胃癌调强放疗中多叶光栅3种状态的剂量学比较
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摘要
目的:通过比较胃癌调强放疗中多叶光栅(MLC)3种不同状态下放疗计划的剂量学差异,为临床放疗方案的选择提供参考依据。方法:选取10例胃癌患者分别制定9野的锁野调强、分野调强和旋转小机头分野调强的治疗计划,比较机器跳数,靶区适形度、均匀性、D_(max)、D_(mean)、V_(45),以及body、肝脏、小肠、脊髓和肾脏V_5、V_(10)、V_(20)、V_(30)、V_(40)、V_(45)、D_(max)、D_(mean)等参数的剂量学差异。结果:3种计划均可满足临床需求。锁野计划相比分野和旋转小机头分野调强计划在body的V_5、V_(10)、V_(20)、V_(30)均显著降低且差异具有统计学意义,同时对于肾脏、肝脏和小肠在某些低剂量区均有一定的降低且有统计学差异。对于body(计划靶区)的D_(max)参数,分野计划稍微低于锁野和旋转小机头分野调强计划且差异具有统计学意义。结论:锁野计划可以更好地保护危及器官,同时减少低剂量区。
Objective To compare the dosimetric differences among split-field, fixed-jaw and rotating multi-leaf collimator(RMLC)used in intensity-modulated radiotherapy of gastric carcinoma for providing reference for the selection of treatment strategy.Methods Ten patients with gastric carcinoma was enrolled in this study, and 3 plans, namely fixed-jaw plan(9-field), split-field plan and RMLC plan, were designed for each patient. Several dosimetric parameters, including monitor units, the conformity index, homogeneity index, Dmax, Dmean, V45 of target areas, and the V5, V10, V20, V30, V40, V45, Dmax, Dmeanof the body, liver, small intestine, spinal cord and kidneys were compared. Results All 3 plans met clinical requirements. The V5, V10, V20 and V30 of the body in fixed-jaw plan were significantly lower than those in split-field plan and RMLC plan, and meanwhile, there were some decreases in the low-dose volume of the kidney, liver and small intestine, with statistical differences. The Dmaxof the body(planning target volume) in split-field plan was lower than that in fixed-jaw plan and RMLC plan, with statistical differences. Conclusion Compared with split-field plan and RMLC plan, fixed-jaw plan achieves a better organs-at-risk protection and reduces low-dose volume.
Objective To compare the dosimetric differences among split-field, fixed-jaw and rotating multi-leaf collimator(RMLC)used in intensity-modulated radiotherapy of gastric carcinoma for providing reference for the selection of treatment strategy.Methods Ten patients with gastric carcinoma was enrolled in this study, and 3 plans, namely fixed-jaw plan(9-field), split-field plan and RMLC plan, were designed for each patient. Several dosimetric parameters, including monitor units, the conformity index, homogeneity index, Dmax, Dmean, V45 of target areas, and the V5, V10, V20, V30, V40, V45, Dmax, Dmeanof the body, liver, small intestine, spinal cord and kidneys were compared. Results All 3 plans met clinical requirements. The V5, V10, V20 and V30 of the body in fixed-jaw plan were significantly lower than those in split-field plan and RMLC plan, and meanwhile, there were some decreases in the low-dose volume of the kidney, liver and small intestine, with statistical differences. The Dmaxof the body(planning target volume) in split-field plan was lower than that in fixed-jaw plan and RMLC plan, with statistical differences. Conclusion Compared with split-field plan and RMLC plan, fixed-jaw plan achieves a better organs-at-risk protection and reduces low-dose volume.
引文
[1]杨子鑫,刘巍.晚期胃癌内科治疗的研究进展[J].中华肿瘤防治杂志, 2011, 18(19):1572-1576.YANG Z X, LIU W. Progress in medical treatment of advanced gastriccancer[J]. Chinese Journal of Cancer Prevention and Treatment, 2011,18(19):1572-1576.
[2] MACDONALD J S, SMALLEY S R, BENEDETTI J, et al.Chemoradiotherapy after surgery compared with surgery alone foradenocarcinoma of the stomach or gastroesophageal junction[J]. NEngl J Med, 2001, 345(10):725.
[3] LAMBRECHT M, NEVENS D, NUYTS S. Intensity-modulatedradiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect onoutcome and toxicity in locally advanced head and neck cancer[J].Strahlenther Onkol, 2013, 189(3):223-229.
[4] ANAND A K, JAIN J, NEGI P S, et al. Can dose reduction to oneparotid gland prevent xerostomia? A feasibility study for locallyadvanced head and neck cancer patients treated with intensity-modulated radiotherapy[J]. Clin Oncol, 2006, 18(6):497-504.
[5]漆利军,张红雁,罗文广,等.胃癌术后放疗方式对肾脏剂量学影响的比较研究[J].中华肿瘤防治杂志, 2012, 19(4):303-306.QI L J, ZHANG H Y, LUO W G, et al. Comparative research of theeffect about the renal dosimetry with different radiotherapy afterresection of gastric carcinoma[J]. Chinese Journal of CancerPrevention and Treatment, 2012, 19(4):303-306.
