| 谢自宏,王鹏.胸中段食管癌调强放疗计划设计剂量对比研究[J].安徽医药,2022,26(8):1593-1597. |
| 胸中段食管癌调强放疗计划设计剂量对比研究 |
| A comparative study of planned doses of intensity-modulated radiotherapy for esophageal cancer in the middle thoracic segment |
| |
| DOI：10.3969/j.issn.1009-6469.2022.08.025 |
| 中文关键词: 食管肿瘤 调强放射治疗(IMRT) 剂量体积直方图(DVH) |
| 英文关键词: Esophageal neoplasms IMRT DVH |
| 基金项目: |
|
| 摘要点击次数: 707 |
| 全文下载次数: 318 |
| 中文摘要: |
| 目的探索中段食管癌采取不同入射角度，不同照射野数对计划靶区和临近相关胸部危及器官剂量分布差异，探索胸中段食管癌常规调强照射野设计，试图预测和减少放射性肺炎。方法选择2017年5月至2020年6月皖南医学院第二附属医院由于医学原因不能手术或者拒绝手术治疗的食管癌病人30例，所有病人均设计3种放疗计划，包括:均分5野，优化5野和均分7野3种调强放射治疗(IMRT)计划。上述放疗计划采用同样的优化参数，包括同样计划靶区和临近相关胸部危及器官(心脏，双肺，脊髓)的剂量约束，通过剂量体积直方图(DVH)加以对比。结果30例中段食管鳞状细胞癌病人的上述调强放疗计划均能达到所预设的靶区剂量学和临近危及器官的剂量约束，而且，与5野调强放疗计划相比，等分7野调强计划的靶区适形指数和均匀指数均显示出一定的优势，三者的CI值分别为(0.86±0.05)、(0.82±0.05)和(0.88±0.03)(P<0.001)；HI值分别为(0.109 5±0.04)、(0.100 9±0.04)和(0.923 6±0.02)(P<0.001)；对于危及器官肺而言，等分7野的全肺V20值(22.9±4.3)%和(8.1±1.2)%较低，有降低的趋势；而优化5野调强计划的全肺V5值(47.1±9.8)%和V10值(34.5±5.1)%要显著低于等分7野调强放疗计划，分别为(56.1±10.2)%和(40.9±6.2)%(P<0.05)；优化5野调强计划靶区脊髓最大剂量和心脏V30照射剂量明显高于等分7野调强计划靶区，差异有统计学意义(P<0.05)；其他组间脊髓最大剂量和心脏V30照射剂量均差异无统计学意义(P>0.05)，所有指标均在正常范围内。结论增加照射野数(7野)调强计划可以提高靶区适形度和提高均匀性，降低V20和V30值的趋势；而缩小入射野与体中线入射角度(优化5野)可以减小双肺的低剂量照射体积(V5，V10)；而减少照射野与中线角度心脏和脊髓受量稍增加，均在临床可接受的范围内。 |
| 英文摘要: |
| Objective To explore the difference in dose distribution of mid-thoracic esophageal cancer with different incident an?gles and different number of irradiation fields to the planned target area and adjacent chest organs at risk, and to explore the design of conventional intensity-modulated irradiation fields for mid-thoracic esophageal cancer and to try to predict and reduce radiation pneu?monia.Methods Thirty patients with esophageal cancer who could not be operated or refused to be operated due to medical reasons in the Second Affiliated Hospital of Wannan Medical College from May 2017 to June 2020 were selected. Three kinds of radiotherapy plans were designed for all 30 patients, including three kinds of intensity-modulated radiotherapy plans: average 5 fields, optimized 5 fields and average 7 fields. The same optimization parameters were used for the above radiotherapy plans, including dose constraints of the same plan target area and adjacent related chest organs (heart, lungs, spinal cord), and the dose volume histogram (DVH) was used for comparison.Results Compared with the 5-field IMRT plan, the 7-field IMRT plan showed advantages in target area conformal in?dex and uniformity index, with CI values of (0.86 ± 0.05), (0.82 ± 0.05) and (0.88 ± 0.03), respectively (P<0.001); The hi values were (0.109 5 ± 0.04), (0.100 9 ± 0.04) and (0.923 6 ± 0.02), respectively (P<0.001); for the lung, the V20 values of the whole lung divided into seven equal fields were (22.9 ± 4.3)% and (8.1 ± 1.2)%, with a decreasing trend; while the V5 values (47.1 ± 9.8)% and V10 val?ues (34.5 ± 5.1)% of the whole lung optimized by the five field IMRT plan were significantly lower than those of the seven equal field IMRT plan, which were (56.1 ± 10.2)% and (40.9 ± 6.2)% (P<0.05); the maximum dose of spinal cord and V30 radiation dose of heart in the optimized 5-field intensity-modulated plan target area were significantly higher than those in the equally divided 7-field intensity-modulated plan target area, the difference was statistically significant (P<0.05); there was no significant difference in the maximum dose of spinal cord and V30 radiation dose of heart between other groups (P>0.05), and all indexes were in the normal range.Conclu?sion Increasing the number of irradiation fields (7 fields) can improve the conformal degree and uniformity of the target area, and re?duce the trend of V20 and V30 values; reducing the incidence angle between the incidence field and the midline of the body (optimized 5 fields) can reduce the volume of low-dose irradiation of both lungs (V5, V10); reducing the angle between the incidence field and the midline of the body can slightly increase the dose of the heart and spinal cord, which are within the clinical acceptable range. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
