胸中段食管癌容积调强放疗计划的验证方法
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摘要
目的:探讨胸中段食管癌在容积调强放疗(VMAT)中剂量与位置验证的方法。方法:随机挑选10例胸中段食管癌病例在Varian Eclipse 10.0计划系统(TPS)中制定VMAT计划,使用IBA Compass 3.0剂量验证系统进行剂量测量,然后与TPS计划数据进行比较,分析靶区(PTV、CTV与GTV)与危及器官受照剂量和体积参数的差异,并得到其γ通过率。应用锥形束CT(CBCT)验证放疗前摆位误差,1次/周,共6周。结果:γ分析在3 mm/3%标准下,靶区与危及器官通过率在95%以上。靶区D_(95%)与D_(mean)的测量数据和TPS计算数据相差小于2%。危及器官中,双肺的V_(20)与V_(30)相比较于测量数据,TPS计算数据偏低,差异在1.65%以内。脊髓D_(max)差异为2.23%,心脏V_(30)、V_(40)差异小于2%。CBCT位置验证中,前后与左右方向误差大于3 mm例数要多于头脚方向。结论:通过Compass 3.0剂量验证系统与CBCT扫描,是保证胸中段食管癌VMAT安全和可靠的必要手段。
Objective To investigate the methods for dosimetric and location verifications in volumetric modulated arc therapy(VMAT)for middle thoracic esophageal carcinoma.Methods Varian Eclipse 10.0 treatment planning system was used to design VMAT plans for 10 patients with middle thoracic esophageal carcinoma who were randomly enrolled in this study.The doses were measured with IBA Compass 3.0 dose verification system and then compared with the data from treatment planning system(TPS).The differences in the doses and volumes of target areas(planning target volume,clinical target volume and gross tumor volume)and organs-at-risk were analyzed,and the gamma passing rates were calculated.Cone beam computed tomography(CBCT)scan was performed once a week for 6 weeks in total.Finally,the setup errors were obtained by the registration between CBCT images and positioning images.Results With the standard of 3 mm/3%,the gamma passing rates of target areas and organs-at-risk were higher than 95%.The differences between measured values of the D_(95%)and D_(mean)in target areas and data from TPS were less than 2%.For the V_(20)and V_(30)of lungs,TPS data were lower than the measured values,and the difference was within 1.65%.For the D_(max)of spinal cord and the V_(30),V_(40)of heart,the differences between measured values and data from TPS were 2.23%and less than 2%,respectively.Setup error analysis showed that the number of cases with error>3 mm in anterior-posterior and left-right directions was more than that of cases with error>3 mm in head-foot direction.Conclusion Compass 3.0 dose verification system and CBCT scan are necessary to ensure the safety and reliability of VMAT to treat patients with middle thoracic esophageal carcinoma.
Objective To investigate the methods for dosimetric and location verifications in volumetric modulated arc therapy(VMAT)for middle thoracic esophageal carcinoma.Methods Varian Eclipse 10.0 treatment planning system was used to design VMAT plans for 10 patients with middle thoracic esophageal carcinoma who were randomly enrolled in this study.The doses were measured with IBA Compass 3.0 dose verification system and then compared with the data from treatment planning system(TPS).The differences in the doses and volumes of target areas(planning target volume,clinical target volume and gross tumor volume)and organs-at-risk were analyzed,and the gamma passing rates were calculated.Cone beam computed tomography(CBCT)scan was performed once a week for 6 weeks in total.Finally,the setup errors were obtained by the registration between CBCT images and positioning images.Results With the standard of 3 mm/3%,the gamma passing rates of target areas and organs-at-risk were higher than 95%.The differences between measured values of the D_(95%)and D_(mean)in target areas and data from TPS were less than 2%.For the V_(20)and V_(30)of lungs,TPS data were lower than the measured values,and the difference was within 1.65%.For the D_(max)of spinal cord and the V_(30),V_(40)of heart,the differences between measured values and data from TPS were 2.23%and less than 2%,respectively.Setup error analysis showed that the number of cases with error>3 mm in anterior-posterior and left-right directions was more than that of cases with error>3 mm in head-foot direction.Conclusion Compass 3.0 dose verification system and CBCT scan are necessary to ensure the safety and reliability of VMAT to treat patients with middle thoracic esophageal carcinoma.
引文
[1]ZHANG W Z,ZHAI T T,LU J Y,et al.Volumetric modulated arc therapy vs.c-IMRT for the treatment of upper thoracic esophageal cancer[J].PLoS One,2015,10(3):e0121385.
