结果 17项研究的323病例纳入Meta分析。VMAT计划中GTV的D_mean、在总剂量≤50.4 Gy时PTV的D_mean和在总剂量>50.4 Gy时PTV的D_max优于IMRT (P=0.009、0.043、0.039)。心脏D_mean、V₃₀、V₄₀,脊髓D_max,肺V₅、V₁₀、D_mean差异均无统计学意义(P>0.05);VMAT计划中肺的V₁₅、V₂₀、V₃₀优于IMRT计划(P=0.001、0.000、0.023)。VMAT计划中单次照射1.8、2.0 Gy的机器跳数较IMRT计划分别减少275.4、134.2 MU (P=0.000、0.022);VMAT计划中单次照射1.8、2.0 Gy的TT比IMRT计划分别缩短323.5、193.7 s (P=0.000、0.009)。结论 VMAT计划能显著减少TT和机器跳数、提高设备使用率,降低肺受照剂量和RP发生风险。VMAT与IMRT相比在照射总剂量≤50.4 Gy时除PTV的D_mean和GTV的D_mean、D_max外,靶区其他剂量参数均无明显优势。对脊髓和心脏保护VMAT也无明显优势。

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	高瀚
	贾鹏飞
	陈炳森
	汤乐民

关键词 ：食管肿瘤/容积调强弧形疗法, 食管肿瘤/调强放射疗法, 荟萃分析

Abstract：

Objective To investigate the dosimetric comparison of target volumes and organs at risk (OAR) between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for esophageal cancer by a meta-analysis. Methods A literature search was performed to collect the clinical studies on dosimetric comparison between VMAT and IMRT. The primary endpoints of interest were dosimetric parameters of target volumes and OAR, number of monitor units (MUs), and treatment time (TT). Results A total of 17 studies involving 323 patients were included in this meta-analysis. When the total dose was>50.4 Gy, VMAT showed significantly lower mean dose (D_mean) of gross tumor volume (GTV) and maximum dose (D_max) of planning target volume (PTV) than IMRT (P=0.009;P=0.039). There were no significant differences in D_mean, V₃₀, and V₄₀ of the heart, D_max of the spinal cord, and V₅, V₁₀, and D_mean of the lung between VMAT and IMRT (P>0.05). VMAT showed significantly lower V₁₅, V₂₀, and V₃₀ of the lung than IMRT (P=0.001;P=0.000;P=0.023). When the single dose was 1.8 Gy and 2.0 Gy, VMAT showed significantly lower TT (reduced by 323.5 s and 193.7 s) and number of MUs (reduced by 275.4 MU and 134.2 MU) than IMRT (P=0.000 and 0.009;P=0.000 and 0.022). Conclusions VMAT can significantly reduce TT, MUs, irradiation dose to the lung, and the risk of radiation pneumonitis, and improve the utilization rate of equipment. Compared with IMRT, VMAT has no significant advantages in protection of the spinal cord and the heart and dosimetric parameters of target volumes except D_mean of PTV and D_mean and D_max of GTV when the total dose was ≤50.4 Gy.

Key words： Esophageal neoplasms/volumetric-modulated arc therapy Esophageal neoplasms/intensity-modulated radiotherapy Meta-analysis

收稿日期: 2016-07-18

通讯作者: 汤乐民,Email:lemint50@ntu.edu.cn

引用本文:

高瀚,贾鹏飞,陈炳森等. 食管癌VMAT与IMRT剂量比较的Meta分析[J]. 中华放射肿瘤学杂志, 2017, 26(9): 1055-1061.

Gao Han,Jia Pengfei,Chen Bingsen et al. Dosimetric comparison between volumetric-modulated arc therapy and intensity-modulated radiotherapy for esophageal cancer:a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1055-1061.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.09.015 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I9/1055

