头颈部肿瘤容积调强旋转放疗和适形调强放疗剂量学比较

doi:10.3760/cma.j.cn371439-20200224-00057

摘要/Abstract

摘要：

目的比较头颈部肿瘤容积调强旋转放疗(VMAT)和适形调强放疗(IMRT)的剂量学差异。方法选取2019年1月至2019年12月安徽医科大学第一附属医院经病理证实的46例头颈部肿瘤患者,所有患者采取仰卧位做CT模拟。勾画两个处方剂量水平的计划靶区(PTV),PTV70和PTV54,35次分割。使用同步加量计划。每例患者分别制定VMAT和IMRT计划,比较两者的剂量学差异。结果 VMAT计划PTV70的适形性指数(CI)95%高于IMRT计划(0.91±0.02 vs. 0.86±0.06),差异有统计学意义(t=4.933,P=0.004)。VMAT计划PTV54的均质性指数(HI)95%优于IMRT(0.09±0.04 vs. 0.26±0.02),差异有统计学意义(t=4.548,P=0.038)。 VMAT的脊髓D_1%低于IMRT(37.62±4.34 vs. 40.93±7.45),差异有统计学意义(t=2.615,P=0.045)。VMAT的左腮腺剂量为(21.28±8.13)Gy,右腮腺剂量为(22.39±7.42)Gy,比IMRT[(22.73±11.42)Gy和(24.25±7.91)Gy]略低,但差异无统计学意义(t=0.703,P=0.322;t=1.134,P=0.315)。与IMRT相比,VMAT可大幅降低机器跳数(521±112 vs. 2 129±564),明显缩短患者治疗时间[(2.12±0.39)min vs.(9.18±2.62)min],差异均有统计学意义(t=18.957,P<0.001;t=18.213,P<0.001)。结论 VMAT技术的剂量分布优于IMRT,危及器官受量降低,并且可减少机器跳数,缩短治疗时间。

关键词: 头颈部肿瘤, 放射疗法,调强适形, 放射治疗剂量

Abstract:

Objective To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for head and neck cancer. Methods From January 2019 to December 2019, 46 cases of patients with head and neck cancer confirmed by pathology in the First Affiliated Hospital of Anhui Medical University were selected. All patients underwent CT-simulation in supine position. Planning target volumes (PTVs) were delineated for two dose levels of PTV70 and PTV54 in 35 equal fraction. Simultaneous integrated boost plan was generated for all patients and optimized with both techniques, VMAT and IMRT with similar planning objectives. The dosimetry differences between the two plans were compared. Results The conformity index (CI)95% of PTV70 in VMAT plan was higher than that in IMRT plan (0.91±0.02 vs. 0.86±0.06), and the difference was statistically significant (t=4.933, P=0.004). The homogeneity index (HI)95% of PTV54 in VMAT plan was superior to that in IMRT (0.09±0.04 vs. 0.26±0.02), and the difference was statistically significant (t=4.548, P=0.038). The spinal cord D_1% of VMAT was lower than that in IMRT (37.62±4.34 vs. 40.93±7.45), and the difference was statistically significant (t=2.615, P=0.045). The dose of left parotid gland in VMAT was (21.28±8.13) Gy and the dose of right parotid gland was (22.39±7.42) Gy, which were slightly lower than those in IMRT [(22.73±11.42) Gy and (24.25±7.91) Gy], but the differences were not statistically significant (t=0.703, P=0.322; t=1.134, P=0.315). Compared with IMRT, VMAT could significantly reduce the number of monitor units (521±112 vs. 2 129±564), and could significantly shorten the treatment time of patients [(2.12±0.39) min vs. (9.18±2.62) min], and the differences were statistically significant (t=18.957, P<0.001; t=18.213, P<0.001). Conclusion The dose distribution of VMAT technology is better than IMRT, the dose of organ at risk is reduced, the monitor unit is lesser, and the treatment time is shorter.

Key words: Head and neck neoplasms, Radiotherapy,intensity-modulated, Radiotherapy dosage

钱雯川, 王凡. 头颈部肿瘤容积调强旋转放疗和适形调强放疗剂量学比较[J]. 国际肿瘤学杂志, 2020, 47(8): 457-461.

Qian Wenchuan, Wang Fan. A dosimetric comparison of volumetric modulated arc therapy with intensity modulated radiation therapy for head and neck cancer[J]. Journal of International Oncology, 2020, 47(8): 457-461.

