3种不同野数的放疗计划对非小细胞肺癌患者剂量分布的影响
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摘要
目的分析3种不同野数的放疗计划对非小细胞肺癌(NSCLC)患者剂量分布的影响。方法将2016年1月-2017年12月南京市胸科医院收治的43例NSCLC患者作为研究对象,处方剂量66Gy/33f,均采取仅改变照射野数目的方式,设计3种不同放疗计划,于靶区95%的体积符合处方剂量的情况下,比较在3种不同野数的放疗计划下同侧肺、对侧肺、脊髓以及心脏剂量分布的差异。结果在3种不同放疗计划中,5-野靶区剂量热点(cGy)较3-野显著下降(P<0.05);而与7-野剂量分布比较,差异无统计学意义(P>0.05)。3种不同放疗计划同侧肺V_5、V_(10)、V_(12)、V_(30)和V_(40)剂量分布比较,差异无统计学意义(P>0.05)。5-野在对侧肺的V_5剂量分布与3-野比较,差异无统计学意义(P>0.05);5-野在对侧肺的V_(10)和V_(20),较3-野明显下降(P<0.05),且其V_5、V_(10)和V_(20)的剂量分布较7-野明显下降(P<0.05)。5-野平均心脏剂量较7-野明显下降(P<0.05),而与3-野比较,差异无统计学意义(P>0.05)。3种不同野数的放疗计划中食道与脊髓最大剂量值的比较,差异无统计学意义(P>0.05)。结论在仅改变照射野数目的方式,靶区95%的体积符合处方剂量的情况下,5-野的放疗计划对NSCLC患者可获得相对较好的收益。
Objective To analyze the effect of three different radiation regimens on dose distribution in patients with non-small cell lung cancer(NSCLC).Methods Forty-three patients with NSCLC from January 2016 to December 2017 in Nanjing Chest Hospital were studied,with the prescription measurement of 66Gy/33f.Three different radiotherapy schemes were designed by changing the number of irradiation fields.The dose fractions of ipsilateral lung,contralateral lung,spinal cord and heart under three different radiotherapy schemes were compared when 95%of the target volume was in accordance with the prescription dose.Results Among the three different radiotherapy schemes,the dose hot-spot of 5-Field target dose(cGy)was significantly lower than that of 3-Field(P<0.05),while there was no significant difference in dose distribution between 5-Field and 7-Field(P>0.05).The dose distributions of V_5,V_(10),V_(20),V_(30)and V_(40)in ipsilateral lung of three different radiotherapy schemes were not statistically significant(P>0.05).The V_5dose distribution of 5-Field in the contralateral lung was not significantly different from that of 3-Field(P>0.05);V_(10)and V_(20)in the contralateral lung were significantly lower than that of 3-Field(P<0.05),and the dose distribution of V_5,V_(10),V_(20)in the contralateral lung was significantly lower than that of 7-Field(P<0.05).The mean cardiac dose of 5-Field was significantly lower than that of 7-Field(P<0.05),but there was no significant difference between 5-Field and 3-Field(P>0.05).There was no significant difference between the maximal dose of esophagus and spinal cord in three different radiotherapy plans(P>0.05).Conclusion With only changing the number of irradiation fields and 95% of the target volume in line with the prescription dose,5-Field of radiotherapy schemes can achieve relatively better benefits for patients with NSCLC.
Objective To analyze the effect of three different radiation regimens on dose distribution in patients with non-small cell lung cancer(NSCLC).Methods Forty-three patients with NSCLC from January 2016 to December 2017 in Nanjing Chest Hospital were studied,with the prescription measurement of 66Gy/33f.Three different radiotherapy schemes were designed by changing the number of irradiation fields.The dose fractions of ipsilateral lung,contralateral lung,spinal cord and heart under three different radiotherapy schemes were compared when 95%of the target volume was in accordance with the prescription dose.Results Among the three different radiotherapy schemes,the dose hot-spot of 5-Field target dose(cGy)was significantly lower than that of 3-Field(P<0.05),while there was no significant difference in dose distribution between 5-Field and 7-Field(P>0.05).The dose distributions of V_5,V_(10),V_(20),V_(30)and V_(40)in ipsilateral lung of three different radiotherapy schemes were not statistically significant(P>0.05).The V_5dose distribution of 5-Field in the contralateral lung was not significantly different from that of 3-Field(P>0.05);V_(10)and V_(20)in the contralateral lung were significantly lower than that of 3-Field(P<0.05),and the dose distribution of V_5,V_(10),V_(20)in the contralateral lung was significantly lower than that of 7-Field(P<0.05).The mean cardiac dose of 5-Field was significantly lower than that of 7-Field(P<0.05),but there was no significant difference between 5-Field and 3-Field(P>0.05).There was no significant difference between the maximal dose of esophagus and spinal cord in three different radiotherapy plans(P>0.05).Conclusion With only changing the number of irradiation fields and 95% of the target volume in line with the prescription dose,5-Field of radiotherapy schemes can achieve relatively better benefits for patients with NSCLC.
