中华放射医学与防护杂志

晏川钧,王先良,温爱萍,罗静月,王培,黎杰.宫颈癌腔内联合组织间插植近距离治疗优化算法剂量学分析研究[J].中华放射医学与防护杂志,2023,43(7):524-531

宫颈癌腔内联合组织间插植近距离治疗优化算法剂量学分析研究

Dosimetric analysis of the optimization algorithm for intracavitary/interstitial brachytherapy of cervical cancer

投稿时间：2023-01-10

DOI：10.3760/cma.j.cn112271-20230110-00009

中文关键词: 宫颈癌|腔内/组织间插植近距离治疗|等效均匀生物有效剂量|肿瘤控制率|正常组织并发症

英文关键词:Cervical cancer|Intracavitary/interstitial brachytherapy|Equivalent uniform biologically effective dose|Tumor control probability|Normal tissue complication

基金项目:四川省科技计划资助项目(2022YFG0194,2022YFS0047,2021YFG0320,2020YJ0446);肿瘤医工创新基金(ZYGX2021YGCX002)

作者	单位	E-mail
晏川钧	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042
王先良	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042
温爱萍	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042
罗静月	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042
王培	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042
黎杰	四川省肿瘤临床医学研究中心四川省肿瘤医院研究所四川省癌症防治中心放疗科放射肿瘤学四川省重点实验室, 成都 610042	jie.li@yeah.net

摘要点击次数: 843

全文下载次数: 315

中文摘要:

目的在宫颈癌腔内联合组织间插植近距离治疗(IC/ISBT)中,基于剂量学及生物学模型的帮助,进行图形优化(GO)、模拟退火逆向计划优化算法(IPSA)和混合逆向计划优化算法(HIPO)的比较分析,为宫颈癌IC/ISBT治疗优化方法的选择提供依据。方法选取65例接受影像引导下IC/ISBT的宫颈癌患者。所有患者后装治疗计划分别采用GO、IPSA、HIPO优化的方式制定3次,处方剂量高危临床靶区体积(HRCTV)D₉₀均为6 Gy。针对3种优化方案的用时、剂量-体积参数及放射生物学差异,采用非参数Friedman检验以及非参数Wilcoxon秩检验进行比较分析。结果逆向计划优化耗时均较正向计划耗时短,时间分别是GO 135.03 s、IPSA 46.53 s、HIPO 98.36 s,肿瘤靶区剂量中高剂量照射的V_150%(53.66%)在HIPO计划中略高,而高剂量照射的V_200%(30.29%)在GO计划中更高。GO的适形度指数(CI)(0.91)较其他计划更好,差异具有统计学意义(χ²=69.98,P<0.001)。HIPO计划的膀胱与直肠的D_<sub>1 cm³、D_{2 cm³}受照射量较低,小肠受照射量与其他计划差异无统计学意义(P＞0.05)。HIPO计划中HRCTV的等效均匀生物有效剂量(EUBED)(12.35 Gy)比GO(12.23 Gy)、IPSA(12.13 Gy)高,膀胱处的EUBED在GO(2.38 Gy)计划中最低,直肠处的EUBED在HIPO(3.74 Gy)计划中最低,小肠的EUBED 3种优化方式未见明显差异(P＞0.05)。3种优化计划预测的肿瘤控制率(TCP)差异无统计学意义(P=0.055),HIPO计划预测膀胱与直肠的正常组织并发症概率(NTCP)比GO、IPSA计划低(χ²=12.95~38.43,P<0.01),小肠的NTCP未见明显区别(P＞0.05)。结论 3种优化方法中,两种逆向优化方式均较正向优化耗时短。GO计划较IPSA、HIPO计划更适形。HIPO计划可以增加靶区生物学覆盖剂量,减少膀胱与直肠处的最大物理或生物受照射量和NTCP。推荐优先使用HIPO作为宫颈癌IC/ISBT的优化算法。

英文摘要:

Objective To provide a basis for selecting the optimization method for intracavitary/interstitial brachytherapy (IC/ISBT) of cervical cancer by comparing graphical optimization (GO), inverse planning simulated annealing (IPSA), and hybrid inverse planning optimization (HIPO) using dosimetric and radiobiological models. Methods This study selected 65 patients with cervical cancer who were treated with image-guided IC/ISBT. The afterloading therapy plans for these patients were optimized using GO, IPSA, and HIPO individually, with a prescription dose high-risk clinical target volume (HRCTV) D₉₀ of 6 Gy. The non-parametric Friedman test and the non-parametric Wilcoxon rank test were employed to analyze the differences in duration, dose-volume parameters, and radiobiology between the three types of optimized plans. Results Inverse planning optimization (IPSA: 46.53 s; HIPO: 98.36 s) took less time than GO (135.03 s). In terms of gross target volume (GTV) dose, the high-dose irradiation V_150% (53.66%) was slightly higher in the HIPO-optimized plans, while the V_200% (30.29%) was higher in the GO-optimized plans. The GO-optimized plans had a higher conformity index (CI; 0.91) than other plans, showing statistically significant differences. Compared with other plans, the HIPO-optimized plans showed the lowest doses of D_{1 cm³} and D_{2 cm³} at bladders and rectums and non-statistically significant doses at small intestines (P ＞ 0.05). In terms of the equivalent uniform biologically effective dose (EUBED) for HRCTV, the HIPO-optimized plans showed a higher value (12.35 Gy) than the GO-optimized plans (12.23 Gy) and the IPSA-optimized plans (12.13 Gy). Moreover, the EUBED at bladders was the lowest (2.38 Gy) in the GO-optimized plans, the EUBED at rectums was the lowest (3.74 Gy) in the HIPO-optimized plans, and the EUBED at small intestines was non-significantly different among the three types of optimized plans (P = 0.055). There was no significant difference in the tumor control probability (TCP) predicted using the three types of optimized plans (P ＞ 0.05). The normal tissue complication probabilities (NTCPs) of bladders and rectums predicted using the HIPO-optimized plans were lower than those predicted using the GO- and IPSA-optimized plans(χ² ＝ 12.95-38.43, P < 0.01), and the NTCP of small intestines did not show significant differences (P ＞ 0.05). Conclusions Among the three types of optimization algorithms, inverse optimization takes less time than GO. GO-optimized plans are more conformal than IPSA- and HIPO-optimized plans. HIPO-optimized plans can increase the biological coverage dose of the target volume and reduce the maximum physical/biological exposure and NTCP at bladders and rectums. Therefore, HIPO is recommended preferentially as an optimization algorithm for IC/ISBT for cervical cancer.

HTML 查看全文查看/发表评论下载PDF阅读器

关闭