图/表 2

表1

表2

参考文献 12

[1]	Studenski MT, Voichita BA, Joshua S, et al. Clinical experience transitioning from IMRT to VMAT for head and neck cancer[J]. Med Dosim, 2013,38(2):171-175. DOI: 10.1016/j.meddos.2012.10.009. doi: 10.1016/j.meddos.2012.10.009
[2]	Zhang T, Liang ZW, Han J, et al. Double-arc volumetric modulated therapy improves dose distribution compared to static gantry IMRT and 3D conformal radiotherapy for adjuvant therapy of gastric cancer[J]. Radiat Oncol, 2015,10:114. DOI: 10.1186/s13014-015-0420-x. pmid: 25986069
[3]	Otto K. Volumetric modulated arc therapy: IMRT in a single arc[J]. Med Phys, 2008,35(1):310-317. DOI: 10.1118/1.2818738. pmid: 18293586
[4]	Johnston M, Clifford S, Bromley R, et al. Volumetric-modulated arctherapy in head and neck radiotherapy: a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma[J]. Clin Oncol (R Coll Radiol), 2011,23(8):503-511. DOI: 10.1016/j.clon.2011.02.002. doi: 10.1016/j.clon.2011.02.002
[5]	Clivio A, Fogliata A, Franzetti-Pellanda A, et al. Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: a treatment planning comparison with fixed field IMRT[J]. Radiother Oncol, 2009,92(1):118-124. DOI: 10.1016/j.radonc.2008.12.020. doi: 10.1016/j.radonc.2008.12.020 pmid: 19181409
[6]	Wagner D, Christiansen H, Wolff H, et al. Radiotherapy of malignant gliomas: comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique[J]. Radiother Oncol, 2009,93(3):593-596. DOI: 10.1016/j.radonc.2009.10.002. doi: 10.1016/j.radonc.2009.10.002 pmid: 19897266
[7]	Mellon EA, Javedan K, Strom TJ, et al. A dosimetric comparison of volumetric modulated arc therapy with step-and-shoot intensity modulated radiation therapy for prostate cancer[J]. Pract Radiat Oncol, 2015,5(1):11-15. DOI: 10.1016/j.prro.2014.03.003. doi: 10.1016/j.prro.2014.03.003 pmid: 25413432
[8]	Braam PM, Roesink JM, Moerland MA, et al. Long-term parotid gland function after radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2005,62(3):659-664. DOI: 10.1016/j.ijrobp.2004.12.015. doi: 10.1016/j.ijrobp.2004.12.015 pmid: 15936542
[9]	Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord[J]. Int J Radiat Oncol Biol Phys, 2010, 76 Supple 3: S42-S49. DOI: 10.1016/j.ijrobp.2009.04.095. doi: 10.1016/j.ijrobp.2009.04.095
[10]	Betzel GT, Yi BY, Niu Y, et al. Is RapidArc more susceptible to delivery uncertainties than dynamic IMRT?[J]. Med Phys, 2012,39(10):5882-5890. DOI: 10.1118/1.4749965. doi: 10.1118/1.4749965
[11]	Jia MX, Zhang X, Yin C, et al. Peripheral dose measurements in cervical cancer radiotherapy: a comparison of volumetric modulated arc therapy and step-and-shoot IMRT techniques[J]. Radiat Oncol, 2014,9:61. DOI: 10.1186/1748-717X-9-61. doi: 10.1186/1748-717X-9-61 pmid: 24555547
[12]	Verbakel WF, Cuijpers JP, Hoffmans D, et al. Volumetric intensity-modulated arc therapy vs conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study[J]. Int J Radiat Oncol Biol Phys, 2009,74(1):252-259. DOI: 10.1016/j.ijrobp.2008.12.033. doi: 10.1016/j.ijrobp.2008.12.033 pmid: 19362244

参数	目标剂量	VMAT	IMRT	t值	P值
PTV70
均值(Gy)	70	70.52±1.34	71.73±1.12	4.825	0.005
D_2%(Gy)	<75	74.26±1.21	74.09±1.43	0.625	0.334
D_98%(Gy)	>66	67.42±1.14	67.35±1.31	0.279	0.356
D_50%(Gy)	70	71.82±1.36	70.65±1.13	4.781	0.032
D_80%(Gy)	70	70.55±1.27	69.43±1.42	4.123	0.041
V_107%	<2%	2.32±1.35	2.84±1.92	1.473	0.312
HI95%	0	0.09±0.03	0.10±0.05	1.047	0.319
CI95%	1	0.91±0.02	0.86±0.06	4.933	0.004
PTV54
D_2%(Gy)	<58	57.45±3.24	57.92±5.13	0.563	0.338
D_98%(Gy)	>51	51.61±2.34	51.46±2.52	0.399	0.341
D_50%(Gy)	50	54.62±1.45	54.12±1.83	1.487	0.281
HI95%	0	0.09±0.04	0.26±0.02	4.548	0.038

