基准剂量优化在直肠癌术后放疗中的应用
摘要
目的:探讨Eclipse 8.6放射治疗计划系统中基准剂量计划(base dose plan,BDP)优化功能用于直肠癌术后调强放疗(intensity modulated radiation therapy,IMRT)的剂量学特性,并比较其与5野常规IMRT(R-IMRT)的剂量学差异。方法:选取直肠癌术后患者15例,分别设计5野R-IMRT计划和BDP计划,评估两组计划靶区和危及器官的剂量学参数和机器跳数(monitor units,MU)的差异。结果:BDP计划术后高危区PTV-1的适形性指数(conformity index,CI)(0.927±0.008)高于R-IMRT(0.915±0.016),均匀性指数(heterogeneity index,HI)(0.053±0.008)低于R-IMRT(0.055±0.007),差异均具有统计学意义(P <0.05)。BDP计划下膀胱D_(mean)、V_(30)、V_(40)、V_(50)低于R-IMRT(P<0.05),Dmax、V_(10)、V_(20)差异均无统计学意义(P> 0.05);小肠D_(max)、D_(mean)、V_(10)、V_(20)低于R-IMRT(P <0.05),V_(30)、V_(40)、V_(50)差异均无统计学意义(P> 0.05);股骨头和正常组织的受照射剂量均低于R-IMRT(P <0.05);MU(1130.93±72.23)略高于R-IMRT(1073.2±55.96)(P <0.05)。结论:IMRT和BDP计划均可满足直肠癌术后患者临床放射治疗的剂量需求,BDP计划的机器跳数有略微增加,但高危区适形度和均匀性,以及正常器官的保护均优于R-IMRT计划。
引文
[1]中国医师协会结直肠肿瘤专委会放疗专委会,中华医学会放射肿瘤治疗学分会,唐源,等.直肠癌术前/术后适形/调强放疗靶区勾画共识与图谱[J].中华放射肿瘤学杂志,2018,27(3):227-234.
[2]Samuelian JM,Callister MD,Ashman JB,et al.Reduced acute bowel toxicity in patients treated with intensitymodulated radiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys,2012,82(5):1981-1987.
[3]Süss P,Bortz M,Küfer KH,et al.The critical spot eraser-a method to interactively control the correction of local hot and cold spots in IMRT planning[J].Physics in Medicine and Biology,2013,58(6):1855-1867.
[4]Feuvret L,No?l G,Mazeron JJ,et al.Conformity index:A review[J].Int J Radiat Oncol Biol Phys,2006,64(2):333-342.
[5]Hodapp N.The ICRU Report 83:prescribing,recording and reporting photon-beam intensity-modulated radiation therapy(IMRT)[J].Strahlenther Onkol,2012,188(1):97-99.
[6]Kawada K,Hasegawa S,Hida K,et al.Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis[J].Surgical Endoscopy,2014,28(10):2988-2995.
[7]荣玲,周荻,戴立言,等.膀胱及小肠受量对直肠癌术后放疗副反应的影响[J].现代生物医学进展,2016,16(27):5313-5316,5339.
[8]Jeraj R,Keall PJ,Siebers JV.The effect of dose calculation accuracy on inverse treatment planning[J].Physics in Medicine&Biology,2002,47(3):391-407.
[9]Dogan N,Siebers JV,Keall PJ,et al.Improving IMRTdose accuracy via deliverable Monte Carlo optimization for the treatment of head and neck cancer patients[J].Medical Physics,2006,33(11):4033.
[10]李剑,韩广森,徐勇超,et al.低位直肠癌前切除术后早期腹泻与吻合口瘘的关系[J].中华胃肠外科杂志,2012,15(4):357-359.
[11]Lu J Y,Lin Z,Zheng J,et al.Dosimetric evaluation of a simple planning method for improving intensitymodulated radiotherapy for stage III lung cancer[J].Scientific Reports,2016,6(1):23543.
[2]Samuelian JM,Callister MD,Ashman JB,et al.Reduced acute bowel toxicity in patients treated with intensitymodulated radiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys,2012,82(5):1981-1987.
[3]Süss P,Bortz M,Küfer KH,et al.The critical spot eraser-a method to interactively control the correction of local hot and cold spots in IMRT planning[J].Physics in Medicine and Biology,2013,58(6):1855-1867.
[4]Feuvret L,No?l G,Mazeron JJ,et al.Conformity index:A review[J].Int J Radiat Oncol Biol Phys,2006,64(2):333-342.
[5]Hodapp N.The ICRU Report 83:prescribing,recording and reporting photon-beam intensity-modulated radiation therapy(IMRT)[J].Strahlenther Onkol,2012,188(1):97-99.
[6]Kawada K,Hasegawa S,Hida K,et al.Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis[J].Surgical Endoscopy,2014,28(10):2988-2995.
[7]荣玲,周荻,戴立言,等.膀胱及小肠受量对直肠癌术后放疗副反应的影响[J].现代生物医学进展,2016,16(27):5313-5316,5339.
[8]Jeraj R,Keall PJ,Siebers JV.The effect of dose calculation accuracy on inverse treatment planning[J].Physics in Medicine&Biology,2002,47(3):391-407.
[9]Dogan N,Siebers JV,Keall PJ,et al.Improving IMRTdose accuracy via deliverable Monte Carlo optimization for the treatment of head and neck cancer patients[J].Medical Physics,2006,33(11):4033.
[10]李剑,韩广森,徐勇超,et al.低位直肠癌前切除术后早期腹泻与吻合口瘘的关系[J].中华胃肠外科杂志,2012,15(4):357-359.
[11]Lu J Y,Lin Z,Zheng J,et al.Dosimetric evaluation of a simple planning method for improving intensitymodulated radiotherapy for stage III lung cancer[J].Scientific Reports,2016,6(1):23543.