| 巩贯忠,尹勇,刘同海,陈进琥,宋金龙,卢洁,马长升,孙涛,白曈.RapidArc进行肝癌放疗时不同靶区确定方法的剂量学比较[J].中华放射医学与防护杂志,2012,32(3):289-293 |
| RapidArc进行肝癌放疗时不同靶区确定方法的剂量学比较 |
| Dosimetric differences among RapidArc plans based on different target volumes in radiotherapy of hepatocelluar carcinoma |
| 投稿时间：2011-07-13 |
| DOI：10.3760/cma.j.issn.0254-5098.2012.03.017 |
| 中文关键词: 原发性肝癌 放射治疗 旋转调强 剂量学 |
| 英文关键词:Hepatocelluar carcinoma Radiotherapy Intensity-modulated arc radiotherapy Dosimetry |
| 基金项目:山东省自然科学基金(ZR2010HM071) |
| 作者 | 单位 | E-mail | | 巩贯忠 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 尹勇 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | yinyongsd@yahoo.com.cn | | 刘同海 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 陈进琥 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 宋金龙 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 卢洁 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 马长升 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 孙涛 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | | | 白曈 | 250117 济南, 山东省医学科学院山东省肿瘤医院放疗科, 山东省放射肿瘤学重点实验室 | |
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| 中文摘要: |
| 目的 研究应用RapidArc进行原发性肝癌(HCC)放射治疗时不同靶区确定方法的剂量学差异。方法 选取10例HCC患者,完成4D-CT、自由呼吸(FB)下3D-CT、主动呼吸控制(ABC)辅助平静吸气末屏气(EIH)下3D-CT扫描;将4D-CT依据呼吸周期分割为10套CT图像。分别在不同CT图像上手动勾画GTV,将4D-CT的10个GTV融合为内靶区1(IGTV1),测量GTVFB到IGTV1的外放距离,并将所得外放距离应用于GTVFB获得内靶区2(IGTV2)。GTVFB、IGTV1、IGTV2、GTVEIH依据不同外放获得PTV-1~PTV-4,针对不同PTV制定相应RapidArc计划(RA1~RA4),其中RA1、RA2、RA3采用单个358°全弧,RA4采用3个135°弧,比较不同计划间剂量学差异。结果 PTV-1、PTV-3体积大于PTV-2、PTV-4,其中PTV-1/PTV-2、PTV-1/PTV-4平均为2.5、1.9。4个RA计划的适形指数、均匀性指数、靶区最大剂量、最小剂量之间的差异均无统计学意义。与RA1、RA3比较,RA2、RA4的正常肝脏平均剂量从10.21 Gy(RA1)、9.62 Gy(RA3)降低到8.23 Gy(RA2)、7.63 Gy(RA4)(χ2=10.68, P<0.05),V30从7.76%、6.12%降低到5.24%、5.05%(χ2=14.76, P<0.05)。4种RA计划胃和十二指肠受量间的差异均无统计学意义。结论 应用RapidArc进行HCC放射治疗时,相对于传统外放标准,4D-CT技术或ABC技术均可在保证靶区准确的基础上完成照射剂量;两者在正常肝脏保护方面的作用基本相当。 |
| 英文摘要: |
| Purpose To investigate the dosimetric differences among RapidArc (RA) plans which were designed on different target volumes in hepatocellular carcinoma (HCC).Methods A total of 10 HCC patients underwent 3D-CT scan under free breathing (FB), end inspiration hold (EIH) associated with active breath coordinator (ABC) and 4D-CT scan. The 4D-CT were sorted into 10 sets of CT images according to respiratory cycle. The gross tumor volume (GTV) was manually contoured on different CT images. The individual internal gross target volume (IGTV1) was obtained from 4D-CT, and the individual margins from GTVFB to IGTV1. IGTV2 were obtained from GTVFB using individual margins. The planned target volumes (PTV-1, PTV-2, PTV-3 and PTV-4) were obtained from GTVFB, IGTV1, IGTV2 and GTVEIH applying different margins. The RA plans (RA1, RA2, RA3 and RA4) were designed from different PTVs, and for RA1, RA2 and RA3 the simple 358° arc were used,while three 135° arcs were used for RA4.The dosimetric differences were compared. Results The PTV-1 and PTV-3 were larger than PTV-2 and PTV-4; the mean values of PTV-1/PTV-2 and PTV-1/PTV-4 were 2.5 and 1.9, respectively. There were no significant differences in conformal index, homogeneity index, maximum dose, and minimum dose of PTV among 4 RA plans. The irradiation dose of normal liver of RA3 and RA4 were 8.23 Gy and 7.63 Gy respectively, both significantly lower than those of RA1 and RA2 (10.21 Gy, 9.62 Gy, χ2=10.68, P<0.05), and the V30 of RA3 and RA4 were 5.24% and 5.05% respectively, both significantly lower than those of RA1 and RA2 (7.76%, 6.12%, χ2=14.76, P<0.05). There were no significant differences in irradiation doses of stomach and duodenum among different plans.Conclusions Using 4D-CT or ABC technology with RapidArc in HCC can define the target volume accurately and achieve prefect dose distribution sparing more normal liver volume, compared to the traditional margins. 4D-CT and ABC play similar roles in sparing normal liver. |
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