三维适形放射治疗非小细胞肺癌的靶区和剂量学分析
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摘要
目的应用三维治疗计划系统评价非小细胞肺癌放射治疗不同的照射方法,以明确非小细胞肺癌三维适形放射治疗的优势。
方法选择非小细胞肺癌患者并设计3 个治疗计划,分别为常规、常规加适形和适形放射治疗计划,计划的总剂量均为66 Gy,用剂量体积直方图(DVH)比较靶区剂量和正常组织的受照射剂量的差异。
结果3 种治疗计划均能满足靶区剂量要求。常规、常规加适形和适形放射治疗计划中,大体肿瘤体积(GTV)的最大剂量(Dmax)为69.9 Gy、69 Gy、70.6 Gy;最小剂量(Dmin)分别为63 Gy、61.5 Gy、61.8 Gy;平均剂量(Dmean)分别为66.3Gy、66.4Gy、68.2Gy。临床靶区体积(CTV3)的最大剂量分别为70.3 Gy、69.2 Gy、70.8 Gy;最小剂量分别为57.3 Gy、54.9 Gy、60.1 Gy;平均剂量分别为66.2 Gy、66.2 Gy、68.0 Gy.。患侧肺(左肺)受到≥20Gy 剂量照射的肺体积占同侧肺总体积的百分数(V20)分别为46.7 %、36.7%、37.5%;≥30Gy剂量照射的肺体积比(V30)分别为35.9%、29.2%、25.8;平均剂量为23.4 Gy、20.5 Gy、17.6 Gy。健侧肺(右肺)受到≥20Gy 剂量照射的肺体积占同侧肺总体积的百分数(V20)分别为12%、4.2 %、4.6%;≥30Gy 剂量照射的肺体积比(V30)为7.9%、3.3%、4.2%;平均剂量为6.2 Gy、4.9 Gy、7.5Gy。双侧肺受到≥20Gy 剂量照射的肺体积占两肺总体积的百分数(V20)分别为25%、16.3 %和17.2 %,≥30Gy 剂量照射的肺体积比(V30)为18.9%、13.6%、12.5%;平均剂量为12.8 Gy、11 Gy、11.5. Gy 食管受到≥45Gy 剂量照射体积百分数(V45)分
别为34.2%、23.4%、17.9%; 受到≥50Gy 剂量照射体积百分数(V50)分别为29%、20%、11.8%;≥60Gy 剂量照射体积百分数(V60)分别为18.7%、6.7%、4.2%。脊髓受照射的最大剂量分别为43.4 Gy、46.5 Gy和26.1 Gy; 最小剂量为0.136 Gy、0.16 Gy、0.93Gy;平均剂量为10.4 Gy、10.5 Gy、2.1 Gy。心脏1/3 体积受照剂量分别为45 Gy、43 Gy、21 Gy;2/3 体积受照剂量分别为14 Gy、6.4 Gy、3.2 Gy;1/2 体积受照剂量分别为31 Gy、19 Gy、13.4 Gy。
结论非小细胞肺癌常规放射治疗设野方法基本能满足靶区的剂量学要求,然而正常组织的受照剂量明显高于其他两种治疗计划。三维适形放射治疗的主要优势在于减少正常组织的受照剂量。
Objective To assess and delineate the dosimetric shortcomings of conventional radiotherapy planning ,as compared with the three dimensional treatment planning system , and to obtain a better technique in the treatment of lung cancers.
Methods Using the eclipse 6.5 treatment planning system , three different methods of radiotherapy planning : conventional planning , conventional and conformal planning , and conformal planning were designed for the patient. The total radiation dose was 66 Gy and DVH were used to assess the dosimetric distribution in the gross tumor volume and the surrounding organs at risk.
