局部晚期鼻咽癌保护海马的IMRT计划对靶区及OAR剂量影响

doi:10.3760/cma.j.issn.1004-4221.2017.01.002

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摘要

目的研究局部晚期鼻咽癌保护海马的IMRT计划对靶区及OAR剂量的影响。方法对2015年间的11例局部晚期鼻咽癌患者做回顾性剂量分析研究。MONACO5.10TPS设计常规VMAT、保护海马VMAT和9个野IMRT计划。评价PTV及PTV_nx的D_98%、D_50%、D_2%、D_mean、CI、HI值及海马和OAR剂量。单因素方差分析,两两比较LSD法或配对t检验。结果常规VMAT、保护海马VMAT、9个野IMRT计划PTV_nx的D_2%分别为7542、7 513、7462 cGy (P=0.016);PTV的D_98%分别为5837、5812、5914 cGy (P=0.029),D_2%分别为7399、7380、7333 cGy (P=0.047),HI分别为0.239、0.241、0.220(P=0.016);脑干V₁₀分别为97.2%、88.1%、90.3%(P=0.001),V₂₀分别为74.2%、62.3%、67.1%(P=0.032),V₃₀分别为50.9%、35.8%、45.5%(P=0.020),V₄₀分别为24.4%、14.75424%、23.3%(P=0.018);海马D_mean分别为1518、899、896 cGy (P=0.000),D_40%分别为1379、642、639 cGy (P=0.000),V₁₀分别为54.1%、25.1%、3.8%(P=0.000),V₂₀分别为26.2%、12.6%、12.0%(P=0.001)。结论保护海马的VMAT和9个固定野IMRT比常规VMAT可降低海马剂量,并不影响靶区及OAR剂量分布。保护海马的VMAT计划可同时降低脑干剂量,优势更明显。

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	顾文栋
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关键词 ：鼻咽癌肿瘤/放射疗法, 保护海马, 放射疗法,容积弧形旋转调强, 放射疗法,调强

Abstract：

Objective To investigate the effects of hippocampal-sparing intensity-modulated radiotherapy (IMRT) on dose distribution of target volume and organs at risk (OARs) in locally advanced nasopharyngeal carcinoma. Methods A retrospective dosimetric analysis was performed among 11 patients with locally advanced nasopharyngeal carcinoma. The MONACOv5.10 Treatment Planning System was used to design three treatment plans:routine volumetric modulated arc therapy (VMAT),hippocampal-sparing VMAT,and nine fixed-fields IMRT.The D_98%,D_50%,D_2%,D_mean,conformity index (CI),and homogeneity index (HI) of planning target volume (PTV) and PTV_nx as well as dose distribution of the hippocampus and OARs were evaluated. Using single factor analysis of variance,two group comparative was LSD or paired t-test. Results For the above three plans,the D_2% values of PTV_nx were ,7513,and 7462 cGy,respectively (P=0.016);the D_98% values of PTV were 5837,5812,and 5914 cGy,respectively (P=0.029);the average D_2% values of PTV were 7399,7380,and 7333 cGy,respectively (P=0.047);the HI values of PTV were 0.239,0.241,and 0.220,respectively (P=0.016);the V₁₀ values of the brain stem were 97.2%,88.1%,and 90.3%,respectively (P=0.001);the V₂₀ values of the brain stem were 74.2%,62.3%,and 67.1%,respectively (P=0.032);the V₃₀ values of the brain stem were 50.9%,35.8%,and 45.5%,respectively (P=0.020);the V₄₀ values of brain stem were 24.4%,14.4%,and 23.3%,respectively (P=0.018);the D_mean values of hippocampus were 1518,899,and 896 cGy,respectively (P=0.000);the D_40% values of hippocampus were 1379,642,and 639 cGy,respectively (P=0.000);the V₁₀ values of the hippocampus were 54.1%,25.1%,and 3.8%,respectively (P=0.000);the V₂₀ values of the hippocampus were 26.2%,12.6%,and 12.0%,respectively (P=0.001). Conclusions Hippocampal-sparing VMAT and nine fixed-fields IMRT can significantly reduce the dose to the hippocampus without affecting dose distribution of target volume and OARs. VMAT may be superior to IMRT because VMAT can simultaneously reduce the dose to the brain stem.

Key words： Locally advanced nasopharyngeal carcinoma Hippocampus sparing VMAT IMRT

收稿日期: 2016-04-19

基金资助:

江苏省临床医学科技专项(BL2014040)

通讯作者: 裴红蕾,Email:jtw316@sina.com

引用本文:

顾文栋,李齐林,田野等. 局部晚期鼻咽癌保护海马的IMRT计划对靶区及OAR剂量影响[J]. 中华放射肿瘤学杂志, 2017, 26(1): 6-11.

Gu Wendong,Li Qilin,Tian Ye et al. Effects of hippocampal-sparing intensity-modulated radiotherapy on dose distribution of target volume and organs at risk in locally advanced nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 6-11.

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