参数	目标剂量	VMAT	IMRT	t值	P值
脊髓
D_1%	<46	37.62±4.34	40.93±7.45	2.615	0.045
左腮腺
均值(Gy)	<26	21.28±8.13	22.73±11.42	0.703	0.322
V_{30 Gy}(%)	<45%	22.39±14.36	22.48±19.81	0.025	0.383
右腮腺
均值(Gy)	<26	22.39±7.42	24.25±7.91	1.134	0.315
V_{30 Gy}(%)	<45%	25.64±13.51	26.43±14.22	0.277	0.362
喉
均值(Gy)	<45	37.42±2.53	41.82±4.35	5.998	0.002
口腔
均值(Gy)	<30	28.14±4.53	32.61±3.46	5.411	0.003

[1]	陈琦, 徐晨阳, 王寅, 雷大鹏. 高光谱成像在头颈部肿瘤诊疗中的应用现状[J]. 国际肿瘤学杂志, 2024, 51(5): 298-302.
[2]	崔腾璐, 吕璐, 孙鹏飞. 放疗联合免疫治疗在头颈部鳞状细胞癌治疗中的应用[J]. 国际肿瘤学杂志, 2023, 50(9): 548-552.
[3]	陈欣祎, 翁一鸣, 魏家燕, 王劲松, 彭敏. 免疫检查点抑制剂在复发或转移性头颈部鳞状细胞癌治疗中的进展[J]. 国际肿瘤学杂志, 2023, 50(9): 553-557.
[4]	鞠逸凡, 徐晨阳, 雷大鹏. 病理组学在头颈部肿瘤中的研究进展[J]. 国际肿瘤学杂志, 2023, 50(5): 294-298.
[5]	李进芝, 赵彪, 文晓博, 张明, 袁美芳, 孙梦真, 蒲琴, 杨毅. Monaco系统计算网格尺寸对T₄期鼻咽癌的剂量学影响[J]. 国际肿瘤学杂志, 2023, 50(11): 641-649.
[6]	许婷婷, 胡超苏, 李宝生. 抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）[J]. 国际肿瘤学杂志, 2023, 50(1): 1-11.
[7]	陈怡, 韩靓, 蔡雳. 头颈部肿瘤患者化疗性口腔黏膜炎发生的多因素分析[J]. 国际肿瘤学杂志, 2022, 49(9): 521-525.
[8]	曾艳, 罗盼, 王子琪, 吴伟莉. 药物在头颈部肿瘤治疗中引起铁死亡的作用机制[J]. 国际肿瘤学杂志, 2022, 49(3): 173-176.
[9]	中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国头颈部肿瘤放射治疗指南(2021年版)[J]. 国际肿瘤学杂志, 2022, 49(2): 65-72.
[10]	劳峥, 涂文勇, 徐璇丽, 张霖, 邵滋旸, 石慧烽. 尼妥珠单抗联合根治性放疗治疗局部晚期不可手术的口腔颌面部鳞状细胞癌[J]. 国际肿瘤学杂志, 2022, 49(11): 665-670.
[11]	徐士飞, 冯欢, 刘海洋, 胡杰, 马露. 头颈部肿瘤旋转误差对放疗位置精准性的影响[J]. 国际肿瘤学杂志, 2021, 48(3): 150-155.
[12]	周非, 刘睿, 吕红英, 梁东海, 陈文秀, 于洪升. 头颈部肿瘤的免疫治疗[J]. 国际肿瘤学杂志, 2020, 47(12): 746-751.
[13]	廖烨, 赵丽娜, 石梅. 老年性食管癌放疗进展[J]. 国际肿瘤学杂志, 2019, 46(2): 113-116.
[14]	柴玥, 董梅. 头颈部鳞状细胞癌的内科治疗[J]. 国际肿瘤学杂志, 2019, 46(2): 94-97.
[15]	臧守梅, 严丹方, 严森祥. 头颈部鳞状细胞癌的非手术治疗进展[J]. 国际肿瘤学杂志, 2019, 46(12): 741-744.