[6] WEBB S. The fish(IMRT)needs a bicycle(MLC)? The bicyclefactories seem flourishing; not so the goldfish-bowl factories[J]. PhysMed, 2011, 27(3):177-180.
[7] RAO M, YANG W, CHEN F, et al. Comparison of Elekta VMAT withhelical tomotherapy and fixed field IMRT:plan quality, deliveryefficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
[8] AHN P, ANAMALAYIL S, LUSTIG R A, et al. Comparison of theeffect of full-neck volumetric modulated arc therapy IMRT versussplit-field IMRT techniques on radiation dose to low neck structures[J]. Int J Radiat Oncol Biol Phys, 2014, 90(1):S573.
[9] MURSHED H, LIU H H, LIAO Z, et al. Dose and volume reductionfor normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2004, 58(4):1258-1267.
[10]WIELAND P, DOBLER B, MAI S, et al. IMRT for postoperativetreatment of gastric cancer:covering large target volumes in the upperabdomen:a comparison of a step-and-shoot and an arc therapyapproach[J]. Int J Radiat Oncol Biol Phys, 2004, 59(4):1236-1244.
[11]BEAUVOIS S, VAN P H. Late effects of radiations on the kidney[J].Cancer Radiother, 1997, 1(6):760-763.
[12]DAWSON L A, KAVANAGH B D, PAULINO A C, et al. Radiation-associated kidney injury[J]. Int J Radiat Oncol Biol Phys, 2010, 76(3):S108-S115.
[13]CHEN F, RAO M, MCCUNE K, et al. SU-GG-T-574:when is fixedfield IMRT superior to VMAT?[J]. Med Phys, 2010, 37(6 Part 25):3319.
[14]ZHENG B M, DONG X X, WU H, et al. Dosimetry comparisonbetween volumetric modulated arc therapy with rapid arc and fixedfield dynamic IMRT for local-regionally advancednasopharyngeal carcinoma[J]. Chinese Journal of Cancer Research,2011, 23(4):259-264.
[15]CHEN J, CHEN X, HUANG M, et al. A fixed-jaw method to protectcritical organs during intensity-modulated radiotherapy[J]. MedDosim, 2014, 39(4):325-329.
[16]王昊,陈华,顾恒乐,等.周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究[J].中华放射肿瘤学杂志, 2017, 26(3):320-323.WANG H, CHEN H, GU H L, et al. A study of lung protection inintensity modulated radiotherapy with split field and fixed jawtechniques for peripheral lung cancer with mediastinal lymph nodemetastasis[J]. Chinese Journal of Radiation Oncology, 2017, 26(3):320-323.
[17]罗居东,李兆斌,章青,等.不同放疗技术在胃癌术后放疗中的剂量学研究[J].肿瘤防治研究, 2011, 38(5):571-574.LUO J D, LI Z B, ZHANG Q, et al. Dosimetry studies of differentradiation technique for postoperative gastric cancer[J]. CancerResearch on Prevention and Treatment, 2011, 38(5):571-574.
[18]胡伟刚,章真,徐志勇,等.三维适形与调强放疗技术在胃癌术后放疗中的剂量学比较[J].中华放射肿瘤学杂志, 2007, 16(4):273-276.HU W G, ZHANG Z, XU Z Y, et al. Comparison of dosimetry betweenthree-dimension conformal and intensity modulated plan inpostoperative radiotherapy for gastric cancer[J]. Chinese Journal ofRadiation Oncology, 2007, 16(4):273-276.
[19]杨波,庞廷田,孙显松,等.直肠癌调强放疗中固定铅门技术和分野技术的剂量学比较[J].中华放射医学与防护杂志, 2012, 32(5):509-512.YANG B, PANG T T, SUN X S, et al. Dosimetric comparison of splitfield and fixed jaw techniques for target volumes in the rectum cancer[J]. Chinese Journal of Radiological Medicine and Protection, 2012,32(5):509-512.
[20]朱小杨,余光伟,王连聪.固定铅门技术在鼻咽癌调强放疗中的应用[J].中华放射医学与防护杂志, 2013, 33(6):636-637.ZHU X Y, YU G W, WANG L C. Application of fixed jawtechnique in intensity modulated radiotherapy for nasopharyngealcarcinoma[J]. Chinese Journal of Radiological Medicine andProtection, 2013, 33(6):636-637.
[2] MACDONALD J S, SMALLEY S R, BENEDETTI J, et al.Chemoradiotherapy after surgery compared with surgery alone foradenocarcinoma of the stomach or gastroesophageal junction[J]. NEngl J Med, 2001, 345(10):725.
[3] LAMBRECHT M, NEVENS D, NUYTS S. Intensity-modulatedradiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect onoutcome and toxicity in locally advanced head and neck cancer[J].Strahlenther Onkol, 2013, 189(3):223-229.