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[7]刘丽虹,王澜,韩春,等.食管癌VMAT与IMRT的剂量学比较[J].中华放射肿瘤学杂志,2015,24(3):318-322.LIU L H,WANG L,HAN C,et al.The application of volumetric arc therapy in esophageal carcinoma[J].Chinese Journal of Radiation Oncology,2015,24(3):318-322.
[8]周兴芹,贾鹏飞.容积调强与静态调强放射治疗食管癌的剂量学比较[J].南通大学学报(医学版),2016,36(3):214-216.ZHOU X Q,JIA P F.Dosimetric comparison of VMAT and IMRT for esophageal carcinoma[J].Journal of Nantong University(Medical Science),2016,36(3):214-216.
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[10]林海磊,黄劭敏,邓小武,等.基于解剖在线测量的调强放疗三维剂量验证系统测试与应用[J].中华放射肿瘤学杂志,2012,21(3):271-275.LIN H L,HUANG S M,DENG X W,et al.A clinical test and application research of IMRT dose verification system based on patient's anatomical structure and on-line dosimetry[J].Chinese Journal of Radiation Oncology,2012,21(3):271-275.
[11]谭丽娜,石梅,柴广金,等.食管癌调强放疗计划中AAA算法与PBC算法的对比研究[J].中国医学物理学杂志,2012,29(1):3093-3095.TAN L N,SHI M,CAI G J,et al.A comparison of anisotropic analytical algorithm(AAA)and pencil beam convolution(PBC)algorithm for IMRT treatment planning of esophageal carcinoma[J].Chinese Journal of Medical Physics,2012,29(1):3093-3095.
[12]张玉海,李月敏,夏火生,等.肺癌调强放疗计划AAA算法与PBC算法比较研究[J].中华放射肿瘤学杂志,2013,22(3):250-252.ZHANG Y H,LI Y M,XIA H S,et al.Comparison of pencil bean convolution and anisotropic analytical algorithm for intensitymodulated radiotherapy planning of lung cancer[J].Chinese Journal of Radiation Oncology,2013,22(3):250-252.
[13]樊林,肖明勇,傅玉川.不同剂量计算算法在临床肺癌调强计划的体积-剂量值差异研究[J].西部医学,2016,28(6):800-810.FAN L,XIAO M Y,FU Y C.Difference in dose-volumetric data among different algorithms in planning of intensity modulated radiation therapy for lung cancer in clinic[J].Medical Journal of West China,2016,28(6):800-810.
[14]WALA J,CRAFT D,PALY J,et al.Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning[J].Med Dosim,2013,38(3):298-303.
[15]CRAFT D,MEQUAID D,WALA J,et al.Multicriteria VMAToptimization[J].Med Phys,2012,39(2):686-696.
[16]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.SHANG K,CHI Z F,WANG J,et al.The analysis of setup error in image-guided radiotherapy with thoracic esophageal carcinoma[J].Chinese Journal of Radiation Oncology,2015,24(1):70-73.
[17]LEI Y,WU Q.A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy[J].Phys Med Biol,2010,55(8):2221-2234.
[18]吴爱东,张绍虎,张红雁,等.锥形束CT测量胸段食管癌调强放疗摆位误差对剂量学的影响[J].中华放射医学与防护杂志,2012,32(4):379-382.WU A D,ZHANG S H,ZHANG H Y,et al.A kV cone-beam CTbased analysis of setup errors and the corresponding impact on dose distribution of intensity modulated radiotherapy for thoracic esophageal carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2012,32(4):379-382.
[19]HASHIMOTO T,SHIRATO H,KATO M,et al.Real-time monitoring of a digestive tract marker to reduce adverse effects of moving organs at risk(QAR)in radiotherapy for thoracic and abdominal tumors[J].Int J Radiat Oncol Biol Phys,2005,61(5):1559-1564.
[2]KATARIA T,GOVARDHAN H B,GUPTA D,et al.Dosimetric comparison between volumetric modulated arc therapy(VMAT)vs.intensity modulated radiation therapy(IMRT)for radiotherapy of mid esophageal carcinoma[J].J Cancer Res Ther,2014,10(4):871-877.
[3]YIN L,WU H,GONG J,et al.Volumetric-modulated arc therapy vs.c-IMRT in esophageal cancer:a treatment planning comparison[J].World J Gastroenterol,2012,18(37):5266-5275.
[4]ZHAO Y,CHEN L,ZHANG S,et al.Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.
