中华放射医学与防护杂志

张伟,马照,邵鹏,姜伟,关玉敏.全中枢神经系统肿瘤放疗技术的剂量学研究[J].中华放射医学与防护杂志,2013,33(5):519-523

全中枢神经系统肿瘤放疗技术的剂量学研究

Comparison of dosimetry in radiotherapy for craniospinal irradiation

投稿时间：2013-01-23

DOI：10.3760/cma.j.issn.0254-5098.2013.05.016

英文关键词:Craniospinal 3D-CRT sIMRT Dosimetry

基金项目:

作者	单位
张伟	264000 烟台, 山东烟台毓璜顶医院放疗科
马照	264000 烟台, 山东烟台毓璜顶医院放疗科
邵鹏	264000 烟台, 山东烟台毓璜顶医院放疗科
姜伟	264000 烟台, 山东烟台毓璜顶医院放疗科
关玉敏	264000 烟台, 山东烟台毓璜顶医院放疗科

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中文摘要:

目的以三维适形放疗技术为参照,探讨中枢神经系统肿瘤简单调强(sIMRT)放疗技术的剂量学特性。方法选取5名已行全脑全脊髓放疗患者,为每位患者设计3D-CRT计划、3野和5野sIMRT计划。利用剂量分布和剂量体积直方图(DVH),评价不同照射技术的靶区和正常器官的照射剂量、靶区剂量均匀性(HI),通过总的机器跳数(MU)间接比较不同照射技术的治疗时间。结果 3D-CRT在射野衔接处只有处方剂量的70%。计划靶区后缘的正常组织接受的剂量达到处方剂量的140%。3野和5野sIMRT计划的靶区剂量均匀性分别为0.09±0.01和0.08±0.01,优于3D-CRT计划的0.18±0.02 (t=7.80、7.65,P<0.05);心脏V₁₀分别为(8.4±1.9)%和(8.4±2.0)%,低于3D-CRT计划的(36.0±6.0)%(t=13.3、13,0,P<0.05);甲状腺V₂₀分别为(12.4±1.5)%和(12.4±1.6)%,低于3D-CRT计划的(69.4±5.7)%(t=26.3、26.4,P<0.05);喉V₂₀分别为(17.2±1.2)%和(17.9±1.5)%,低于3D-CRT计划的(89.4±7.0)%(t=25.5、26.5,P<0.05);靶区后缘正常组织V₃₀分别为(4.4±1.4)%,(4.9±1.9)%,低于3D-CRT计划的(31.9±6.1)%(t=8.5、10.1,P<0.05);平均机器跳数(MU)分别为1100±106和1160±129,高于3D-CRT计划的640±78。结论 3野和5野sIMRT计划在剂量分布、危及器官(OAR)保护、靶区剂量均匀性等方面均好于3D-CRT计划。

英文摘要:

Objective To explore the dosimetry of simplified intensity modulated radiotherapy(sIMRT)in the spinal component of craniospinal irradiation (CSI) compared with conventional plan (3D-CRT). Methods Five previously treated patients were adopted to generate 3D-CRT, 3- and 5-field sIMRT plans. The prescribed dose was 36 Gy to the planning target volume (PTV) in 20 fractions. The dose distributions of target volume and normal tissues, and homogeneity index (HI) were ananlyzed using the dose volume histogram. The total monitor units (MUs) were also analyzed to compare the delivery time indirectly. Results For 3D-CRT plans, the region of the neighbouring fields only received 70% of the prescribed dose, and the maximum dose delivered in the normal tissues was increased to approximately 140% of the prescribed dose. The homogeneity index (HI) of 3- and 5-field sIMRT were 0.09±0.01 and 0.08±0.01, respectively, superior to that of 3D-CRT (0.18±0.02,t=7.80, 7.65,P<0.05). The values of V₁₀ for the heart of 3- and 5-field sIMRT were (8.4±1.9)% and (8.4±2.0)%, respectively, lower than that of 3D-CRT( (36.0±6.0)%(t=13.3,13.0,P<0.05).V₂₀ for the thyroid gland were (12.4±1.5)% and (12.4±1.6)%, respectively, lower than (69.4±5.7)% of 3D-CRT(t=26.3, 26.4,P<0.05).V₂₀ for the larynx were (17.2±1.2)% and (17.9±1.5)%, respectively, lower than that of 3D-CRT[(89.4±7.0)%(t=25.5, 26.5,P<0.05)].V₃₀ for the NT was (4.4±1.4)%,(4.9±1.9)%, lower than that of 3D-CRT[(31.9±6.1)%(t=8.5,10.1,P<0.05)].The averaged values of total MUs for 3- and 5-field sIMRT were 1100±177 and 1160±204, respectively, higher than that of 3D-CRT(640±151). Conclusions Compared with the 3D-CRT CSI technique, 3- and 5-field sIMRT have better dose distribution and can improve target dose uniformity and protect the organs at risk.

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