直肠癌静态调强与容积旋转调强放疗剂量学研究
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摘要
目的比较直肠癌术后放疗中静态调强放疗(IMRT)和容积旋转调强放疗(VMAT)的剂量学差异,为临床治疗方法的选择提供参考.方法对10例Ⅱ～Ⅲ期直肠癌术后放疗患者分别进行双弧VMAT和7野IMRT的计划设计,利用剂量体积直方图评价靶区剂量分布以及危及器官的照射剂量,并进行比较分析.结果 IMRT和VMAT治疗计划的治疗剂量均能满足临床要求.IMRT和VMAT计划的适形指数(CI)及均匀指数(HI)比较差异均无统计学意义.IMRT和VMAT计划的正常组织如小肠、膀胱、骨盆和股骨头的剂量均相似.IMRT和VMAT计划的平均机器跳数分别为581.80和960.37(P=0.001),相应的治疗时间分别为558 s和170 s(P=0.003).结论直肠癌VMAT和IMRT计划均可满足患者临床要求,采用VMAT计划的患者治疗时间明显缩短,治疗效率明显提高.
Objective To compare the dosimetric differences between static intensity modulated radiotherapy( IMRT) and volume rotation intensity modulated radiotherapy( VMAT) in postoperative radiotherapy for rectal cancer,and to provide references for the selection of clinical treatment methods.Method Ten patients with stageⅡ-Ⅲ rectal cancer who underwent post-operative radiotherapy were given dual-arc VMAT and 7-field IMRT planning respectively.Dose volume histogram was used to evaluate the dose distribution in target area and the radiation dose of organs at risk. Results Both IMRT and VMAT treatment plans met the clinical requirements.There was no significant difference in CI and HI between IMRT and VMAT. The doses of IMRT and VMAT in normal tissues such as small intestine,bladder,pelvis and femoral head were similar.The average machine hops of IMRT and VMAT were 581.80 and 960.37( P = 0.001),respectively,and the corresponding treatment time was558 s and 170 s( P = 0.003).Conclusion Both VMAT and IMRT plans for rectal cancer can meet the clinical requirements. The treatment time of patients with VMAT plans is significantly shortened and the treatment efficiency is significantly improved.
Objective To compare the dosimetric differences between static intensity modulated radiotherapy( IMRT) and volume rotation intensity modulated radiotherapy( VMAT) in postoperative radiotherapy for rectal cancer,and to provide references for the selection of clinical treatment methods.Method Ten patients with stageⅡ-Ⅲ rectal cancer who underwent post-operative radiotherapy were given dual-arc VMAT and 7-field IMRT planning respectively.Dose volume histogram was used to evaluate the dose distribution in target area and the radiation dose of organs at risk. Results Both IMRT and VMAT treatment plans met the clinical requirements.There was no significant difference in CI and HI between IMRT and VMAT. The doses of IMRT and VMAT in normal tissues such as small intestine,bladder,pelvis and femoral head were similar.The average machine hops of IMRT and VMAT were 581.80 and 960.37( P = 0.001),respectively,and the corresponding treatment time was558 s and 170 s( P = 0.003).Conclusion Both VMAT and IMRT plans for rectal cancer can meet the clinical requirements. The treatment time of patients with VMAT plans is significantly shortened and the treatment efficiency is significantly improved.
引文
[1] Arbea L,Ramos L I,Martínez-Monge R,et al. Intensitymodulated radiation therapy(IMRT)vs.3D conformal radiotherapy(3DCRT)in locally advanced rectal cancer(LARC):dosimetric comparison and clinical implications[J].Radiat Oncol,2010,5:17.
[2] Mok H,Crane C H,Palmer M B,et al.Intensity modulated radiation therapy(IMRT):differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma[J].Radiat Oncol,2011,6:63.
[3] Samuelian J M,Callister M D,Ashman J B,et al. Reduced acute bowel toxicity in patients treated with intensitymodulated radiotherapy for rectal cancer[J]. Int J Radiat Oncol Biol Phys,2012,82:1981-1987.
[4] Parekh A,Truong M T,Pashtan I,et al. Acute gastrointestinal toxicity and tumor response with preoperative intensity modulated radiation therapy for rectal cancer[J].Gastrointest Cancer Res,2013,6(5-6):137-143.
[5]杨咏强,冯林春,贾宝庆,等.局部中晚期直肠癌术前同期加量调强放疗前瞻性临床研究的初步结果[J].中华放射医学与防护杂志,2013,33(5):512-515.
[6]李明,高鸿,李高峰,等.术前同期放化疗治疗局部进展期中低位直肠癌疗效分析[J].中华放射肿瘤学杂志,2014,23(4):286-290.
