| 曹洋森,李左峰,徐宁,郭晓晶,张火俊.胰腺癌质子调强与光子容积旋转调强计划的剂量学比较[J].中华放射医学与防护杂志,2022,42(2):103-109 |
| 胰腺癌质子调强与光子容积旋转调强计划的剂量学比较 |
| Comparisons of dose distributions between IMPT and VMAT for pancreatic cancer |
| 投稿时间：2021-07-27 |
| DOI：10.3760/cma.j.cn112271-20210727-00294 |
| 中文关键词: 胰腺癌 光子 质子 直线加速器 剂量分布 |
| 英文关键词:Pancreatic cancer Photon Proton Linear accelerator Dose distributions |
| 基金项目:上海申康临床"五新"创新研发项目（SHDC2020CR3087B） |
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| 中文摘要: |
| 目的 比较质子调强和光子容积旋转调强在胰腺癌大分割放射治疗计划中的剂量学差异。方法 回顾性选取10例胰腺癌患者临床资料，分别使用Eclipse和RayStation进行容积旋转调强治疗（VMAT）和质子调强治疗（IMPT）的计划设计。完成计划后的剂量文件统一导入MIM软件以提取评估参数。主要评估参数包括计划靶区（PTV）的Dmin、Dmean、Dmax、适形指数（CI）和新适形指数（nCI）、均匀指数（HI）、梯度指数（GI）、覆盖率（coverage）和危及器官的受照剂量。结果 靶区方面两组的适形性差异无统计学意义（P>0.05），VMAT组取得了更高的PTV Dmin、Dmax、D98%、D2%、HI和覆盖率以及更优的剂量梯度GI和D2 cm（t/Z=-4.63~5.32，P<0.05），IMPT组则获得了更低的10%_PD （t=-7.47，P<0.05）。危及器官方面，两组的空回肠最大剂量Dmax、胃Dmax、十二指肠Dmax以及左肾的平均剂量Dmean差异无统计学意义（P>0.05）。IMPT组在空回肠的体积剂量D5 cm3、胃的D10 cm3、十二指肠的D5 cm3及D10 cm3、左肾的D2/3、右肾的Dmean及D2/3上均低于VMAT组（t/Z=-8.12~-2.60，P<0.05），但是IMPT组脊髓的Dmax和D<sub>0.35 cm3均高于VMAT组（t=7.30、6.77，P<0.05）。结论 VMAT和IMPT都能实现满足临床要求的胰腺癌大分割放射治疗计划。二者在在毗邻胰腺靶区的胃肠道组织最大受量上的保护无差异，在胃肠道的体积受量保护上IMPT拥有更大优势，但对射束肿瘤靶区前缘的危及器官保护上可能弱于VMAT。 |
| 英文摘要: |
| Objective To compare dose distributions of hypofractionated radiotherapy for pancreatic cancer between IMPT and VMAT. Methods Ten pancreatic cancer cases were included in this retrospective study. Photon (Edge) and proton (Proteus®PLUS) plans were designed by Eclipse and RayStation TPS, respectively. All plans were transferred to MIM system for extraction of parameters, which included Dmin, Dmean and Dmax of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, Dmax and dose-volume of the organs at risk (OARs). Results There was no significant difference in CI between the two groups. The higher PTV Dmin, Dmean, Dmax, D98%, D2%, HI, coverage and the better GI, D2 cm were found in VMAT (t/Z=-4.63-5.32, P<0.05). The lower 10%_PD was found in IMPT (t=-7.47,P<0.05). Regarding the OARs, Dmax of the intestine, stomach, and duodenum and Dmean of the left kidney were similar between two groups without significant difference (P>0.05). The D5 cm3 of the intestine, D10 cm3 of the stomach, D5 cm3 and D10 cm3 of the duodenum, D2/3 of the left kidney, Dmean and D2/3 of the right kidney were lower in IMPT than those in VMAT (t/Z=-8.12——2.60, P<0.05). However, the Dmax and D0.35 cm3 of the spinal cord were higher in IMPT than those in VMAT (t=7.30, 6.77, P<0.05). Conclusions Both of hypofractionated radiotherapy plans of pancreatic cancer designed by VMAT and IMPT could meet clinical needs. No significant difference was found in Dmax of the adjacent gastrointestinal tracts between the two groups. While IMPT had the advantage over VMAT in the case of lower dose-volumes of the gastrointestinal tracts. Nevertheless, less protections of the OARs in front of the tumor volume could be provided by IMPT compared with VMAT. |
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