摘要
目的:比较容积旋转调强放疗(VMAT)和适形调强放疗(IMRT)技术在非小细胞肺癌靶区和危及器官(OAR)的剂量学差异。方法:选取首程接受放射治疗的20例非小细胞肺癌患者,分别设计5野IMRT(5F-IMRT)、7野IMRT(7FIMRT)、双弧VMAT(D-VMAT)和部分弧VMAT(P-VMAT)计划,比较靶区剂量分布、OAR剂量体积参数。结果:4种计划中计划靶区的D_(mean)比较差异无统计学意义(P>0.05);两种VMAT计划中计划靶区的均匀性指数和适形度指数均优于两种IMRT(P<0.05);4种计划中D-VMAT肺平均剂量高于其余3种计划(P<0.05);P-VMAT的双肺V_5、V_(10)稍好于DVMAT(P<0.05),但两种VMAT计划均高于两种IMRT计划(P<0.05);4种计划中P-VMAT的双肺V_(20)最优,且4种计划相互间比较差异有统计学意义(P<0.05);D-VMAT与P-VMAT双肺的V_(30)相当(P>0.05),但均优于两种IMRT计划(P<0.05);4种计划双肺V_(40)和心脏的V_(30)、V_(40)比较差异无统计学意义(P>0.05)。P-VMAT计划的脊髓D_(max)最低,与其余计划相比差异均有统计学意义(P<0.05)。结论:非小细胞肺癌靶区剂量分布D-VMAT和P-VMAT好于IMRT计划。P-VMAT在OAR的保护方面体现的优势更多。综合考虑,非小细胞肺癌的放疗优先推荐P-VMAT,但对于重点考虑肺低剂量区,而次要考虑靶区剂量分布的病例推荐7F-IMRT。
Objective To compare the dosimetric differences in target areas and organs-at-risk （OAR） between volumetric modulated arc therapy （VMAT） and intensity-modulated radiotherapy （IMRT） for non-small cell lung cancer （NSCLC）. Methods Four different kinds of plans, namely 5-field IMRT （5F-IMRT）, 7-field IMRT （7F-IMRT）, double-arc VMAT （D-VMAT） and partial-arc VMAT （P-VMAT）, were designed for 20 NSCLC patients receiving radiotherapy for the first course. The dose distribution in target areas and OAR dose-volume parameters were compared. Results No significant differences were found in the Dmean of planning target areas among the 4 plans （P〉0.05）. The homogeneity index and conformal index of two VMAT plans were better than those of two IMRT plans （P〈0.05）. Compared with the other 3 plans, D-VMAT plans had the highest mean lung dose （P〈0.05）. The V5 and V10 of lungs in P-VMAT plan were slightly better than those in D-VMAT plan （P〈0.05）, and both of them were higher than those in two IMRT plans （P〈0.05）. The V20 of lungs in P-VMAT was the optimal among the 4 plans, and the differences between the 4 plans were statistically significant （P〈0.05）. D-VMAT and P-VMAT plans had similar V30 of lungs （P〉0.05）, superior to two IMRT plans （P〈0.05）. The comparison of the V30 of lungs and the V30, V40 of heart between the 4 plans didn’t showed any statistical differences （P〉0.05）. The Dmax of spinal cord in P-VMAT was the lowest among the 4 plans, and the differences were statistically significant as compared with other plans （P〈0.05）. Conclusion The target dose distributions in D-VMAT and P-VMAT plans for NSCLC are better than those in IMRT plans, moreover, P-VMAT shows more advantages in OAR sparing. Therefore, P-VMAT is recommended preferentially in radiotherapy for NSCLC, but 7F-IMRT is recommended for cases in which the low dose areas of lung is the main focus, while the target dose distribution is secondarily considered.
作者
蔡俊涛
陈凡
王财
冯瑞兴
殷麟
常巧梅
王晓莉
刘子宁
林晶
CAI Juntao;CHEN Fan;WANG Cai;FENG Ruixing;YIN Lin;CHANG Qiaomei;WANG Xiaoli;LIU Zining;LIN Jing(Department of Radiation Oncology, Affiliated Hospital of Qinghai University, Xining 810001, China)
出处
《中国医学物理学杂志》
CSCD
2018年第4期389-393,共5页
Chinese Journal of Medical Physics
基金
青海省科技支撑计划项目(2015-SF-131)
关键词
非小细胞肺癌
容积旋转调强放疗
调强放疗
放射治疗剂量
non-small cell lung cancer
volumetric modulated arc therapy
intensity-modulated radiotherapy
radiotherapic dose