[7] Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J].Med Phys,2008,35:310-317.
[8]杨波,庞廷田,孙显松,等.宫颈癌术后盆腔容积调强弧形治疗与固定野调强放疗计划的剂量学研究[J].中华放射肿瘤学杂志,2012,21(6):543-546.
[9] Lu S H,Cheng J C,Kuo S H,et al.Volumetric modulated arc therapy for nasopharyngeal carcinoma:a dosimetric comparison with Tomo Therapy and step-and-shoot IMRT[J].Radiother Oncol,2012,104:324-330.
[10]唐正中,吴爱东,钱立庭,等.鼻咽癌静态IMRT与VMAT同步加量放疗剂量学比较[J].安徽医科大学学报,2014,49(8):1164-1167.
[11] T reutwein M,Hipp M,Koelbl O,et al. Volumetricmodulated arc therapy and intensity-modulated radiation therapy treatment planning for prostate cancer with flattened beam and flattening filter free linear accelerators[J]. J Appl Clin Med Phys,2017,18(5):307-314.
[12] Cilla S,Caravatta L,Picardi V,et al.Volumetric modulated arc therapy with simultaneous integrated boost for locally advanced rectal cancer[J].Clin Oncol,2012,24:261-268.
[13] Baglan K L,Frazier R C,Yan D,et al.The dose-volume relationship of acute small bowel toxicity from concurrent5-FU-based chemotherapy and radiation therapy for rectal cancer[J]. Int J Radiat Oncol Biol Phys,2002,52:176-183.
[14] Gallagher M J,Brereton H D,Rostock R A,et al. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation[J]. Int J Radiat Oncol Biol Phys,1986,12(9):1565-1573.
[15] Rose B S,Aydogan B,Liang Y,et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J].Int J Radiat Oncol Biol Phys,2011,79(3):800-807.
[2] Mok H,Crane C H,Palmer M B,et al.Intensity modulated radiation therapy(IMRT):differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma[J].Radiat Oncol,2011,6:63.
[3] Samuelian J M,Callister M D,Ashman J B,et al. Reduced acute bowel toxicity in patients treated with intensitymodulated radiotherapy for rectal cancer[J]. Int J Radiat Oncol Biol Phys,2012,82:1981-1987.
[4] Parekh A,Truong M T,Pashtan I,et al. Acute gastrointestinal toxicity and tumor response with preoperative intensity modulated radiation therapy for rectal cancer[J].Gastrointest Cancer Res,2013,6(5-6):137-143.
[5]杨咏强,冯林春,贾宝庆,等.局部中晚期直肠癌术前同期加量调强放疗前瞻性临床研究的初步结果[J].中华放射医学与防护杂志,2013,33(5):512-515.
[6]李明,高鸿,李高峰,等.术前同期放化疗治疗局部进展期中低位直肠癌疗效分析[J].中华放射肿瘤学杂志,2014,23(4):286-290.
[7] Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J].Med Phys,2008,35:310-317.
[8]杨波,庞廷田,孙显松,等.宫颈癌术后盆腔容积调强弧形治疗与固定野调强放疗计划的剂量学研究[J].中华放射肿瘤学杂志,2012,21(6):543-546.
[9] Lu S H,Cheng J C,Kuo S H,et al.Volumetric modulated arc therapy for nasopharyngeal carcinoma:a dosimetric comparison with Tomo Therapy and step-and-shoot IMRT[J].Radiother Oncol,2012,104:324-330.
[10]唐正中,吴爱东,钱立庭,等.鼻咽癌静态IMRT与VMAT同步加量放疗剂量学比较[J].安徽医科大学学报,2014,49(8):1164-1167.
[11] T reutwein M,Hipp M,Koelbl O,et al. Volumetricmodulated arc therapy and intensity-modulated radiation therapy treatment planning for prostate cancer with flattened beam and flattening filter free linear accelerators[J]. J Appl Clin Med Phys,2017,18(5):307-314.
[12] Cilla S,Caravatta L,Picardi V,et al.Volumetric modulated arc therapy with simultaneous integrated boost for locally advanced rectal cancer[J].Clin Oncol,2012,24:261-268.
[13] Baglan K L,Frazier R C,Yan D,et al.The dose-volume relationship of acute small bowel toxicity from concurrent5-FU-based chemotherapy and radiation therapy for rectal cancer[J]. Int J Radiat Oncol Biol Phys,2002,52:176-183.
[14] Gallagher M J,Brereton H D,Rostock R A,et al. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation[J]. Int J Radiat Oncol Biol Phys,1986,12(9):1565-1573.
[15] Rose B S,Aydogan B,Liang Y,et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J].Int J Radiat Oncol Biol Phys,2011,79(3):800-807.