[5]邵凯南,杜锋磊,李剑龙.Ray Arc在胸部旋转调强放射治疗计划设计中的应用[J].中国医学物理学杂志,2017,34(2):131-138.SHAO K N,DU F L,LI J L.Application of RayArc in volumetric modulated arc therapy planning of chest cancer[J].Chinese Journal of Medical Physics,2017,34(2):131-138.
[6]BRAGG C M,WINGATE K,CONWAY J.Clinical implication of the anisotropic analytical algorithm for IMRT treatment planning and verification[J].Radiother Oncol,2008,86(2):276-284.
[7]刘丽虹,王澜,韩春,等.食管癌VMAT与IMRT的剂量学比较[J].中华放射肿瘤学杂志,2015,24(3):318-322.LIU L H,WANG L,HAN C,et al.The application of volumetric arc therapy in esophageal carcinoma[J].Chinese Journal of Radiation Oncology,2015,24(3):318-322.
[8]周兴芹,贾鹏飞.容积调强与静态调强放射治疗食管癌的剂量学比较[J].南通大学学报(医学版),2016,36(3):214-216.ZHOU X Q,JIA P F.Dosimetric comparison of VMAT and IMRT for esophageal carcinoma[J].Journal of Nantong University(Medical Science),2016,36(3):214-216.
[9]RAMESH B,FRIEDLIEB L,LUTZ M,et al.Experimental validation of a commercial 3D dose verification system for intensity-modulated arc therapies[J].Phys Med Biol,2010,55(19):5619-5633.
[10]林海磊,黄劭敏,邓小武,等.基于解剖在线测量的调强放疗三维剂量验证系统测试与应用[J].中华放射肿瘤学杂志,2012,21(3):271-275.LIN H L,HUANG S M,DENG X W,et al.A clinical test and application research of IMRT dose verification system based on patient's anatomical structure and on-line dosimetry[J].Chinese Journal of Radiation Oncology,2012,21(3):271-275.
[11]谭丽娜,石梅,柴广金,等.食管癌调强放疗计划中AAA算法与PBC算法的对比研究[J].中国医学物理学杂志,2012,29(1):3093-3095.TAN L N,SHI M,CAI G J,et al.A comparison of anisotropic analytical algorithm(AAA)and pencil beam convolution(PBC)algorithm for IMRT treatment planning of esophageal carcinoma[J].Chinese Journal of Medical Physics,2012,29(1):3093-3095.
[12]张玉海,李月敏,夏火生,等.肺癌调强放疗计划AAA算法与PBC算法比较研究[J].中华放射肿瘤学杂志,2013,22(3):250-252.ZHANG Y H,LI Y M,XIA H S,et al.Comparison of pencil bean convolution and anisotropic analytical algorithm for intensitymodulated radiotherapy planning of lung cancer[J].Chinese Journal of Radiation Oncology,2013,22(3):250-252.
[13]樊林,肖明勇,傅玉川.不同剂量计算算法在临床肺癌调强计划的体积-剂量值差异研究[J].西部医学,2016,28(6):800-810.FAN L,XIAO M Y,FU Y C.Difference in dose-volumetric data among different algorithms in planning of intensity modulated radiation therapy for lung cancer in clinic[J].Medical Journal of West China,2016,28(6):800-810.
[14]WALA J,CRAFT D,PALY J,et al.Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning[J].Med Dosim,2013,38(3):298-303.
[15]CRAFT D,MEQUAID D,WALA J,et al.Multicriteria VMAToptimization[J].Med Phys,2012,39(2):686-696.
[16]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.SHANG K,CHI Z F,WANG J,et al.The analysis of setup error in image-guided radiotherapy with thoracic esophageal carcinoma[J].Chinese Journal of Radiation Oncology,2015,24(1):70-73.
[17]LEI Y,WU Q.A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy[J].Phys Med Biol,2010,55(8):2221-2234.
[18]吴爱东,张绍虎,张红雁,等.锥形束CT测量胸段食管癌调强放疗摆位误差对剂量学的影响[J].中华放射医学与防护杂志,2012,32(4):379-382.WU A D,ZHANG S H,ZHANG H Y,et al.A kV cone-beam CTbased analysis of setup errors and the corresponding impact on dose distribution of intensity modulated radiotherapy for thoracic esophageal carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2012,32(4):379-382.
[19]HASHIMOTO T,SHIRATO H,KATO M,et al.Real-time monitoring of a digestive tract marker to reduce adverse effects of moving organs at risk(QAR)in radiotherapy for thoracic and abdominal tumors[J].Int J Radiat Oncol Biol Phys,2005,61(5):1559-1564.