Results Three designs are able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The maximum dose at GTV were 69.9 Gy、69 Gy、70.6 Gy; and the minimum dose were63 Gy、61.5 Gy、61.7 Gy ; the mean dose were 66.2 Gy、66.3 Gy、68.1 Gy . The maximum dose at CTV3 were 70.3 Gy、69.2 Gy、70.8 Gy; and the minimum dose were57.3 Gy、54.9 Gy、60.1 Gy ; the mean dose were 66.2 Gy、66.17 Gy、68 Gy. The left lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were 46.7 %、36.7%和37.5%;and ≥30 Gy(V30) were 35.9%、29.2%、25.8;the mean dose were 6.2 Gy、4.9 Gy、7.4 Gy. The right lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were12%、4.2 %和4.6%;and ≥30
Gy(V30) were 7.92%、3.3%、4.2%; the mean dose were 6.2 Gy、4.9 Gy、7.4 Gy。The whole lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were 25%、16.3 %和17.2 %; and ≥30 Gy(V30) were18.9%、13.6%、12.5%; the mean dose were12.8 Gy、11 Gy、11.5. The esophageal volume which received radiation of ≥45 Gy (V45) were 34.2%、23.4%和17.9%; the esophageal volume which received radiation of ≥50 Gy (V50) were 29%、20%和11.8%;the volume which received radiation of ≥60 Gy (V60) were 18.7%、6.69%和4.2%.The maximum dose at the spinal cord were 43.4 Gy、46.5 Gy和26.1 Gy ;and the minimum dose were1.36 Gy、0.16 Gy、0.93 Gy ; the mean dose were 10.4 Gy、10.5 Gy、2.1 Gy。The radiation dose to the 1/3 volume of heart were 45 Gy、43 Gy、21 Gy;the radiation dose to the 2/3 volume were 14 Gy、6.4 Gy、3.2 Gy; 1/2 volume dose were31 Gy、19 Gy、13.4 Gy。
Conclusions Conventional radiotherapy planning is able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The three dimensional conformal radiation therapy planning system is able to provide superior delivery of high dose to the target volume without inflicting too high a risk to the surrounding normal tissues and organs.
方法选择非小细胞肺癌患者并设计3 个治疗计划,分别为常规、常规加适形和适形放射治疗计划,计划的总剂量均为66 Gy,用剂量体积直方图(DVH)比较靶区剂量和正常组织的受照射剂量的差异。
结果3 种治疗计划均能满足靶区剂量要求。常规、常规加适形和适形放射治疗计划中,大体肿瘤体积(GTV)的最大剂量(Dmax)为69.9 Gy、69 Gy、70.6 Gy;最小剂量(Dmin)分别为63 Gy、61.5 Gy、61.8 Gy;平均剂量(Dmean)分别为66.3Gy、66.4Gy、68.2Gy。临床靶区体积(CTV3)的最大剂量分别为70.3 Gy、69.2 Gy、70.8 Gy;最小剂量分别为57.3 Gy、54.9 Gy、60.1 Gy;平均剂量分别为66.2 Gy、66.2 Gy、68.0 Gy.。患侧肺(左肺)受到≥20Gy 剂量照射的肺体积占同侧肺总体积的百分数(V20)分别为46.7 %、36.7%、37.5%;≥30Gy剂量照射的肺体积比(V30)分别为35.9%、29.2%、25.8;平均剂量为23.4 Gy、20.5 Gy、17.6 Gy。健侧肺(右肺)受到≥20Gy 剂量照射的肺体积占同侧肺总体积的百分数(V20)分别为12%、4.2 %、4.6%;≥30Gy 剂量照射的肺体积比(V30)为7.9%、3.3%、4.2%;平均剂量为6.2 Gy、4.9 Gy、7.5Gy。双侧肺受到≥20Gy 剂量照射的肺体积占两肺总体积的百分数(V20)分别为25%、16.3 %和17.2 %,≥30Gy 剂量照射的肺体积比(V30)为18.9%、13.6%、12.5%;平均剂量为12.8 Gy、11 Gy、11.5. Gy 食管受到≥45Gy 剂量照射体积百分数(V45)分
别为34.2%、23.4%、17.9%; 受到≥50Gy 剂量照射体积百分数(V50)分别为29%、20%、11.8%;≥60Gy 剂量照射体积百分数(V60)分别为18.7%、6.7%、4.2%。脊髓受照射的最大剂量分别为43.4 Gy、46.5 Gy和26.1 Gy; 最小剂量为0.136 Gy、0.16 Gy、0.93Gy;平均剂量为10.4 Gy、10.5 Gy、2.1 Gy。心脏1/3 体积受照剂量分别为45 Gy、43 Gy、21 Gy;2/3 体积受照剂量分别为14 Gy、6.4 Gy、3.2 Gy;1/2 体积受照剂量分别为31 Gy、19 Gy、13.4 Gy。
结论非小细胞肺癌常规放射治疗设野方法基本能满足靶区的剂量学要求,然而正常组织的受照剂量明显高于其他两种治疗计划。三维适形放射治疗的主要优势在于减少正常组织的受照剂量。
Objective To assess and delineate the dosimetric shortcomings of conventional radiotherapy planning ,as compared with the three dimensional treatment planning system , and to obtain a better technique in the treatment of lung cancers.
