半野调强照射技术在食管癌放疗中的应用探讨

doi:10.3760/cma.j.cn113030-20210906-00352

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摘要目的探索基于半野剂量分布特性结合IMRT技术,实现食管癌放疗降低肺剂量的新技术。方法采用三维水箱测量对称野及半野的射野边缘剂量分布并比较分析。选取20例胸中下段食管癌放疗患者(处方剂量50.4~60.0Gy),基于瓦里安Vital beam加速器和Eclipse计划系统、采用均整器(FF)和非均整器(FFF)技术对称野、半野设计(射野设置皆为前1后4方式),比较和分析靶区和危及器官各种剂量数据以及机器跳数。结果与对称野计划相比,半野计划能显著改善肺受量(P<0.05),其中半野FFF又稍优于半野FF模式。全肺V5Gy、V20Gy、V30Gy、Dmean在FF对称野与FFF半野分别为(49.64±5.39)%与(42.70±5.5)%、(15.99±3.93)%与(13.32±3.06)%、(9.24±2.77)%与(8.50±2.62)%、(10.45±1.76)%与(9.50±1.53)%(均P<0.05)。心脏受量对称野优于半野(P<0.05),靶区CI和HI、机器跳数、脊髓均相近(均P>0.05)。结论基于半野形式IMRT可以显著改善肺受量,可给临床增加一个选择的方式。

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	刘杨
	丁丹红
	魏胜涛
	王颖颖
	李定杰

关键词 ：半野照射, 均整器, 非均整器, 食管肿瘤/调强放射疗法

Abstract：Objective To explore a new technique for lung dose reduction in esophageal cancer radiotherapy based on the dose distribution characteristics of the half-field combined with intensity-modulated radiotherapy (IMRT) technique. Methods A three-dimensional water tank was used to measure the dose distribution at the edge of the symmetrical field and half-field, which was then compared and analyzed. Twenty patients with the middle and lower thoracic esophageal cancer receiving radiotherapy with prescription doses of 50.4-60.0Gy were selected. Based on the Varian Vital beam linear accelerator and Eclipse planning system, flattening filter (FF) technique symmetrical field and half-field beam design and the flattening filter-free (FFF) technique symmetrical field and half-field design were adopted to compare and analyze various dose data and treatment MU numbers for the target area and the endangered organs. The field settings were chosen in the front 1 and back 4 mode. Results Compared with the symmetrical field plan, the half-field plan significantly improved the irradiated dose to the lung with a statistically significant difference (P<0.05), and the half-field FFF was slightly better than the half-field FF mode. Compared with the total lung V5Gy, V20Gy, V30Gy, and Dmean dosimetric parameters (Gy), the FF symmetric field and FFF half-field were (49.64±5.39)% vs.(42.70±5.53)%,(15.99±3.93)% vs.(13.32±3.06)%,(9.24±2.77)% vs.(8.50±2.62)%, and (10.45±1.76)% vs.(9.50±1.53)%, respectively. There was a significant reduction in the volume dose values for all structures of the lung (all P<0.05). For other comparative data, the irradiated dose for the heart of the symmetrical field was better than that of the half-field mode (P<0.05), and the differences in conformity index (CI) and homogeneity index (HI), number of treated MU, and spinal cord associated with the target area were not statistically significant (all P>0.05). Conclusions During radiotherapy for esophageal cancer, target area coverage and dose volume data of the lung are the main parameters affecting the efficacy and side effects. IMRT treatment based on the half-field mode can give full play to the advantages of half-field and IMRT, and significantly improve the irradiated dose to the lung, which can offer an additional clinical option.

Key words： Half-field irradiation Flattening filter Flattening filter free Esophageal neoplasm/intensity-modulated radiotherapy

收稿日期: 2021-09-06

基金资助:河南省科技厅重点科技攻关项目(212102310117);河南省卫健委省部共建项目(SB201901106);河南省卫健委联合共建项目(LHGJ20200158)

通讯作者: 李定杰,Email:150304089@qq.com

引用本文:

刘杨,丁丹红,魏胜涛等. 半野调强照射技术在食管癌放疗中的应用探讨[J]. 中华放射肿瘤学杂志, 2022, 31(1): 65-70.

Liu Yang,Ding Danhong,Wei Shengtao et al. Exploration of the application of half-field intensity-modulated irradiation technique in the radiotherapy for esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 65-70.

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