摘要
目的:比较VarianEclipse治疗计划系统和Truebeam加速器(VET)与ElektaMonaco治疗计划系统和Synergy加速器(EMS)两种精确放射治疗系统在立体定向放射治疗(SBRT)周围型肺癌的剂量学特点,为选择合适的精确放射治疗系统进行周围型肺癌SBRT提供参考。方法:选择在医院接受放射治疗的15例周围型肺癌患者,分别采用VET系统和EMS系统进行治疗,每个系统分别设计动态多叶准直器(DMLC)和容积旋转调强治疗(VMAT)两种计划(EMS-DMLC、EMSVMAT、VET-DMLC和VET-VMAT计划),处方剂量66 Gy/11次。对VET和EMS两种精确放射治疗系统的DMLC计划和VMAT计划进行比较,比较靶区的最大剂量(Dmax)、平均剂量(Dmean)、最小剂量(Dmin)、2%靶体积剂量(D2)、98%靶体积剂量(D98)、适形指数(CI)、均匀性指数(HI)及危及器官的受照剂量和机器跳数。结果:VET和EMS系统计划靶区D98的VET-DMLC与VET-VMAT比较、EMS-DMLC与EMS-VMAT计划比较、VET-VMAT与EMS-VMAT计划比较和VET-VMAT与EMS-DMLC计划比较,差异均有统计学意义(t=0.664,t=2.697,t=-4.674,t=-4.641;P<0.05)。危及器官剂量学比较中,VET系统对患侧肺保护优于EMS系统,患侧肺VET-DMLC计划与EMS-DMLC、EMS-VMAT比较,患侧肺平均剂量(MLD)、20%肺体积所受照剂量(V20)差异有统计学意义(tEMS-DMLC=-5.002,t=-4.467;tEMS-VMAT=-3.811,t=-4.449;P<0.05);VET-VMAT计划与EMS-DMLC、EMS-VMAT比较,患侧肺MLD、V20差异有统计学意义(tEMS-DMLC=-5.287,t=-3.520;tEMS-VMAT=-4.670,t=-3.123;P<0.05)。VET-DMLC计划健侧肺MDL、V5剂量学参数数值低于EMS-DMLC计划,差异有统计学意义(t=-3.717,t=-3.298;P<0.05)。心脏MHD剂量VET-DMLC计划优于EMS-DMLC,VET-VMAT计划优于EMS-VMAT,差异有统计学意义(t=-3.053,t=-2.892;P<0.05)。脊髓1 cc体积所受照剂量(D1cc)VET-DMLC计划优于VET-VMAT计划,差异有统计学意义(t=-3.018,P<0.05)。结论:VET和EMS两种精确放射治疗系统在周围型肺癌SBRT治疗中都能满足临床要求。EMS精确放射治疗系统靶区剂量学参数优于VET精确放射治疗系统,而VET精确放射治疗系统能更好的保护患侧肺和心脏。
Objective: To compare the dosimetric characteristics of two kinds of precise radiotherapy systems [Varian Eclipse treatment planning system with Truebeam accelerator(VET) and Elekta Monaco treatment planning system with Synergy accelerator(EMS)] in stereotactic body radiotherapy(SBRT) for peripheral lung cancer so as to provide reference for choosing suitable radiotherapy system in SBRT of peripheral lung cancer. Methods: 15 patients with peripheral lung cancer who underwent radiotherapy in hospital were selected and were implemented treatments by VET system and EMS system, respectively. And each system was designed dynamic multi leaf collimator(DMLC) plan and volumetric modulated arc therapy(VMAT) plan(EMS-DMLC, EMS-VMAT, VET-DMLC and VET-VMAT), respectively, and the prescribed dose was 66 Gy/11 times. The maximum dose(Dmax), average dose(Dmean), minimum dose(Dmin), D2, D98, conformal index(CI), homogeneous index(HI) of planning target, exposure dose of organ at risk(OAR) and monitor unit(MU) of two kinds of precise radiotherapy systems between DMLC plan and VMAT plan were compared. Results: The differences of D98 of planning target between VET-DMLC and VET-VMAT, between EMS-DMLC and EMS-VMAT, between VET-VMAT and EMS-VMAT, and between VET-VMAT and EMS-DMLC were significant(t=0.664, t=2.697, t=-4.674, t=-4.641, P<0.05). In the dosimetry comparison of OAR, the protective effect of VET system for affected-side of lung was better than that of EMS system, and the differences of MLD and V20 of affected-side of lung between VETDMLC and EMS-DMLC or EMS-VMAT were significant(tEMS-DMLC=-5.002, t=-4.467, tEMS-VMAT=-3.811, t=-4.449, P<0.05). The differences of MLD and V20 between VET-VMAT and EMS-DMLC or EMS-VMAT were significant(tEMS-DMLC=-5.287, t=-3.520, tEMS-VMAT=-4.670, t=-3.123, P<0.05). The MDL and V5 of health-side lung of VET-DMLC were significantly lower than those of EMS-DMLC(t=-3.717, t=-3.298, P<0.05). The MHD dose of heart of VET-DMLC was significantly better than that of EMS-DMLC, and the MHD dose of heart of VET-VMAT was significantly better than that of EMSVMAT(t=-3.053, t=-2.892, P<0.05). D1 cc dose of spinal cord of VET-DMLC plan were significantly superior to that of VET – VMAT(t=-3.018, P<0.05). Conclusion: Both the two kinds of precise radiotherapy system(VET and EMS) can meet clinical requirement of SBRT treatment for peripheral lung cancer. And the dosimetry parameters of target region of EMS precise radiotherapy system was better than VET precise radiotherapy system, while VET precise radiotherapy system can better protect affected-side lung and heart.
作者
陈星宇
孙博
王俊杰
CHEN Xing-yu;SUN Bo;WANG Jun-jie(Department of Radiotherapy,Peking University International Hospital,Beijing 102206,China)
出处
《中国医学装备》
2020年第8期39-45,共7页
China Medical Equipment