Methods Using the eclipse 6.5 treatment planning system , three different methods of radiotherapy planning : conventional planning , conventional and conformal planning , and conformal planning were designed for the patient. The total radiation dose was 66 Gy and DVH were used to assess the dosimetric distribution in the gross tumor volume and the surrounding organs at risk.
Results Three designs are able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The maximum dose at GTV were 69.9 Gy、69 Gy、70.6 Gy; and the minimum dose were63 Gy、61.5 Gy、61.7 Gy ; the mean dose were 66.2 Gy、66.3 Gy、68.1 Gy . The maximum dose at CTV3 were 70.3 Gy、69.2 Gy、70.8 Gy; and the minimum dose were57.3 Gy、54.9 Gy、60.1 Gy ; the mean dose were 66.2 Gy、66.17 Gy、68 Gy. The left lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were 46.7 %、36.7%和37.5%;and ≥30 Gy(V30) were 35.9%、29.2%、25.8;the mean dose were 6.2 Gy、4.9 Gy、7.4 Gy. The right lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were12%、4.2 %和4.6%;and ≥30
Gy(V30) were 7.92%、3.3%、4.2%; the mean dose were 6.2 Gy、4.9 Gy、7.4 Gy。The whole lung volumes which received radiation dose of ≥20 Gy (V20) at the three designs were 25%、16.3 %和17.2 %; and ≥30 Gy(V30) were18.9%、13.6%、12.5%; the mean dose were12.8 Gy、11 Gy、11.5. The esophageal volume which received radiation of ≥45 Gy (V45) were 34.2%、23.4%和17.9%; the esophageal volume which received radiation of ≥50 Gy (V50) were 29%、20%和11.8%;the volume which received radiation of ≥60 Gy (V60) were 18.7%、6.69%和4.2%.The maximum dose at the spinal cord were 43.4 Gy、46.5 Gy和26.1 Gy ;and the minimum dose were1.36 Gy、0.16 Gy、0.93 Gy ; the mean dose were 10.4 Gy、10.5 Gy、2.1 Gy。The radiation dose to the 1/3 volume of heart were 45 Gy、43 Gy、21 Gy;the radiation dose to the 2/3 volume were 14 Gy、6.4 Gy、3.2 Gy; 1/2 volume dose were31 Gy、19 Gy、13.4 Gy。
Conclusions Conventional radiotherapy planning is able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The three dimensional conformal radiation therapy planning system is able to provide superior delivery of high dose to the target volume without inflicting too high a risk to the surrounding normal tissues and organs.
引文
1. Emani B , Lyman J ,Brown ,A ,et al . Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys , 1991 ,21 :109-122.,
2. 郑小康, 陈龙华. 三维适形放疗临床实践[M ]. 北京: 人民卫生出版社, 2001: 10.
3. 殷蔚伯, 谷铣之. 肿瘤放射治疗学[M ]. 北京: 中国协和医科大学出版社, 2002: 112.