引文
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[12]TEKATLI H,HAASBEEK N,DAHELE M,et al.Outcomes of hypofractionated high-dose radiotherapy in poor-risk patients with“ultracentral”non-small cell lung cancer[J].JThorac Oncol,2016,11(7):1081-1089.
[13]郝龙英,王德林,曹玉娟,等.多野动态调强治疗非小细胞肺癌剂量学差异分析[J].中华医学杂志,2015,95(19):1526-1529.
[14]TAHIR B A,BRAGG C M,WILD J M,et al.Impact of field number and beam angle on functional image-guided lung cancer radiotherapy planning[J].Phys Med Biol,2017,62(17):7114-7130.
[2]DAVIS J N,MEDBERY C,SHARMA S,et al.Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch○Rpatient registry[J].Radiat Oncol,2015,10(1):113.
[3]何丹,范志勤,汪洋,等.胸腔镜下肺癌根治术对于Ⅰ期非小细胞肺癌患者近期及远期疗效分析[J].新疆医科大学学报,2015,38(7):896-899.
[4]BRADLEY J D,PAULUS R,KOMAKI R,et al.Standarddose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer(RTOG 0617):a randomised,two-by-two factorial phase 3study[J].Lancet Oncol,2015,16(2):187-199.
[5]陈旎,刘义保,张九堂,等.Ⅲ期非小细胞肺癌三维适形与调强技术的剂量学比较[J].中国医学物理学杂志,2016,33(2):198-203.
[6]CHANG J Y,SENAN S,PAUL M A,et al.Stereotactic ablative radiotherapy versus lobectomy for operable stage I nonsmall-cell lung cancer:apooled analysis of two randomised trials[J].Lancet Oncol,2015,16(6):630-637.
[7]FARR K P,KALLEHAUGE J F,MLLER D S,et al.Inclusion of functional information from perfusion SPECT improves predictive value of dose-volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer:aprospective study[J].Radiother Oncol,2015,117(1):9-16.
[8]NESTLE U,De RUYSSCHER D,RICARDI U,et al.ESTROACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer[J].Radiother Oncol,2018,127(1):1-5.
[9]蔡俊涛,陈凡,王财,等.非小细胞肺癌混合调强放疗剂量学研究[J].中华肿瘤防治杂志,2017,24(23):1668-1672.
[10]MERNA C,RWIGEMA J C M,CAO M,et al.A treatment planning comparison between modulated tri-cobalt-60teletherapy and linear accelerator-based stereotactic body radiotherapy for central early-stage non-small cell lung cancer[J].Med Dosim,2016,41(1):87-91.
[11]郭跃信,王海洋,刘乐乐,等.早期非小细胞肺癌不同放疗技术的剂量学差异分析[J].中华放射肿瘤学杂志,2017,26(1):62-65.
[12]TEKATLI H,HAASBEEK N,DAHELE M,et al.Outcomes of hypofractionated high-dose radiotherapy in poor-risk patients with“ultracentral”non-small cell lung cancer[J].JThorac Oncol,2016,11(7):1081-1089.
[13]郝龙英,王德林,曹玉娟,等.多野动态调强治疗非小细胞肺癌剂量学差异分析[J].中华医学杂志,2015,95(19):1526-1529.
[14]TAHIR B A,BRAGG C M,WILD J M,et al.Impact of field number and beam angle on functional image-guided lung cancer radiotherapy planning[J].Phys Med Biol,2017,62(17):7114-7130.