| 胡彩容,阴晓娟,张秀春,等.不同调强方式在胸中上段食管癌放疗中的剂量学研究[J].中华放射医学与防护杂志,2014,34(3):220-224.Hu Cairong,Yin Xiaojuan,Zhang Xiuchun,et al.Dosimetric study of different intensity-modulated modalities in the radiotherapy for mid and upper thoracic esophageal carcinoma[J].Chin J Radiol Med Prot,2014,34(3):220-224 |
| 不同调强方式在胸中上段食管癌放疗中的剂量学研究 |
| Dosimetric study of different intensity-modulated modalities in the radiotherapy for mid and upper thoracic esophageal carcinoma |
| 投稿时间：2013-06-01 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.03.016 |
| 中文关键词: 静态调强 容积旋转调强 食管癌 剂量学 |
| 英文关键词:Intensity-modulated radiotherapy Volumetric modulated arc therapy Esophageal cancer Dosimetry |
| 基金项目:福建省科技厅重点项目（2011Y0014） |
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| 中文摘要: |
| 目的 对胸中上段食管癌患者进行静态调强（IMRT）和容积旋转调强（VMAT）两种放疗方式的剂量学对比研究。方法 对20例IMRT治疗的食管癌患者行VMAT（单弧和双弧）计划的重新设计。在单弧的VMAT计划中，对其中5例患者行不同子野间隔（4°、3°、2°）以及不同计划系统（Monaco和MasterPlan）的计划设计。比较靶区和危及器官（OAR）的剂量学差异及治疗参数。结果 双弧VMAT计划各项靶区剂量学参数明显好于IMRT计划和单弧VMAT计划（P<0.05），靶区均匀性（HI）（P<0.05）和适形度（CI）（P<0.05）最好。危及器官参数VMAT可在一定程度上降低OAR的受照剂量，但是IMRT对肺组织和正常组织（E-P）的低剂量保护要优于VMAT（P<0.05）；不同子野间隔的VMAT计划中，2°相对于3°和4°其OAR的受照剂量是减小的（P<0.05），除了心脏的Dmean；不同计划系统设计的VMAT计划，以Monaco对OAR的保护为最优（P<0.05）；VMAT的机器跳数少于IMRT，而且有效节省了治疗时间。 结论 VMAT方式相对于IMRT能够实现更好的靶区覆盖、均匀性和适形度，同时能降低脊髓、肺组织、心脏和E-P的受照剂量；对于VMAT来说，双弧技术、小子野角度间隔能够进一步地改善靶区和OAR的受照剂量；此外，在物理参数和优化参数一致的前提下，Monaco可以更好地保护OAR。 |
| 英文摘要: |
| Objective To compare the static intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for mid and upper thoracic esophageal cancer. Method The data of twenty esophageal cancer patients were retrospectively re-planned with VMAT(single arc and double arcs) modality using Pinnacle treatment plan system. Five of these patients were selected again to simulate single arc plans with different segment intervals (4°, 3°, 2°) and re-planned on other treatment planning systems ( Monaco and MasterPlan ). Differences of dose distribution and treatment parameters were compared. Results In comparison to IMRT and single-VMAT (S-VMAT), Double-VMAT (D-VMAT) significantly improves the dosimetric parameters for targets(P<0.05), dose homogeneity(P<0.05) and conformity(P<0.05). Though VMAT plans were slightly better than IMRT in reducing the doses to the organs at risk (OARs), no advantage was observed in the low-dose protection of lung and E-P (P<0.05). For the VMAT plans with different segment intervals, lower OAR doses were observed using an interval of 2° (P<0.05), except for the mean dose of the heart. For the VMAT plans on different treatment planning systems, Monaco-based plans protected OARs better (P<0.05). The number of monitor units (MU) and treatment time were less in VMAT cases. Conclusions VMAT plans perform better in target coverage, dose homogeneity and conformity, and can reduce the radiation dose to the spinal cord, lungs, heart and other normal tissue than IMRT plans. The VMAT plan quality could be further improved by using double arcs and smaller segment interval. Monaco-based plans provide better OAR protections under the same conditions of physical and optimization parameters. |
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