4. Graham MV. P redicting radiation response (edito rial). Int J Radiat Oncol Biol Phys, 1997; 39 (3) : 561～562.
5. Graham MV , Purdy JA , Emami B, et al. Clinical dose-volume histogram analysis for peneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys, 1999; 45(2) : 323～329.
6. M ark s LB, Spencer DP, Sherouse GW , et al. The role of three dimensional functional lung in Radiation treatment planning: the functional dose-volume histogram. Int J radiat Oncol Biol Phys, 1995; 33(1) : 65～75.
7. Graham MV ,Purdy JA ,Emami B ,et al . Preliminary results of prospective trial using three dimesional radiotherapy for lung canncer. Int J Radiation Oncologybiol Phys , 1995 ,33 :993.
8. Kwa SL S, L ebesque JV , Thenws JCM , et al. Radiation pneumonitis as a function of mean lung Dose: a analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys, 1998; 42 (1) : 1～9.
9. M aguire P D, Sibley G S, Zhou S M , et al. Clinical and do simetric p redicto rs of radiation induced esophageal toxicity [J ]. Int J Radiat Oncol Biol Phys, 1999,45 (1) : 97-103.
10. Singh A K, Lockett M A , Bradley J D.P redictors of radiation-induced esophageal toxicity in patients with non-small cell lung cancer treated with three dimensional conformal radiotherapy [ J ]. Int J Radiat Oncol Biol Phys,2003, 55 (2) : 337-341.
11. Rosenman J G, Halle J S, Socinski M A ,et al. High dose conformal radio therapy for treatment of stageⅢa/Ⅲb non-small cell lung cancer: technical issues and results of a phase Ⅰ/Ⅱtrial[J ]. Int J Radiat Oncol Biol Phys, 2002, 54 (2) 348-356.
12. Davis KS. Intrathoracic changes following X-ray treatment :a clinical and experimental study. adiology ,1924 ,3 :3012322
13. Stewart JR ,Fajardo LF. Radiation induced heart disease :an update. Prog Cardiovasc Dis ,1984 ,27 :173-194.
14. Stewart JR , Fajardo LF. Radiation induced heart disease. Radiol Clin North Am, 1971 , 3 :511-531.
15. Hayman JA , Martel MK, Ten Haken RK, et al .Dose escalation in non2small2cell lung cancer using three-dimensional conformal radiation therapy : update of a phase Ⅰtrial . J Clin Oncol ,2001 ,19 (1) :127-136.
16. Robertson JM, Ten Haken RK, Hazuka MB , et al . Dose escalation for non-small cell lung cancer using conformal radiation therapy. Int J Radiat Oncol Biol Phys ,1997 ,37 (5) :1079-1085.
17. Armstrong J , Raben A , Zelefsky M , et al. Promising survival with three-dimensional conformal radiation therapy for non-small cell lung cancer[J ] . Radiother Oncol , 1997 ,44 (1) : 17222.
18. Bahri S , Flickinger JC , Kalend AM. Results of multifield conformal radiation therapy of non-small cell lung carcinoma using multileaf collimation beams [ J ] . Radiat Oncol Investig , 1999 , 7 ( 5) : 297-308.
19. Socinski MA , Rosenman JG, Halle J , et al . Dose escalating conformal thoracic radiationtherapy with induction and concurrent carboplatin/ paclitaxel in unresectable stage ⅢA/ B non-small cell lung carcinoma : a modified phase Ⅰ/Ⅱtrial . Cancer ,2001 ,92 (5) : 1213-1223.
20. Chen LM,Ignacio L ,Jacobs R ,et al . results of a phase Ⅱconcurrent chemoradiotherapy study using three-dimensional conformal radiotherapy with cispolatin and oral etoposide instage Ⅲnon-small cell lung cancer. Radiat Oncol Investig ,1999 ,7 :49-53.
2. 郑小康, 陈龙华. 三维适形放疗临床实践[M ]. 北京: 人民卫生出版社, 2001: 10.
