中华放射医学与防护杂志

李克新,鞠永健,曹丽媛,等.前列腺癌患者定位与调强放疗时膀胱充盈程度不一致对剂量学参数的影响[J].中华放射医学与防护杂志,2019,39(3):192-196.Li Kexin,Ju Yongjian,Cao Liyuan,et al.The dosimetric effect of inconsistency of bladder filling states between CT simulation and IMRT treatment for prostate cancer patients[J].Chin J Radiol Med Prot,2019,39(3):192-196

前列腺癌患者定位与调强放疗时膀胱充盈程度不一致对剂量学参数的影响

The dosimetric effect of inconsistency of bladder filling states between CT simulation and IMRT treatment for prostate cancer patients

投稿时间：2018-05-31

DOI：10.3760/cma.j.issn.0254-5098.2019.03.006

中文关键词: 膀胱体积前列腺癌锥形束CT 剂量学参数

英文关键词:Bladder volume Prostate cancer CBCT Dosimetric parameters

基金项目:国家自然科学基金资助项目（10705016）；江苏省六大人才高峰课题（2014-WSN-075）

作者	单位	E-mail
李克新	南通市第一人民医院放疗科 226001
鞠永健	南通市第一人民医院放疗科 226001	juyongjian@aliyun.com
曹丽媛	南通市第一人民医院放疗科 226001
张亮	南通市第一人民医院放疗科 226001
高璇	南通市第一人民医院放疗科 226001

摘要点击次数: 3635

全文下载次数: 1869

中文摘要:

目的分析前列腺癌调强放疗患者治疗与定位时膀胱充盈程度不一致对剂量学参数的影响。方法 42例行调强放疗的前列腺癌患者，真空垫体位固定后行定位CT扫描，用放疗计划系统进行靶区和危及器官勾画、计划设计及计算。患者首次治疗时行锥形束CT（CBCT），与定位CT图像配准后将CBCT图像导入计划系统，将定位CT计划的靶区拷贝至CBCT图像上，并勾画危及器官，采用与定位CT计划相同的计划设计进行剂量计算。比较定位CT计划和CBCT计划获得的剂量学参数差异，包括计划靶区（PTV）平均剂量、均匀性指数（HI）、适形指数（CI）；膀胱及直肠的平均剂量、V₃₀、V₄₀、V₅₀、V₆₀、V₆₅。结果根据治疗与定位时相比膀胱体积变化，将患者分为膀胱体积缩小组和膀胱体积增大组，42例患者中膀胱体积缩小组有27例，膀胱体积增大组有15例。定位CT计划与CBCT计划比较，下列剂量学参数差异有统计学意义：两组膀胱体积、PTV HI、PTV CI（t=6.838、-4.372、-3.553、-3.462、6.380、5.037，P<0.05）；膀胱体积缩小组膀胱V₃₀、V₄₀、V₅₀、V₆₀、V₆₅（t=-5.004、-4.092、-3.124、-2.707、-2.489，P <0.05）和直肠V₄₀、V₅₀、V₆₀、V₆₅、平均剂量（t=-2.946、-2.643、-2.426、-3.127、-2.530，P <0.05）；膀胱体积增大组膀胱V₃₀、V₄₀、V₅₀及平均剂量（t=5.107、4.204、3.777、4.155，P <0.05）。结论前列腺癌患者进行调强放疗时，定位和治疗时膀胱充盈程度不一致，会导致靶区及危及器官剂量学参数实际数值与治疗计划计算结果存在差异。

英文摘要:

Objective To analyze the dosimetric effect of inconsistent bladder filling states between the CT simulation and treatment for prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT). Methods A total of 42 prostate cancer patients treated with IMRT were selected. After vacuum pad immobilization and simulation CT scan, the delineation of targets and organs-at-risk (OARs), treatment planning and dose calculation were performed on treatment planning system (TPS). The cone-beam-CT (CBCT) acquired before the first treatment was registered to planning CT, on which the target contours were duplicated and OARs were delineated. After dose recalculation on the CBCT using the same plan, the dosimetric differences on the CT and CBCT were compared, including mean dose of the planning target volume (PTV), homogeneity index (HI), conformity index (CI); the mean dose, V₃₀, V₄₀, V₅₀, V₆₀, and V₆₅ of bladder and rectum respectively. Results Relative to the bladder volumes at simulation, the patients were divided into two groups with larger (15 cases) or smaller (27 cases) bladders at the first treatment. Comparing the parameters obtained from simulation CT with that from CBCT, the differences of the following parameters were of statistical significance:the bladder volume, PTV HI, PTV CI in both groups (t=6.838, -4.372, -3.553, -3.462, 6.380, 5.037, P<0.05), the bladder V₃₀, V₄₀, V₅₀, V₆₀, V₆₅ (t=-5.004, -4.092, -3.124, -2.707, -2.489, P <0.05) and rectal V₄₀, V₅₀, V₆₀, V₆₅, mean dose in the group with smaller bladders (t=-2.946, -2.643, -2.426, -3.127, -2.530, P <0.05), and the bladder V₃₀, V₄₀, V₅₀ and mean dose in group with larger bladders (t=5.107, 4.204, 3.777, 4.155, P<0.05). Conclusions For prostate cancer patients undergoing IMRT, the inconsistent bladder filling states between the planning and treatment will cause disimetric differences of targets and OARs.

HTML 查看全文查看/发表评论下载PDF阅读器

关闭