期刊文献+

非小细胞肺癌三维适形放疗过程中肿瘤退缩对剂量分布的影响 被引量:5

The impact of tumor regression on the dose distribution of the three dimensional conformal radiotherapy for non-small cell lung cancer
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摘要 背景与目的:放疗过程中,肿瘤退缩会造成其空间位置改变.进而可能影响肿瘤内放疗剌最分布。本研究探讨NSCLC放疗过程中肿瘤退缩对计划靶体积(TPV)和肿瘤周围关键器官剂量分布的影响.方法:选择从2003年1月-2005年12月,在我院接受根治性放疗的NSCLC患者10例。所有患者均行定位CT扫描,制定三维适形放疗计划,在放疗开始约4周后,大体肿瘤体积(GTV)剂量达到40—50Gy时,行第2次定位CT扫描,两次定位CT扫描,患者采用相同固定装置、保持相同体位。回顺性分析这些患者的定位CT:根据首次定位CT制定三维适形放疗计划Plan1,处方剂量为64Gy/32次;根据第2次定位CT制定的三维适形放疗计划Plan2,处方剂量为24Gy/12次;将Plan1的处方剂量更改为40Gy/20次.之后与Plan2叠加,形成计划Plan3,Plan3用于模拟开始放疗时采用Plan1.当GTV剂量达40Gy后,采用根据退缩后肿瘤制定的放疗计划Plan2完成冶疗、比较两次定位CT上GTV的体积;以D95(95%PTV体积接受的剂量)、D99和V100%(接受处方剂量的PTV体积所占的百分比)为参数,比较采用Plan1时,PTV1(根据首次定位CT确定的计划靶体积)和PTV2(根据第2次定位CT确定的计划靶体积)的剂量分布差异;以双肺(减去PTV的体积)接受大于20Gy照射的体积(V20)、甲均剂量(MLD),脊髓的最大剂量(Dmax)、1cm^3脊髓受到的剂量(D1cm^3),心脏的平均剂量(MHD),食管接受大于55Gy照射的体积(V55)、平均剂量(MED)为参数,比较采用Plan1与采用Plan3时肿瘤周围关键器官的剂量分布差异。资料采用配对t检验.结果:GTV剂量达到39.6~52.5Gy后,GTV体积绝对缩小量的中位值为:9.5cm^3(1.7~64.4cm^3),GTV体积相对缩小量的中位值为:22.35%(10.05%~54.81%),与放疗前相比,GTV的体积差异具有最菩性(P=0.015),、采用Plan1,PTV1与PTV2的剂量分布差异无显著性。Plan1与Plan3相比,正常肺组织、脊髓和食管的剂量分布差异无显著性;心脏接受的剂量在采用Plan3时减小(P=0.023).结论:NSCLC放疗过程中肿瘤退缩对PTV剂量分布未产生具有统计学显著性的影响.但是,根据退缩后的肿瘤重新制定放疗计划可以减少肿瘤周围关键器官接受的剂量,尤其是可以减少心脏接受的剂量。 Background and purpose: The dose distribution of tumor may be affected by geometrical changes due to tumor shrinkage during 3-DCRT for non-small cell lung cancer ( NSCLC). In this study, we evaluated the effect of tumor regression during treatment on the dose distribution of 3D-CRT fnr non-small cell lung cancer. Methods: Ten NSCLC patients, who received 3D-CRT in our hospital between Jan 2003 and Dec 2005, were entered into this study. All patients underwent simulation CT scans before radiotherapy and once during radiotherapy, after about 40 Gy. Target vohunes and critical organs were delineated on both CT scans. The gross tumor volumes of two CT scans were compared. Treatment plans, plan 1 and plan 2, were generated based on the two simulation CT scans, respectively. To evaluate the impact of tumor regression, the dose distribution of PTVI and PTV2 were compared when Plan 1 was used, and V20 of lung, mean lung dose (MLD), Dmax of spinal cord, D1cm^3 of spinal cord, mean heart dose(MHD), V55 of esophagus,mean esophagus dose (MED) were selected as the end points to compare the dose distribution of normal tissues when plan I was used with plan 3( the hybrid plan of plan 1 and plan 2) . Paired-samples t test was used for statistics. Results: The median absolute loss of the GTV was 9.5cm^3(1. 7-64.4 cm^3) after about 40 Gy radiotherapy, and the median relative loss of GTV was 22.35 % ( 10.05 % -54.81% ). The difference of GTV before treatment and after about 40 Gy radiotherapy have statistical significance( P =0.015). The dose distribution of PTV was not changed after about 40 Gy external beam radiotherapy, but a modified plan that was based on the intratreatment CT image could significantly diminish the treated heart volume. Conclusions: The conformal radiation therapy plan, based on the first simulation CT scan, still had good tumor coverage after about 40 Gy external beam radiotherapy despite the tumor regression. Replanning can significantly diminish the dose to the heart.
出处 《中国癌症杂志》 CAS CSCD 2007年第4期329-332,共4页 China Oncology
关键词 肺肿瘤 非小细胞肺癌 放射疗法 肿瘤退缩 lung neoplasm non-small cell lung cancer radiation therapy tumor regression
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参考文献8