[1] Chen DF,Yang ZY,Yin WB.Radiotherapy of 180 cases of operable esophageal carcinoma[J].World J Gastroenterol,1997,3(2):123-126.DOI:10.3748/wjg.v3.I².123.
[2] Lin YS,Totsuka Y,He YT,et al. Epidemiology of esophageal cancer in Japan and China[J].J Epidemiol,2013,23(4):233-242.DOI:10.2188/jea. JE20120162.
[3] Fenkell L,Kaminsky I,Breen S,et al. Dosimetric comparison of IMRT vs.3D conformal radiotherapy in the treatment of cancer of the cervical esophagus[J].Radiother Oncol,2008,89(3):287-291.DOI:10.1016/j.radonc.2008.08.008.
[4] Hall EJ,Wuu CS.Radiation-induced second cancers:the impact of 3D-CRT and IMRT[J].Int J Radiat Oncol Biol Phys,2003,56(1):83-88.DOI:10.1016/S0360-3016(03)00073-7.
[5] Chandra A,Guerrero TM,Liu HH,et al. Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer[J].Radiother Oncol,2005,77(3):247-253.DOI:10.1016/j.radonc.2005.10.017.
[6] Fu WH,Wang LH,Zhou ZM,et al. Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma[J].World J Gastroenterol,2004,10(8):1098-1102.DOI:10.3748/wjg.v10.i8.1098.
[7] Welsh J,Palmer MB,Ajani JA,et al. Esophageal cancer dose escalation using a simultaneous integrated boost technique[J].Int J Radiat Oncol Biol Phys,2012,82(1):468-474.DOI:10.1016/j.ijrobp.2010.10.023.
[8] Bertelsen A,Hansen CR,Johansen J,et al. Single Arc Volumetric Modulated Arc Therapy of head and neck cancer[J].Radiother Oncol,2010,95(2):142-148.DOI:10.1016/j.radonc.2010.01.011.
[9] Verbakel WFAR,Cuijpers JP,Hoffmans D,et al. Volumetric intensity-modulated arc therapy vs.conventional IMRT in head-and-neck cancer:a comparative planning and dosimetric study[J].Int J Radiat Oncol Biol Phys,2009,74(1):252-259.DOI:10.1016/j.ijrobp.2008.12.033.
[10] Shaffer R,Morris WJ,Moiseenko V,et al. Volumetric modulated Arc therapy and conventional intensity-modulated radiotherapy for simultaneous maximal intraprostatic boost:a planning comparison study[J].Clin Oncol,2009,21(5):401-407.DOI:10.1016/j.clon.2009.01.014.
[11] Yin Y,Chen JH,Xing LG,et al. Applications of IMAT in cervical esophageal cancer radiotherapy:a comparison with fixed-field IMRT in dosimetry and implementation[J].J Appl Clin Med Phys,2011,12(2):48-57.DOI:10.1120/jacmp.v12I².3343.
[12] Lin JC,Tsai JT,Chang CC,et al. Comparing treatment plan in all locations of esophageal cancer:volumetric modulated arc therapy versus intensity-modulated radiotherapy[J].Medicine,2015,94(17):e750.DOI:10.1097/MD.0000000000000750.
[13] Abbas AS,Moseley D,Kassam Z,et al. Volumetric-modulated arc therapy for the treatment of a large planning target volume in thoracic esophageal cancer[J].J Appl Clin Med Phys,2013,14(3):192-202.DOI:10.1120/jacmp.v14i3.4269.
[14] Van Benthuysen L,Hales L,Podgorsak MB.Volumetric modulated arc therapy vs. IMRT for the treatment of distal esophageal cancer[J].Med Dosim,2011,36(4):404-409.DOI:10.1016/j.meddos.2010.09.009.
[15] Zhao YQ,Chen L,Zhang S,et al. Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.DOI:10.1111/1759-7714.12142.
[16] Ma P,Wang XZ,Xu YJ,et al. Applying the technique of volume-modulated arc radiotherapy to upper esophageal carcinoma[J].J Appl Clin Med Phys,2014,15(3):221-228.DOI:10.1120/jacmp.v15i3.4732.
[17] Kataria T,Govardhan HB,Gupta D,et al. Dosimetric comparison between Volumetric Modulated Arc Therapy (VMAT) vs. Intensity Modulated Radiation Therapy (IMRT) for radiotherapy of mid esophageal carcinoma[J].J Cancer Res Ther,2014,10(4):871-877.DOI:10.4103/0973-1482.138217.
[18] Wu ZQ,Xie CY,Hu ML,et al. Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer:is the conformal radiotherapy still an alternative option?[J].J Appl Clin Med Phys,2014,15(3):93-101.DOI:10.1120/jacmp.v15i3.4641.
[19] Lin CY,Huang WY,Jen YM,et al. Dosimetric and efficiency comparison of high-dose radiotherapy for esophageal cancer:volumetric modulated arc therapy versus fixed-field intensity-modulated radiotherapy[J].Dis Esophagus,2014,27(6):585-590.DOI:10.1111/dote.12144.
[20] 张耀文,郑安平,董尚文,等.胸上段食管癌容积旋转调强与静态调强放疗计划的剂量学比较[J].中华肿瘤防治杂志,2014,21(23):1902-1906,1910.