3. 殷蔚伯, 谷铣之. 肿瘤放射治疗学[M ]. 北京: 中国协和医科大学出版社, 2002: 112.
4. Graham MV. P redicting radiation response (edito rial). Int J Radiat Oncol Biol Phys, 1997; 39 (3) : 561～562.
5. Graham MV , Purdy JA , Emami B, et al. Clinical dose-volume histogram analysis for peneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys, 1999; 45(2) : 323～329.
6. M ark s LB, Spencer DP, Sherouse GW , et al. The role of three dimensional functional lung in Radiation treatment planning: the functional dose-volume histogram. Int J radiat Oncol Biol Phys, 1995; 33(1) : 65～75.
7. Graham MV ,Purdy JA ,Emami B ,et al . Preliminary results of prospective trial using three dimesional radiotherapy for lung canncer. Int J Radiation Oncologybiol Phys , 1995 ,33 :993.
8. Kwa SL S, L ebesque JV , Thenws JCM , et al. Radiation pneumonitis as a function of mean lung Dose: a analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys, 1998; 42 (1) : 1～9.
9. M aguire P D, Sibley G S, Zhou S M , et al. Clinical and do simetric p redicto rs of radiation induced esophageal toxicity [J ]. Int J Radiat Oncol Biol Phys, 1999,45 (1) : 97-103.
10. Singh A K, Lockett M A , Bradley J D.P redictors of radiation-induced esophageal toxicity in patients with non-small cell lung cancer treated with three dimensional conformal radiotherapy [ J ]. Int J Radiat Oncol Biol Phys,2003, 55 (2) : 337-341.
11. Rosenman J G, Halle J S, Socinski M A ,et al. High dose conformal radio therapy for treatment of stageⅢa/Ⅲb non-small cell lung cancer: technical issues and results of a phase Ⅰ/Ⅱtrial[J ]. Int J Radiat Oncol Biol Phys, 2002, 54 (2) 348-356.
12. Davis KS. Intrathoracic changes following X-ray treatment :a clinical and experimental study. adiology ,1924 ,3 :3012322
13. Stewart JR ,Fajardo LF. Radiation induced heart disease :an update. Prog Cardiovasc Dis ,1984 ,27 :173-194.
14. Stewart JR , Fajardo LF. Radiation induced heart disease. Radiol Clin North Am, 1971 , 3 :511-531.
15. Hayman JA , Martel MK, Ten Haken RK, et al .Dose escalation in non2small2cell lung cancer using three-dimensional conformal radiation therapy : update of a phase Ⅰtrial . J Clin Oncol ,2001 ,19 (1) :127-136.
16. Robertson JM, Ten Haken RK, Hazuka MB , et al . Dose escalation for non-small cell lung cancer using conformal radiation therapy. Int J Radiat Oncol Biol Phys ,1997 ,37 (5) :1079-1085.
17. Armstrong J , Raben A , Zelefsky M , et al. Promising survival with three-dimensional conformal radiation therapy for non-small cell lung cancer[J ] . Radiother Oncol , 1997 ,44 (1) : 17222.
18. Bahri S , Flickinger JC , Kalend AM. Results of multifield conformal radiation therapy of non-small cell lung carcinoma using multileaf collimation beams [ J ] . Radiat Oncol Investig , 1999 , 7 ( 5) : 297-308.
19. Socinski MA , Rosenman JG, Halle J , et al . Dose escalating conformal thoracic radiationtherapy with induction and concurrent carboplatin/ paclitaxel in unresectable stage ⅢA/ B non-small cell lung carcinoma : a modified phase Ⅰ/Ⅱtrial . Cancer ,2001 ,92 (5) : 1213-1223.
20. Chen LM,Ignacio L ,Jacobs R ,et al . results of a phase Ⅱconcurrent chemoradiotherapy study using three-dimensional conformal radiotherapy with cispolatin and oral etoposide instage Ⅲnon-small cell lung cancer. Radiat Oncol Investig ,1999 ,7 :49-53.