中华放射医学与防护杂志

胡江,孙文钊,王彬,黄虹,祁振宇.早期结外鼻腔NK/T细胞淋巴瘤固定野调强和旋转调强放疗的剂量学比较[J].中华放射医学与防护杂志,2014,34(2):116-119

早期结外鼻腔NK/T细胞淋巴瘤固定野调强和旋转调强放疗的剂量学比较

A dosimetric comparison of volumetric modulated arc therapy with fixed-fields intensity modulated radiotherapy for Ⅰ_E and Ⅱ_E nasal NK/T-cell lymphoma

投稿时间：2013-03-19

DOI：10.3760/cma.j.issn.0254-5098.2014.02.010

中文关键词: 鼻腔NK/T淋巴瘤调强放疗非共面旋转调强

英文关键词:Nasal NK/T-cell lymphoma Intensity modulated radiotherapy Non-coplanar RapidArc therapy

基金项目:国家科技支撑计划（2012BAI15B01）；广东省自然科学基金（S201210009442）

作者	单位	E-mail
胡江	510080 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
孙文钊	510080 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
王彬	510080 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
黄虹	510080 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
祁振宇	510080 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心	qizhy@sysucc.org.cn

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中文摘要:

目的探讨早期结外鼻腔NK/T细胞淋巴瘤固定野调强和旋转调强放疗的剂量学和执行效率差异。方法选取10例I_E~Ⅱ_E期鼻腔NK/T细胞淋巴瘤患者，分别设计共面5野（5F）、共面9野（9F）、非共面5野（5F-N）和旋转调强（RapidArc）方案，以5F计划为参照，9F、5F-N和RapidArc计划分别与其就靶区适形度指数（CI）、均匀性指数（HI）和危及器官的受照剂量进行比较，同时比较各计划剂量验证通过率、出束跳数和治疗时间。结果 CI值9F（0.478±0.181）、5F-N（0.465±0.121）、RapidArc（0.518±0.111）与5F（0.419±0.159）计划相比，差异无统计学意义；HI值9F（0.111±0.027）、RapidArc（0.112±0.031）显著低于5F计划的（0.136±0.038）（t=3.11、3.04，P<0.05）。9F计划晶状体D_max显著高于5F计划（健侧t=2.82，P<0.05；患侧t=3.25，P<0.05）。5F-N计划视神经D_max显著低于5F计划（健侧t=4.27，P<0.05；患侧t=2.82，P<0.05）。RapidArc计划健侧晶状体（t=3.25，P<0.05）、眼球（t=3.25，P<0.05）和视神经（t=2.57，P<0.05）D_max显著低于5F计划。此外，RapidArc计划视交叉D_max显著低于5F计划（t=7.62，P<0.05）。各计划执行效率为RapidArc >5F >5F-N >9F。结论在剂量学和计划执行效率方面，RapidArc较共面固定野5野调强更具优势，推荐作为早期结外鼻腔NK/T细胞淋巴瘤调强放疗布野模式首选。

英文摘要:

Objective To investigate the dosimetric characteristics and their clinical applications of volumetric modulated Arc therapy (RapidArc) with fixed-fields intensity modulated radiotherapy for early stage nasal NK/T-cell lymphoma. Methods Ten patients with stage Ⅰ_E and Ⅱ_E nasal NK/T-cell lymphoma were enrolled in the study. Five field coplanar plan (5F), nine field coplanar plan (9F), five field non-coplanar plan (5F-N) and RapidArc plans were designed for each patient, in which 5F plan was set as the control group. Conformity index (CI) and homogeneity index (HI) as well as the maximum dose of organs at risks were compared. Results The target CI of 5F, 9F, 5F-N and RapidArc plan was 0.419±0.159, 0.478±0.181, 0.465±0.121 and 0.518±0.111, respectively. Compared with 5F (0.136±0.038), the target HI of 9F and RapidArc plan was 0.111±0.027 and 0.112±0.031 (t=3.11, 3.04, P<0.05). 9F plan significantly increased the D_max of lens in the contralateral side(t=2.82, P<0.05) and in ipsilateral side(t=3.25, P<0.05), while 5F-N plan decreased the D_max of optical nerves by up to 9%. RapidArc plan effectively reduced the radiation to organs at risk in lens(t=3.25, P<0.05), eyes (t=3.25, P<0.05), optical nerve (t=2.57, P<0.05) and optical chaism(t=7.62, P<0.05). The delivery efficiency of four plans ranked as RapidArc > 5F> 5F-N> 9F. Conclusions RapidArc produced statistically significant improvement in the dose distributions of targets, and also reduced the D_max of organs at risk, which would be the better choice of radiotherapy for nasal NK/T-cell lymphoma.

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