中华放射医学与防护杂志

杨继明,陆婷,马敏,吴勇,周瑛瑛,任江平,王洵,郭建新.三种固定野调强计划在鼻腔及鼻旁窦肿瘤放疗中的对比研究[J].中华放射医学与防护杂志,2022,42(12):950-957

三种固定野调强计划在鼻腔及鼻旁窦肿瘤放疗中的对比研究

Comparison of three fixed-field IMRT plans for nasal cavity and paranasal sinus tumors

投稿时间：2022-08-24

DOI：10.3760/cma.j.cn12271-20220824-00342

基金项目:

作者	单位	E-mail
杨继明	宁波市第一医院放化疗中心, 宁波 315000
陆婷	青海红十字医院肿瘤放疗科, 西宁 810000
马敏	国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科, 北京 100021
吴勇	兴义市人民医院放疗科, 兴义 562400
周瑛瑛	宁波市第一医院放化疗中心, 宁波 315000
任江平	宁波市第一医院放化疗中心, 宁波 315000
王洵	中国科学院大学宁波华美医院, 宁波 315000
郭建新	宁波市第一医院放化疗中心, 宁波 315000	gjx1696@yeah.net

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中文摘要:

目的对比3种鼻腔及鼻旁窦肿瘤的固定野调强放射治疗计划,包括基于常规C型臂加速器(Trilogy)的共面调强放疗(IMRT)(C-IMRT)、非共面IMRT (NC-IMRT)和基于O型环加速器(Halcyon)的共面IMRT (H-IMRT)计划。方法选择2018年12月至2021年12月在宁波市第一医院的10例鼻腔及鼻旁窦肿瘤术后放疗患者的资料,以相同处方剂量和目标条件重新设计3种计划,比较靶区和危及器官剂量、验证通过率以及执行时间的差异。统计方法采用Friedman检验,结果有差异时进一步多重比较。结果 3种计划关于计划靶区(PTV)和PTV_boost适形指数CI的差异有统计学意义(χ²=7.51、9.69,P < 0.05);多重比较显示H-IMRT高于NC-IMRT (Z=2.53、2.68,P < 0.05),其他靶区参数差异均无统计学意义(P>0.05)。H-IMRT较C-IMRT计划降低了双侧眼晶状体、双侧角膜、患侧视神经和患侧眼球的D_max(Z=2.80、2.80、2.80、2.80、2.81、2.09,P < 0.05)。NC-IMRT与C-IMRT计划相比降低了双侧眼晶状体、角膜、眼球和对侧视神经的D_max(Z=2.80、2.66、2.80、2.70、2.29、2.29、2.65,P < 0.05),同时减小了双侧眼球的D_mean(Z=2.80、2.80,P < 0.05)。H-IMRT较NC-IMRT计划的患侧眼晶状体和角膜D_max有所下降(Z=2.50、2.08,P < 0.05),但对侧视神经D_max和双侧眼球的D_mean更高(Z=2.80、2.80、2.80,P < 0.05)。3种计划的验证通过率均满足机构标准,差异无统计学意义(P>0.05)。此外,H-IMRT执行计划的中位用时最短(172.00 s),C-IMRT次之(337.50 s),NC-IMRT最长(388.00 s)。结论所有计划的验证通过率均可满足治疗实施要求;3种计划的靶区剂量学差异相近,但H-IMRT和NC-IMRT对正常组织尤其是眼部各器官的保护更好,有利于降低放疗不良反应,亦为肿瘤局部加量或复发的再程放疗提供剂量空间;执行效率方面,H-IMRT > C-IMRT > NC-IMRT。建议根据实际情况选择合适的放疗设备和技术。

英文摘要:

Objective To compare three fixed-field intensity-modulated radiotherapy (IMRT) plans for nasal cavity and paranasal sinus tumors, including the coplanar IMRT (C-IMRT) plan and the non-coplanar IMRT(NC-IMRT) plan which were based on a conventional C-arm LINAC (Trilogy), and the coplanar IMRT (H-IMRT) plan based on an O-ring LINAC (Halcyon).Methods Based on the data of 10 patients in the Ningbo First Hospital from December 2018 to December 2021 with nasal cavity and paranasal sinus tumors who underwent postoperative radiotherapy, this study redesigned three IMRT plans with the same prescribed doses and optimization objectives. Then, this study compared the doses of target volumes and organ at risks(OARs), the validation pass rates, and the execution time of these plans. Friedman test was employed in this study, and multiple comparisons were further made in cases of different results.Results The differences in the conformal index (CI) of PTV and PTV_boost of the three plans were statistically significant (χ² = 7.51, 9.69, P < 0.05). The multiple comparisons showed that the median CI of the H-IMRT plan was higher than that of the NC-IMRT plan (Z = 2.53, 2.68, P < 0.05). The differences in other parameters of target volumes were not statistically significant. Compared with the C-IMRT plan, the H-IMRT plan reduced the D_max of bilateral lenses, bilateral corneas, ipsilateral optic nerve, and ipsilateral eyeball (Z = 2.80, 2.80, 2.80, 2.80, 2.81, 2.09, P < 0.05). Compared with the C-IMRT plan, the NC-IMRT reduced the D_max of bilateral lenses, corneas, and eyeballs and contralateral optic nerve (Z = 2.80, 2.66, 2.80, 2.70, 2.29, 2.29, 2.65, P < 0.05) and reduced the D_mean of bilateral eyeballs (Z = 2.80, 2.80, P < 0.05). Compared with the NC-IMRT plan, the H-IMRT plan reduced the D_max of the ipsilateral lens and cornea (Z = 2.50, 2.08, P < 0.05), but increased the D_max of the contralateral optic nerve and the D_mean of bilateral eyeballs (Z = 2.80, 2.80, 2.80, P < 0.05). The validation pass rate of the three plans met the institutional standards, and the differences were not statistically significant. Moreover, the H-IMRT plan had the shortest median execution time (172.00 s), followed by the C-IMRT plan (337.50 s), and the NC-IMRT plan (388.00 s).Conclusions The verification pass rate of the three plans can achieve the requirements of treatment implementation. The three plans had similar dosimetric differences in target volumes. However, the H-IMRT and NC-IMRT plans can protect the normal tissues (especially optical organs) more effectively than the C-IMRT plan, which is conducive to reducing the toxicity after radiotherapy and provides space for local dose increase or the radiotherapy for the treatment of tumor recurrence. The execution efficiency of the three plans is in the order of H-IMRT > C-IMRT > NC-IMRT. It is necessary to select appropriate radiotherapy equipment and technology according to actual situations.

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