  • 1Tyldesley S,Boyd C,Schulze K,et al.Estimating the need for radiotherapy for lung cancer:an evidence-based,epidemiologic approach[J].Int J Radiat Oncol Biol Phys,2001,49(4):973-985.
  • 2Kupelian PA,Bamsey C,Meeks SL,et al.Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer:observations on tumor regression during treatment[J].Int J Radiat Oncol Biol Phys.2005,63 (4):1024-1028.
  • 3谢松喜,李伟雄,林映如,邹文长.大分割三维适形放疗在非小细胞肺癌治疗中的应用[J].中国癌症杂志,2006,16(12):1034-1037. 被引量:7
  • 4王艳阳,傅小龙.CT在影像引导下放疗中应用的历史与现状[J].中国癌症杂志,2006,16(6):448-453. 被引量:22
  • 5Perez CA,Stanley K,Rubin P,et al.A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung.preliminary report by the Radiation Therapy Oncology Group[J].Cancer.1980,45 (11):2744-2753.
  • 6Van de Bunt L,van der Heide UA,Ketelaars M,et al.Conventional,conformal,and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer:The impact of tumor regression[J].Int J Radiat Oncol Biol Phys.2006,64(1):189-196.
  • 7吴开良,蒋国梁,王鹏,周莉均.肺癌三维适形放射治疗靶体积确定的影响因素[J].中华放射肿瘤学杂志,2003,12(3):188-191. 被引量:36
  • 8Giraud P,Antoine M,Larrouy A,et al.Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning[J].Int J Radiat Oncol Biol Phys,2000,48(4):1015-1024.

二级参考文献47

  • 1洪应中.肺野[A].见:荣独山主编.X线诊断学:第2版[C].上海:上海科学技术出版社,1993.37-38.
  • 2Seddon B, Bidmead M, Wilson J, et al. Target volmne definition in confonnal radiotherapy for prostate cancer: quality asaumace in the MRC RT-01 trial. Radiother Oncol,2000,56:73-83.
  • 3lnternational Commission on Radiation Units and Measurements.Prescribing, recording, and reporting photon beam therapy(Supplement to ICRU Report 50) ,ICRU Report,62.Bethesda:ICRU ,2000.
  • 4Harris K, Adams H, Lloyd D, et al. The effect on apparent size of simulated pulmmonary nodules of using three standard CT window setting. Clin Radiol,1993,47:421.
  • 5Musset D,Grenier P,Carrette M,et al.Primary lung cancer staging:prospective comparative study of MR imaging with CT. Radiology, 1986,11:160-167.
  • 6Lynch D. Radiology staging in lung cencer . Lung Grocer, 1997, 18 Suppl 2:98-99.
  • 7Beatrice S, Margaret B, Jane W, et al. Target volmne definition in conformal radiotherapy for prostate cancer: quality assurance in the MRC RT-01 trial. Radiother Oncol, 2000,56:73-83.
  • 8Giraud P, Antoine M, Larrouy A, et al. Evaluation of microscopic tumor extension in non-retail-cell lung cancer for three-dimensional conformal radioation therapy planning, lnt J Radial Oneol Biol Phys ,2000 ,48:1015-1024.
  • 9Rosenzweig KE, Sire S,Mychalclczak B,et al. Elective nodal irradiation in treament of non-small cell lung cancer with lhree-dimemional conformal radiation therapy(3D-CRF). Int J Radiat Oncol Biol Phys,1999,45(1 Suppl 3):243-244.
  • 10International Conanission d Radiation Units and Measurements.Prescribing, recordlng and reporting photon beam therapy, report No50.Bethesda: ICRU, 1993.

共引文献62

同被引文献28

  • 1胡松柳,徐向英.非小细胞肺癌三维适形放射治疗的研究现状[J].实用肿瘤学杂志,2006,20(5):448-451. 被引量:14
  • 2Sura S, Gupta V, Yorke E, et al.Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: the Memorial Sloan-Kettering Cancer Center (MSKCC)experience [J].Radiother Oncol, 2008, 87( 1 ) : 17-23.
  • 3Govaert SL,Troost EG, Schuurbiers OC,et al.Treatment outcome and toxicity of intensity-modulated(chemo) radiotherapy in stage III non- small cell lung cancer patients [ J ].Radiat Oncol, 2012,7 : 150.
  • 4Erridge SC,Seppenwoolde Y,Muller SH,et al. Portal imaging to assess set-up errors,tumor motion and tumor shrinkage during conformal radiotherapy of non-small cell lung cancer [J].Radiother Oncol, 2003,66( 1 ) :75-85.
  • 5Fox J,Ford E,Redmond K,et al. Quantification of tumor volume changes during radiotherapy for non-smallcell lung cancer[J ]Ant J Radiat Oncol Biol Phys, 2009,74( 2 ) : 341-348.
  • 6Butler EB, Teh BS, Grant WH, et al.Smart (simultaneous modulated accelerated radiation therapy) beost:a new accelerated fraetionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy[J].Int J Radiat Oncol Biol Phys, 1999,45 (1):21-32.
  • 7Ramsey CR,Langen KM,Kupelian PA,et al.A technique for adapti- ve image-guided helical tomotherapy for lung cancer[J].Int J Radiat Oncol Biol Phys, 2006,64 (4) : 1237-1244.
  • 8Kong FM,Ten Haken RK,Schipper MJ,et al.High-dose radiation improved local tumor control and overall survival in patients withinoperable/unresectable non-smallcell lung cancer: longterm results of a radiation dose escalation study[J ].Int J Radiat Oncol Biol Phys,2005,63(2):324-333.
  • 9Fox J, Ford E, Redmond K, et al. Quantification of tumor volume changes during radiotherapy for non - small- cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2009,74 (2) : 341 - 348.
  • 10Feng M,Kong FM,Gross M,et al. Using fluorodeox- yglucose positron emission tomography to assess tumor volume during radiotherapy for non - small - cell lung cancer and its potential impact on adaptive dose escalation and normal tissue sparing[J]. Int J Radiat Oneol Biol Phys, 2009,73 (4) : 1228 - 1234.

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