非小细胞肺癌SBRT放疗剂量分布的研究
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摘要
目的分别设计IMRT、VMAT和非共面VMAT三种放疗计划进行对比,以指导临床选择更优的SBRT治疗非小细胞肺癌(NSCLC)。方法 20例NSCLC患者,采用4D-CT定位获取定位图像,分别采用逆向调强(IMRT)、容积旋转调强(VMAT)和非共面容积旋转调强(N-VMAT)进行SBRT治疗计划的设计,比较计划靶区(PTV)和危及器官(OAR)的剂量分布图、剂量体积直方图(DVH)和机器的相关参数。结果对于靶区PTV的D_(2%)、D_(95%)、D_(50%)三种计划之间比较差异没有统计学意义(P>0.05)。靶区PTV的适形指数(CI),N-VMAT计划在剂量学的分布上整体优于IMRT计划和VMAT计划(P<0.05)。对于左肺的V_(5%)、V_(10%)、Dmean和右肺的V_(5%)、Dmean,N-VMAT计划在剂量学的分布上优于IMRT计划和VMAT计划(P<0.05)。结论 N-VMAT计划在剂量学的分布上整体优于IMRT计划和VMAT计划,它不仅有较好的靶区适形度和均匀度,而且有利于对肺组织的保护,可以为NSCLC患者的SBRT治疗提供理论参考。
Objective To guide a better clinical selection of SBRT plan in the treatment of non-small-cell lung cancer by comparing the plan of IMRT,VMAT and non-co-face VMAT. Methods The 20 NSCLC patients' positioning images was obtained by 4 D-CT technique,and adopt Intensity Modulated Radiation Therapy(IMRT),Volumetric Modulated Arc Therapy(VMAT) and non coplanar Volumetric Modulated Arc Therapy(VMAT) to design SBRT treatment plan,then comparing the dose distribution,dose volume histogram(DVH) and the related parameters of plan target volum(PTV),organs at risk(OAR) and parameters of the machine. Results For D2%,D95%and D50%of PTV,there was no statistically significant difference between three plans(P>0.05). The conformal index(CI) of PTV were superior to the IMRT plan and VMAT plan(P<0.05). For V5%,V10%,Dmeanof the right lung and V5%,Dmean of the left lung,the N-VMAT plan is better than the IMRT plan and the VMAT plan in the distribution of dosimetry(P<0.05). Conclusion N-VMAT plan as a whole is better than that of IMRT plan and VMAT plan. It not only has a good conformal target,but also has a lower illuminating dose for normal lung. It provides theoretical reference for SBRT treatment of NSCLC patients.
Objective To guide a better clinical selection of SBRT plan in the treatment of non-small-cell lung cancer by comparing the plan of IMRT,VMAT and non-co-face VMAT. Methods The 20 NSCLC patients' positioning images was obtained by 4 D-CT technique,and adopt Intensity Modulated Radiation Therapy(IMRT),Volumetric Modulated Arc Therapy(VMAT) and non coplanar Volumetric Modulated Arc Therapy(VMAT) to design SBRT treatment plan,then comparing the dose distribution,dose volume histogram(DVH) and the related parameters of plan target volum(PTV),organs at risk(OAR) and parameters of the machine. Results For D2%,D95%and D50%of PTV,there was no statistically significant difference between three plans(P>0.05). The conformal index(CI) of PTV were superior to the IMRT plan and VMAT plan(P<0.05). For V5%,V10%,Dmeanof the right lung and V5%,Dmean of the left lung,the N-VMAT plan is better than the IMRT plan and the VMAT plan in the distribution of dosimetry(P<0.05). Conclusion N-VMAT plan as a whole is better than that of IMRT plan and VMAT plan. It not only has a good conformal target,but also has a lower illuminating dose for normal lung. It provides theoretical reference for SBRT treatment of NSCLC patients.
引文
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[10]HE J,HUANG Y,SHI S,et al.Comparison of effects between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy via helical tomotherapy[J].Technol Cancer Res Treat,2015,14(6):701-707.
[2]VANSTEENKISTE J,CRINO I,DOOMS,et al.2nd ESMO Consensus Conference on Lung Cancer:early-stage non-smallcell lung cancer consensus on diagnosis,treatment and followup[J].Ann Oncol,2014,25(8):1462-1474.
[3]BERNSTEIN MB,KRISHNAN S,HODUE JW,et al.Immunotherapy and stereotachc ahlative radiotherapy(ISABR):a curative approach[J].Nat Rev Clin Oncol,2016,13(8):516-524.
[4]SHURYAK I,CARLSON DJ,BROWN JM,et al.High-dose and fractionation effects in stereotactic radiation therapy:analysis of tumor control data from 2965 patients[J].Radiother Oncol,2015,115(3):327-334.
[5]MODH A,RIMNER A,WILLIAMS E,et al.Local control and toxicity in a large cohort of central lung tumors treated with stereotactic body radiation therapy[J].Int J Radiat Oncol Bio Phys,2014,90(5):1168-1176.
[6]FOOTE M,BAILEY M,SMITH L,et al.Guidelines for safe practice of stereotactic body(ablative)radiation therapy[J].JMed Imaging Radiat Oncol,2015,59(5):646-653.
[7]ZHANG J,YANG F,LI B,et al.Which is the optimal biologically effective dose of stereotartic body radiotherapy for Stage I non-small-cell lung cancer?A meta-analysis[J].Int J Radiat Oncol Biol Phys,2011,81(4):305-316.
[8]SHIRVANI SM,IIANC J,CHANU JY,et al.Comparative effectiveness of 5 treatment strategies for early-stage non-small-cell lung Cancer in the elderly[J].Int J Radiat Oncol Biol Phys,2012,84(5):1060-1070.
[9]VERSTEGEN NE,OOSTERHUIS JW,PALMA DA,et al.StageⅠ-Ⅱnon-small-cell lung cancer treated using either stereotactic ablative radiotherapy(SABR)or lobectomy by video-assisted thoracoscopic surgery(VATS):outcomes of a propensity score-matched analysis[J].Ann Oncol,2013,24(6):1543-1548.
[10]HE J,HUANG Y,SHI S,et al.Comparison of effects between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy via helical tomotherapy[J].Technol Cancer Res Treat,2015,14(6):701-707.