Zhang YW,Zheng AP,Dong SW,et al. Dosimetric comparison between volumetric moduled arc therapy and step-and-shoot IMRT for upper-thoracic esophageal cancer[J].Chin J Cancer Prev Treat,2014,21(23):1902-1906,1910.
[21] 孙晓东,刘粉霞,翟倩倩,等.食管癌VMAT和IMRT计划的剂量对比分析[J].中国实用医刊,2014,41(18):63-65.DOI:10.3760/cma.j.issn.1674-4756.2014.18.025.
Sun XD,Liu FX,Zhai QQ,et al. Dose comparison of esophageal carcinoma VMAT and IMRT analysis of the plan[J].Chin J Pract Med,2014,41(18):63-65.DOI:10.3760/cma.j.issn.1674-4756.2014.18.025.
[22] 何志杰,王晓敏,赵一电,等.食管癌静态调强放疗与容积调强弧形放疗计划的剂量学比较[J].中国癌症防治杂志,2014,6(3):275-279.DOI:10.3969/j.issn.1674-5671.2014.03.12.
He ZJ,Wang XM,Zhao YD,et al. Comparison of dosimetry achieved using volumetric modulated arc therapy or static intensity-modulated radiotherapy to treat esophageal neoplasm[J].Chin J Oncol Prev Treat,2014,6(3):275-279.DOI:10.3969/j.issn.1674-5671.2014.03.12.
[23] 胡彩容,阴晓娟,张秀春,等.不同调强方式在胸中上段食管癌放疗中的剂量学研究[J].中华放射医学与防护杂志,2014,34(3):220-224.DOI:10.3760/cma.j.issn.0254-5098.2014.03.016.
Hu CR,Yin XJ,Zhang XC,et al. Dosimetric study of different intensity-modulated modalities in the radiotherapy for mid and upper thoracic esophageal carcinoma[J].Chin J Radiol Med Prot,2014,34(3):220-224.DOI:10.3760/cma.j.issn.0254-5098.2014.03.016.
[24] 刘丽虹,王澜,韩春,等.食管癌VMAT与IMRT的剂量学比较[J].中华放射肿瘤学杂志,2015,24(3):318-322.DOI:10.3760/cma.j.issn.1004-4221.2015.03.022.
Liu LH,Wang L,Han C,et al. The application of volumetric modulated arc therapy in esophageal carcinoma[J].Chin J Radiat Oncol,2015,24(3):318-322.DOI:10.3760/cma.j.issn.1004-4221.2015.03.022.
[25] 张瑞,习勉,李巧巧,等.胸上段食管癌容积旋转调强和静态调强与三维适形放疗计划的剂量学比较[J].中山大学学报(医学科学版),2012,33(2):260-264.
Zhang R,Xi M,Li QQ,et al. Volumetric modulated arc therapy,conventional intensity-modulated radiotherapy and three-dimensional conformal techniques for upper thoracic esophageal cancer:a planning comparison study[J].J Sun Yat-Sen Univ (Med Sci),2012,33(2):260-264.
[26] Zhang WZ,Zhai TT,Lu JY,et al. Volumetric modulated arc therapy vs.c-IMRT for the treatment of upper thoracic esophageal cancer[J/OL].PLoS One,2015,10(3):e0121385.DOI:10.1371/journal.pone.0121385.
[27] 陈婷婷,张西志,花威,等.容积旋转调强与固定野动态调强在上段食管癌治疗中的剂量学比较[J].临床肿瘤学杂志,2013,18(2):151-154.DOI:10.3969/j.issn.1009-0460.2013.02.014.
Chen TT,Zhang XZ,Hua W,et al. Dosimetric comparison between Rapid Arc and fixed gantry dynamic IMRT for upper esophageal cancer[J].Chin Clin Oncol,2013,18(2):151-154.DOI:10.3969/j.issn.1009-0460.2013.02.014.
[28] Gao M,Li QL,Ning ZH,et al. Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma[J].Med Dosim,2016,41(2):131-135.DOI:10.1016/j.meddos.2015.10.007.
[29] Holt A,van Vliet-Vroegindeweij C,Mans A,et al. Volumetric-modulated arc therapy for stereotactic body radiotherapy of lung tumors:a comparison with intensity-modulated radiotherapy techniques[J].Int J Radiat Oncol Biol Phys,2011,81(5):1560-1567.DOI:10.1016/j.ijrobp.2010.09.014.
[30] Hope AJ,Lindsay PE,El Naqa I,et al. Modeling radiation pneumonitis risk with clinical,dosimetric,and spatial parameters[J].Int J Radiat Oncol Biol Phys,2006,65(1):112-124.DOI:10.1016/j.ijrobp.2005.11.046.
[31] 陈亚正,黎杰,廖雄飞,等.VMAT和IMRT技术在乳腺癌根治术后放疗中的剂量学比较[J].肿瘤预防与治疗,2014,27(5):226-230.DOI:10.3969/j.issn.1674-0904.2014.05.003.
Chen YZ,Li J,Liao XF,et al. Dosimetric comparison between VMAT and IMRT for postoperative radiotherapy of breast carcinoma[J].J Cancer Control Treat,2014,27(5):226-230.DOI:10.3969/j.issn.1674-0904.2014.05.003.
[32] Otto K.Volumetric modulated arc therapy:IMRT in a single gantry arc[J].Med Phys,2008,35(1):310-317.DOI:10.1118/1.2818738.
[33] Jin XC,Yi JL,Zhou YQ,et al. Comparison of whole-field simultaneous integrated boost VMAT and IMRT in the treatment of nasopharyngeal cancer[J].Med Dosim,2013,38(4):418-423.DOI:10.1016/j.meddos.2013.05.004.
[34] Graham MV,Purdy JA,Emami B,et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)[J].Int J Radiat Oncol Biol Phys,1999,45(2):323-329.DOI:10.1016/S0360-3016(99)00183-2.
[35] Wang SL,Liao ZX,Wei X,et al. Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT)[J].Int J Radiat Oncol Biol Phys,2006,66(5):1399-1407.DOI:10.1016/j.ijrobp.2006.07.1337.