[4] ANAND A K, JAIN J, NEGI P S, et al. Can dose reduction to oneparotid gland prevent xerostomia? A feasibility study for locallyadvanced head and neck cancer patients treated with intensity-modulated radiotherapy[J]. Clin Oncol, 2006, 18(6):497-504.
[5]漆利军,张红雁,罗文广,等.胃癌术后放疗方式对肾脏剂量学影响的比较研究[J].中华肿瘤防治杂志, 2012, 19(4):303-306.QI L J, ZHANG H Y, LUO W G, et al. Comparative research of theeffect about the renal dosimetry with different radiotherapy afterresection of gastric carcinoma[J]. Chinese Journal of CancerPrevention and Treatment, 2012, 19(4):303-306.
[6] WEBB S. The fish(IMRT)needs a bicycle(MLC)? The bicyclefactories seem flourishing; not so the goldfish-bowl factories[J]. PhysMed, 2011, 27(3):177-180.
[7] RAO M, YANG W, CHEN F, et al. Comparison of Elekta VMAT withhelical tomotherapy and fixed field IMRT:plan quality, deliveryefficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
[8] AHN P, ANAMALAYIL S, LUSTIG R A, et al. Comparison of theeffect of full-neck volumetric modulated arc therapy IMRT versussplit-field IMRT techniques on radiation dose to low neck structures[J]. Int J Radiat Oncol Biol Phys, 2014, 90(1):S573.
[9] MURSHED H, LIU H H, LIAO Z, et al. Dose and volume reductionfor normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2004, 58(4):1258-1267.
[10]WIELAND P, DOBLER B, MAI S, et al. IMRT for postoperativetreatment of gastric cancer:covering large target volumes in the upperabdomen:a comparison of a step-and-shoot and an arc therapyapproach[J]. Int J Radiat Oncol Biol Phys, 2004, 59(4):1236-1244.
[11]BEAUVOIS S, VAN P H. Late effects of radiations on the kidney[J].Cancer Radiother, 1997, 1(6):760-763.
[12]DAWSON L A, KAVANAGH B D, PAULINO A C, et al. Radiation-associated kidney injury[J]. Int J Radiat Oncol Biol Phys, 2010, 76(3):S108-S115.
[13]CHEN F, RAO M, MCCUNE K, et al. SU-GG-T-574:when is fixedfield IMRT superior to VMAT?[J]. Med Phys, 2010, 37(6 Part 25):3319.
[14]ZHENG B M, DONG X X, WU H, et al. Dosimetry comparisonbetween volumetric modulated arc therapy with rapid arc and fixedfield dynamic IMRT for local-regionally advancednasopharyngeal carcinoma[J]. Chinese Journal of Cancer Research,2011, 23(4):259-264.
[15]CHEN J, CHEN X, HUANG M, et al. A fixed-jaw method to protectcritical organs during intensity-modulated radiotherapy[J]. MedDosim, 2014, 39(4):325-329.
[16]王昊,陈华,顾恒乐,等.周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究[J].中华放射肿瘤学杂志, 2017, 26(3):320-323.WANG H, CHEN H, GU H L, et al. A study of lung protection inintensity modulated radiotherapy with split field and fixed jawtechniques for peripheral lung cancer with mediastinal lymph nodemetastasis[J]. Chinese Journal of Radiation Oncology, 2017, 26(3):320-323.
[17]罗居东,李兆斌,章青,等.不同放疗技术在胃癌术后放疗中的剂量学研究[J].肿瘤防治研究, 2011, 38(5):571-574.LUO J D, LI Z B, ZHANG Q, et al. Dosimetry studies of differentradiation technique for postoperative gastric cancer[J]. CancerResearch on Prevention and Treatment, 2011, 38(5):571-574.
[18]胡伟刚,章真,徐志勇,等.三维适形与调强放疗技术在胃癌术后放疗中的剂量学比较[J].中华放射肿瘤学杂志, 2007, 16(4):273-276.HU W G, ZHANG Z, XU Z Y, et al. Comparison of dosimetry betweenthree-dimension conformal and intensity modulated plan inpostoperative radiotherapy for gastric cancer[J]. Chinese Journal ofRadiation Oncology, 2007, 16(4):273-276.
[19]杨波,庞廷田,孙显松,等.直肠癌调强放疗中固定铅门技术和分野技术的剂量学比较[J].中华放射医学与防护杂志, 2012, 32(5):509-512.YANG B, PANG T T, SUN X S, et al. Dosimetric comparison of splitfield and fixed jaw techniques for target volumes in the rectum cancer[J]. Chinese Journal of Radiological Medicine and Protection, 2012,32(5):509-512.
[20]朱小杨,余光伟,王连聪.固定铅门技术在鼻咽癌调强放疗中的应用[J].中华放射医学与防护杂志, 2013, 33(6):636-637.ZHU X Y, YU G W, WANG L C. Application of fixed jawtechnique in intensity modulated radiotherapy for nasopharyngealcarcinoma[J]. Chinese Journal of Radiological Medicine andProtection, 2013, 33(6):636-637.