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非小细胞肺癌 3~5个脑转移瘤优选调强放疗的可行性研究
胡银祥, 卢冰, 韩蕾, 甘家应, 欧阳伟炜, 苏胜发, 洪卫, 付和谊
550004 贵阳医学院附属医院肿瘤科贵州省肿瘤医院肿瘤科
The feasibility of choosing intensity-modulated radiotherapy to treat 3－5 brain metastases from non-small cell lung cancer
HU Yin-xiang, LU Bing, HAN Lei, GAN Jia-ying, OUYANG-Wei-wei, SU Sheng-fa, HONG Wei, FU He-yi
Department of Oncology, Guizhou Province Cancer Hospital;Department of Thoracic Oncology, Affiliated Hospital of Guiyang Medical College;Guiyang 550004,China
Corresponding author:LU Bing, Email:lbgymaaaa@sohu.com
Objective This study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1－5 brain metastases from non-small cell lung cancer (NSCLC). Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively. Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT+3DCRT) and WBRT plus stereotactic radiotherapy (WBRT+SRT) plans were generated. Planning target volume (PTV) and organs at risk dose were measured and compared by dose volume histogram. Differences were analyzed in the three techniques by Wilcoxon Z -test. Results D99% of the shoulder (D99%-D90%) from IMRT were higher than from WBRT+3DCRT and WBRT+SRT in all cases. From D15% of slope (D90%-D10%) to D5% of tail (D10%-D1%), IMRT were lower than WBRT+3DCRT and WBRT+SRT (Z=－4.72,P=0.000 and Z=－4.72,P=0.000). D10% and D5% of IMRT were (35.1±1.42) Gy and (37.7±2.91) Gy, WBRT+3DCRT were (36.5±2.86) Gy and (39.1±3.56) Gy;WBRT+SRT were (36.2±2.57) Gy and (38.7±3.67) Gy. IMRT vs WBRT+3DCRT and WBRT+SRT were significant (Z=－3.18,－3.18,P=0.001,0.001 and Z=－4.11,－3.02,P=0.000,0.002) in 13 patients with 3－5 brain metastases. The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT, WBRT+3DCRT and WBRT+SRT plans, respectively, with a 38.7% reduction from IMRT to WBRT+SRT (Z=－4.78,－4.78,P=0.000,0.000). The brain doses around metastases were similar in the three techniques with 1－2 metastases, but IMRT was the best with 3－5 metastases. Conclusions IMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases. Only IMRT is the best choice for just sparing the dose around brain metastases among 3－5 brain metastases.
HU Yin-xiang,LU Bing,HAN Lei et al. The feasibility of choosing intensity-modulated radiotherapy to treat 3－5 brain metastases from non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2012, 21(4): 369-373.
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