| 张喜乐,杨瑞杰,孟娜,李孟昭,王俊杰,庄洪卿,田素青.Halo-Vest支架对颈椎原发恶性肿瘤放疗剂量分布的影响[J].中华放射医学与防护杂志,2020,40(8):612-617 |
| Halo-Vest支架对颈椎原发恶性肿瘤放疗剂量分布的影响 |
| Effect of Halo-Vest on dose distribution of radiotherapy for primary cervical spine malignant tumors |
| 投稿时间：2019-09-23 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.08.007 |
| 中文关键词: Halo-Vest支架 外轮廓 容积旋转调强放射治疗 固定野调强放射治疗 剂量 |
| 英文关键词:Halo-Vest Contour Volumetric-modulated arc therapy Intensity-modulated radiation therapy Dose |
| 基金项目:北京市自然科学基金（7202223）；北京市科技计划课题（Z201100005620012）；首都卫生发展科研专项（2020-2Z-40919） |
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| 中文摘要: |
| 目的 探讨Halo-Vest支架对颈椎原发恶性肿瘤不同放疗技术剂量分布的影响。方法 选择10例曾接受Halo-Vest支架手术后进行放射治疗的颈椎原发恶性肿瘤患者进行回顾性研究，使用Monaco计划系统，在勾画Halo-Vest支架结构外轮廓的CT序列图像上设计调强放疗（IMRT）和容积旋转调强放疗（VMAT）计划，然后复制相同射野参数的IMRT和VMAT计划到不勾画Halo-Vest支架结构外轮廓的CT序列图像上重新计算剂量分布，比较靶区、危及器官和正常组织的剂量分布差异。结果 对于VMAT计划，两组计划的计划靶区（PTV）和计划肿瘤靶区（PGTV）的剂量学参数除PGTV107%外的各参数平均差异均< 1%。相比外轮廓勾画Halo-Vest支架，外轮廓不勾画支架的图像计算的脊髓和脊髓-PRV平均最大剂量分别增加0.38和0.42 Gy（Z=-2.803、-2.803，P<0.05），脊髓和脊髓PRV Dmean分别增加0.35和0.37 Gy（Z=-2.703、-2.801，P<0.05）。黏膜、甲状腺、腮腺、下颌骨、下颌关节和正常组织的V5、V30和Dmean最大差异为0.74%。对于IMRT计划，两组计划的PTV和PGTV间剂量学参数差异较VMAT技术的差异增大，大部分差异超过1%，最大差异为4.55%。相比外轮廓勾画Halo-Vest支架，外轮廓不勾画支架的图像计算的脊髓平均最大剂量和脊髓-PRV最大剂量分别增加0.48和0.59 Gy（P>0.05），脊髓和脊髓PRV的平均Dmean分别增加0.57和0.59 Gy（Z=-2.293、-2.293，P<0.05）。其他危及器官的最大差异为1.98%。结论 CT图像外轮廓勾画或不勾画Halo-Vest支架结构，VMAT计划间剂量差异很小，临床上可以忽略，但IMRT计划间剂量差异偏大，需要考虑忽略或部分勾画Halo-Vest支架结构的外轮廓时对剂量分布带来的影响。 |
| 英文摘要: |
| Objective To investigate the effect of Halo-Vest on the dose distribution of different radiotherapy techniques for primary cervical spine malignant tumors. Methods Ten patients with primary cervical spine malignancies who underwent radiotherapy after Halo-Vest surgery were retrospectively studied. The IMRT and VMAT plans were designed on the contoured CT images including Halo-Vest delineations using Monaco planning system. The IMRT and VMAT plans with the same field parameters were duplicated to the CT images without the Halo-Vest delineations, and the dose distribution was recalculated. The dose distribution of the target, organs at risk and normal tissues was analyzed and compared for the plans with and without the Halo-Vest delineation. Results For most dosimetric parameters of VMAT plans, the mean deviations induced by the Halo-Vest were less than 1%, except for PGTV107%. Without Halo-Vest delineation, the mean maximum dose of spinal cord and spinal cord-PRV increased by 0.38 Gy and 0.42 Gy (Z=-2.803,-2.803,P<0.05), respectively. The mean Dmean of spinal cord and spinal cord PRV increased by 0.35 Gy and 0.37 Gy, respectively (Z=-2.703,-2.701,P<0.05). The maximum deviation observed in the mean V5, V30, and Dmean of mucosa, thyroid, parotid gland, mandible, mandibular joint, and normal tissues was 0.74%. For IMRT plans, larger dosimetric deviations than VMAT plans were observed in PTV and PGTV, most of which were more than 1.0% and the maximum deviation was 4.55%. The absence of Halo-Vest delineation increased the mean maximum dose of spinal cord and spinal cord-PRV by 0.48 Gy and 0.59 Gy (P>0.05), respectively. The mean Dmean of spinal cord and spinal cord PRV increased by 0.57 Gy and 0.59 Gy, respectively (Z=-2.293,-2.293,P<0.05). The maximum deviation of other organs at risk was 1.98%. Conclusions There are no clinically significant dose differences for VMAT planning with or without Halo-Vest delineation on the CT images. But the dosimetric impact of absent or partial Halo-Vest delineation on IMRT planning is relatively large and should be considered. |
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