摘要
目的:探讨直肠癌术后患者在Monaco计划系统中采用3种不同通量平滑方式设计容积旋转调强放射治疗(VMAT)计划的剂量学差异。方法:采用医科达Monaco5.11计划系统对随机选取的16例直肠癌患者影像学资料,使用3种通量平滑方式在相同优化条件下设计3组VMAT计划(即FSH组、FSM组和FSL组),并用Matrixx二维平板探测器行剂量验证。评估靶区和危及器官(OAR)剂量-体积参数,以及CI、HI、GI、MU、CP、出束时间(T)和γ通过率(GRP)的差异。结果:FSL的CI明显优于FSM和FSH,HI略优于FSM和FSH,GI与FSM两者相近,均好于FSH组。FSL和FSM两者在提高PTV的Dmin和D98%方面均有明显优势,相比FSH可最大提高2.84%,差异有统计学意义(P<0.05)。在OAR方面,膀胱的Dmean、V30和V40,FSL较FSM和FSH均降低,最大为3.76%和7.01%,差异有统计学意义(P<0.05);右侧股骨头的Dmean和V20,FSL较FSM与FSH可最大降低为9.10%,差异有统计学意义(P<0.05);FSL和FSM在左侧股骨头保护方面,均略优于FSH;在肠道保护方面,三者结果相近。FSH和FSM的平均值较FSL对CP降低15.93%和8.68%,对MU降低14.30%和8.33%,对T可减少13.39%和6.91%,差异有统计学意义(P<0.05)。3组计划的GRP在3%/3mm标准下均大于99%,均满足临床要求,但在1%/1mm和2%/2mm较高标准下,FSH和FSM的GRP相近,均明显高于FSL,差异有统计学意义(P<0.05)。结论:在直肠癌术后VMAT计划中,FSH、FSM和FSL 3组计划的剂量学参数和GRP均能满足临床要求。在提高计划质量,降低膀胱和股骨头受照射剂量及毒副反应方面,FSL依次优于FSM和FSH;在提高计划执行效率方面,FSH和FSM好于FSL。因此,在计划设计时,要根据临床要求和患者个体差异综合考虑,可优先选择FSM,既能满足较好的计划质量也能提高计划执行效率。
Objective:To investigate the dosimetric differences of volume rotary intensity modulated radiotherapy(VMAT)plan designed by three different flux smoothing methods in Monaco plan system.Methods:16 patients with rectal cancer were randomly selected to design VMAT plans(FSH,FSM,FSL)by three different fluence smoothing modes under the same optimized conditions and used the Monaco 5.11 TPS and the VersaHD accelerator model.The dose verification was measured by matrixx detector.The parameters mainly included the target volume and OAR dose-volume histogram,as well as conformity index(CI),homogeneity index(HI),dose gradient index(GI),monitor unit(MU),control point(CP),beam time(T)and gamma pass rate(GRP)were considered.Results:Ci of FSL was significantly better than that of FSM and FSH,hi was slightly better than that of FSM and FSH,GI was similar to that of FSM,and both were better than that of FSH group.Both FSL and FSM had obvious advantages in increasing Dmin and D98%of PTV.Compared with FSH,FSL and FSM could increase by 2.84%(P<0.05).In oar,Dmean,V30,V40 and FSL of bladder were lower than those of FSM and FSH,with the maximum of 3.76%and 7.01%(P<0.05);Dmean,V20 and FSL of the right femoral head decreased by 9.10%compared with FSM and FSH(P<0.05);FSL and FSM were slightly better than FSH in the protection of left femoral head;In terms of intestinal protection,the results of the three were similar.The average values of FSH and FSM were 15.93%and 8.68%lower than that of FSL for CP,were decreased by 14.30%and 8.33%for mu,13.39%and 6.91%for t(P<0.05).The difference was statistically significant(P<0.05).The planned GRP of the three groups was greater than 99%under the standard of 3%/3mm,which met the clinical requirements.However,under the higher standard of 1%/1mm and 2%/2mm,the GRP of FSH and FSM was similar,which was significantly higher than that of FSL(P<0.05).Conclusion:In the postoperative VMAT plan for rectal cancer,the dosimetric parameters and GRP of FSH,FSM and FSL can meet the clinical requirements.FSL is superior to FSM and FSH in improving the quality of the plan,reducing the radiation dose and toxic and side effects of bladder and femoral head;FSH and FSM are better than FSL in improving the efficiency of plan implementation.Therefore,when designing the plan,we should comprehensively consider the clinical requirements and individual differences of patients,and give priority to FSM,which can not only meet the better plan quality,but also improve the plan implementation efficiency.
作者
葛双
王寻
郗会珍
马俊
叶书成
陈长建
陈其超
马守印
徐宁
GE Shuang;WANG Xun;CHI Huizhen(Affiliated Hospital of Jining Medical University, Shandong Jining 272001, China)
出处
《河北医学》
CAS
2021年第11期1888-1894,共7页
Hebei Medicine
基金
济宁医学院附属医院苗圃科研计划项目,(编号:MP-2018-024)
中华国际医学交流基金会肿瘤精准放疗星火计划科研项目,(编号:2019-N-11-22)。
