晚期肺癌非共面和共面IMRT剂量学比较研究

doi:10.3760/cma.j.issn.1004-4221.2015.01.020

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摘要目的比较研究晚期肺癌非共面IMRT计划剂量学分布特点,并观察计划执行安全性。方法对14例晚期肺癌患者优化设计共面和非共面5、7个野IMRT计划,对比共面、非共面各组内及组间计划优化结果。观察4例患者非共面7个野计划的执行过程。结果随射野数目增加共面及非共面靶区CI均改善(P值均为0.000),非共面野靶区D_mean、D_max、V_95%、HI亦有改善(P=0.001、0.001、0.009、0.000);共面野全肺、患、健肺V₅增加(P=0.000、0.002、0.000)及全肺D_mean增加(P=0.000),相反非共面野全肺、健肺V₅降低(P=0.001、0.005)。组间非共面7个野较共面5个野计划靶区各指标均改善(P值均为0.000);各肺V₂₀均降低(P值均为0.000)且全肺D_mean、V₃₀及健肺V₅降低(P=0.000、0.001、0.000),脊髓D_max亦有减少(P=0.033);但患肺V₅及心脏D_mean增加(P=0.000、0.003)。较共面7个野计划患肺V₅及心脏D_mean亦增加(P=0.000、0.048),但全肺及健肺V₅均降低(所有P=0.000)。4例患者均顺利完成非共面IMRT,全程未发生碰撞风险。结论非共面7个野IMRT计划改善了靶区剂量分布,降低肺V₂₀、D_mean也控制了低剂量肺体积增加趋势且临床实施安全有效,值得推荐。

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	胡睿
	吴锦昌
	周俊东
	沈丹青
	吴朝霞
	王石

关键词 ：肺肿瘤/调强放射疗法, 非共面, 剂量学

Abstract：Objective To study the dosimetry and safety of the non-coplanar IMRT plan for advanced lung cancer. Methods The two groups IMRT plans were designed with coplanar (5,7F) and non-coplanar field (5,7F-n) for patients. To compare the dosimetry of two groups and perform 4 patients F7-n IMRT plan. Results With the increase of the fields in each group PTV′s CI were improved (all P=0.000), especially the 7F-n plan PTV′s D_mean, D_max, V_95% and HI also were improved (P=0.001,0.001,0.009,0.000);in the coplanar group each lung′s V₅ increased (P=0.000, 0.002, 0.000) and whole lung′s D_mean increased (P=0.000), but non-coplanar group whole lung′s and contralateral lung′s V₅ reduce (P=0.001, 0.005). Between the groups, 7F-n plan PTV′s indicators were all improved to compared with 5F plan (all P=0.000),and each lung′s V₂₀ reduced (all P=0.000), and whole lung′s D_mean,V₃₀, contralateral lung′s V₅ reduced (P=0.000,0.001,0.000), and spinal cord′s D_max also reduced (P=0.033), but ipsilateral lung′s V₅ and heart′s D_mean increased (P=0.000,0.003);with compared to 7F plan, the 7F-n′s ipsilateral lung′s V₅ and heart′s D_mean also increased (P=0.000,0.048), but whole lung′s and contralateral lung′s V₅ decreased (all P=0.000). Four patients were performed successfully non-coplanar IMRT treatment, no collision occurred. Conclusions 7 fields non-coplanar IMRT plan not only improve the dose distribution of PTV, but also effectively control the volume of low dose lung increase, lung V₂₀ and D_mean reduce too. Thus recommended to use this design in patients with advanced lung cancer for radiotherapy

Key words： Lung neoplasm/intensity-modulated radiotherapy Non-coplanar Dosimetry

收稿日期: 2013-10-14

通讯作者: 王石,Email: wangshi@tsinghua.edu.cn

引用本文:

胡睿,吴锦昌,周俊东等. 晚期肺癌非共面和共面IMRT剂量学比较研究[J]. 中华放射肿瘤学杂志, 2015, 24(1): 74-77.

Hu Rui,Wu Jinchang,Zhou Jundong et al. Comparative study of coplanar and non-coplanar intensity-modulated radiotherapy in advanced lung cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(1): 74-77.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2015.01.020 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2015/V24/I1/74

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