中华放射医学与防护杂志

王境生,于旭耀,李丰彤,等.早期非小细胞肺癌射波刀放疗中肺部组织的剂量学分析[J].中华放射医学与防护杂志,2018,38(12):933-937.Wang Jingsheng,Yu Xuyao,Li Fengtong,et al.A dosimetric analysis of lung tissue in early stage non-small cell lung cancer patients treated by Cyberknife radiotherapy[J].Chin J Radiol Med Prot,2018,38(12):933-937

早期非小细胞肺癌射波刀放疗中肺部组织的剂量学分析

A dosimetric analysis of lung tissue in early stage non-small cell lung cancer patients treated by Cyberknife radiotherapy

投稿时间：2018-04-26

DOI：10.3760/cma.j.issn.0254-5098.2018.12.010

中文关键词: 射波刀非小细胞肺癌治疗计划体积百分比放射性肺炎

英文关键词:CyberKnife Non-small cell lung cancer Treatment plan Volume percentage Radiation pneumonitis

基金项目:

作者	单位
王境生	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
于旭耀	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
李丰彤	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
董洋	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
陈华明	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
宋勇春	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
陶振	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心
袁智勇	300060 天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心

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中文摘要:

目的分析早期非小细胞肺癌患者采用射波刀治疗时，正常肺部组织所受剂量。方法回顾性分析天津医科大学肿瘤医院射波刀中心2011年1月至2013年12月收治的264例早期非小细胞肺癌患者的放疗计划，根据肿瘤体积大小和位置不同，采用PTV区域剂量体积直方图（DVH）、剂量均匀指数（HI）、同侧和对侧肺组织接受照射的体积百分比V₅、V₁₀、V₂₀和V₃₀参数对物理计划进行评价，并对肿瘤贴近肺门患者的放疗计划，加入对侧肺组织保护进行优化，评价对侧肺和全肺组织的照射体积比。结果贴近胸壁肿瘤的照射体积比：同侧肺组织V₅≥（15.21±3.12）%，对侧肺组织V₅≥（1.34±0.67）%。贴近肺门的肿瘤的照射体积比：同侧肺组织V₅≥（39.4±11.90）%，对侧肺组织V₅≥（1.48±0.34）%。同侧和对侧肺组织的照射体积比均随肿瘤体积增大而增大。加入对侧肺部保护限制进行重新优化设计后，对侧肺和全肺的照射体积比V₅、V₁₀有明显的降低（t=2.44、4.81、3.53、3.17，P<0.05）。结论贴近肺门的肿瘤对同侧和对侧肺组织的放射性损伤明显高于贴近胸壁的肿瘤。加入对侧肺部保护进行优化放疗计划后，能够减小对侧肺和全肺组织的损伤，实现了保护正常肺部组织。

英文摘要:

Objective To analyze the radiation dose to the normal lung tissue of patients with early stage of non-small cell lung cancer treated by Cyberknife.Methods A retrospective analysis was conducted by summarizing the treatment plans of 264 patients with early stage non-small cell lung cancer from January 2011 to December 2013 in Tianjin Medical University Cancer Institute and Hospital. Sorted by the tumor volumes and locations, the Cyberknife plans were evaluated by means of dose volume histograms (DVH), homogeneity indexes (HI), percentage volumes receiving at least x Gy (V_x) of dose, i.e., V₅, V₁₀, V₂₀, and V₃₀ of the ipsilateral and contralateral lungs. For the tumors approximate to the hilus, the contralateral lungs were included in the optimization process, and the dose-volume metrics were analyzed for the contralateral and bilateral lungs.Results For the tumors close to the chest wall, V₅ ≥ (15.21±3.12)% in ipsilateral lung tissue and V₅ ≥ (1.34±0.67)% in contralateral lung tissue were observed. For the tumors near the hilus, V₅ ≥ (39.4±11.90)% in ipsilateral lung tissue and V₅ ≥ (1.48±0.34)% in contralateral lung tissue were observed. The irradiated volume ratios of both ipsilateral and contralateral lung tissue increased with the enlargement of tumor sizes. After including the contralateral lung tissue into the optimization, the irradiated volume ratios of the contralateral and bilateral lung tissue (V₅, V₁₀) decreased significantly(t=2.44, 4.81, 3.53, 3.17, P<0.05).Conclusions Higher risk of radiation injury in both ipsilateral and contralateral lung tissue can be expected for tumors near the hilus than near the chest wall. After including contralateral lung tissue into the planning optimization, lower dose to the contralateral and whole lung tissue was achieved, indicating a better protection of normal lung tissue.

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