食管癌旋转容积调强与螺旋断层调强的靶区和危及器官的剂量学研究
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摘要
目的:探讨食管癌旋转容积调强(volumetricmodulatedarctherapy,VMAT)与螺旋断层调强(To m o H e l i c a l, T H)两种放射治疗(简称"放疗")方案的靶区和危及器官的剂量学特点。方法:选取食管癌患者12例,分别设计VMAT和TH两种放疗方案,比较两种方案的靶区和肺、心、脊髓的剂量学参数。结果:在靶区方面,除大体肿瘤靶区(gross tumor volume,GTV)与计划靶区(planning target volume,PTV)的D98%外其余参数比较,差异均具有统计学意义(P<0.05)。而在危及器官的剂量学方面,对左肺、右肺及双肺的V5,V10,V15,Dmean而言,VMAT显著优于TH(P<0.05),同样,心脏的V10,VMAT也显著低于TH(P<0.05),但心脏的V20,V25,V30的比较上,TH计划明显优于VMAT;另外TH也明显降低了脊髓的D2。结论:VMAT和TH两种方案均能满足临床治疗要求,但TH在靶区上更具有优势,而危及器官的保护上两种方案各有特点,整体上VMAT对肺和心脏的低剂量区的保护上更具优势。
Objective: To compare the dose distribution of volumetric modulated arc therapy(VMAT) versus TomoHelical(TH) for esophageal cancer in the target area and organs at risk(OARs). Methods: Twelve patients with esophageal cancer were selected, VMAT and TH plans were designed respectively. The dosimetric parameters of target area, lung, heart and spinal cord were analyzed. Results: For target areas, there were statistically significant differences except gross tumor volume(GTV) D98% and planning target volume(PTV)'s D98%(P<0.05). For OARs, VMAT is superior to TH in V5, V10, V15, Dmean of left lung, right lung and both lungs(P<0.05). VMAT is significantly lower than TH in V10 of heart, but for V20, V25 and V30 of heart, TH is better; for the spinal cord's D2%,TH is lower. Conclusion: VMAT and TH plans can meet the clinical treatment requirements, but the TH plan has advantages in the target area. Both plans have different advantages in OARs sparing, but VMAT has an advantage in protecting the low-dose areas of the lungs and heart.
Objective: To compare the dose distribution of volumetric modulated arc therapy(VMAT) versus TomoHelical(TH) for esophageal cancer in the target area and organs at risk(OARs). Methods: Twelve patients with esophageal cancer were selected, VMAT and TH plans were designed respectively. The dosimetric parameters of target area, lung, heart and spinal cord were analyzed. Results: For target areas, there were statistically significant differences except gross tumor volume(GTV) D98% and planning target volume(PTV)'s D98%(P<0.05). For OARs, VMAT is superior to TH in V5, V10, V15, Dmean of left lung, right lung and both lungs(P<0.05). VMAT is significantly lower than TH in V10 of heart, but for V20, V25 and V30 of heart, TH is better; for the spinal cord's D2%,TH is lower. Conclusion: VMAT and TH plans can meet the clinical treatment requirements, but the TH plan has advantages in the target area. Both plans have different advantages in OARs sparing, but VMAT has an advantage in protecting the low-dose areas of the lungs and heart.
引文
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12 .Fukada J, Shigematsu N, Takeuchi H, et al. Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients[J].Int J Radiat Oncol Biol Phys, 2013, 87(3):487-493.
2 .Tachibana M, Kinugasa S, Hirahara N, et al. Lymph node classification of esophageal squamous cell carcinoma and adenocarcinoma[J]. Eur J Cardiothorac Surg, 2008, 34(2):427-431.
3 .Nguyen NP, Jang S, Vock J, et al. Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer[J].BMC Cancer, 2014, 14:265.
4 .Chen YJ, Liu A, Han C, et al. Helical tomotherapy for radiotherapy in esophageal cancer:a preferred plan with better conformal target coverage and more homogeneous dose distribution[J]. Med Dosim,2007, 32(3):166-171.
5 .赖霄晶,谷庆,杨双燕,等.食管癌螺旋断层放疗及三维适形调强放疗计划剂量学研究[J].中华肿瘤防治杂志, 2017, 24(10):696-702.LAI Xiaojing, GU Qing, YANG Shuangyan, et al. Dosimetric study ofspiralcomputedtomographyandthree-dimensionalconformal intensity-modulated radiotherapy for esophageal cancer[J]. Chinese Journal of Cancer Prevention and Treatment, 2017, 24(10):696-702.
6 .Yamaguchi S, Ohguri T, Matsuki Y, et al. Radiotherapy for thoracic tumors:associationbetweensubclinicalinterstitiallungdisease and fatal radiation pneumonitis[J]. Int J Clin Oncol, 2015, 20(1):45-52.
7 .Jiang ZQ, Yang K, Komaki R, et al. Long-term clinical outcome of intensity-modulated radiotherapy for inoperable non-small cell lung cancer:the MD Anderson experience[J]. Int J Radiat Oncol Biol Phys,2012, 83(1):332-339.
8 .JoIY,KayCS,KimJY,etal.Significanceoflow-doseradiation distribution in development of radiation pneumonitis after helicaltomotherapy-basedhypofractionatedradiotherapyforpulmonary metastases[J]. J Radiat Res, 2013, 55(1):105-112.
9 .KimY,HongSE,KongM,etal.Predictivefactorsforradiation pneumonitisinlungcancertreatedwithhelicaltomotherapy[J].Cancer Res Treat, 2013, 45(4):295.
10 .龙金华,卢冰,欧阳伟炜,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响[J].中华放射肿瘤学杂志, 2012, 21(1):23-27.LONG Jinhua, LU Bing, OYANG Weiwei, et al. Prospective clinical study of stage III non-small cell lung cancer chemotherapy combined with thoracic three-dimensional radiotherapy(III)—effects of different radiotherapydosesonsurvival[J].ChineseJournalofRadiation Oncology, 2012, 21(1):23-27.
11 .熊绮丽,徐刚,石勇,等.食管癌放射治疗计划的剂量学比较[J].辐射研究与辐射工艺学报, 2016, 34(5):50111-50117.XIONG Qili, XU Gang, SHI Yong, et al. Dosimetric comparison of radiotherapyplansforesophagealcancer[J].JournalofRadiation Research and Radiation Processing, 2016, 34(5):50111-50117.
12 .Fukada J, Shigematsu N, Takeuchi H, et al. Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients[J].Int J Radiat Oncol Biol Phys, 2013, 87(3):487-493.