国际肿瘤学杂志

国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (10): 653-658.doi: 10.3760/cma.j.cn371439-20250217-00112

• 质子放疗剂量学特点 • 上一篇    下一篇

肺癌3例质子放疗剂量学特点分析

陶城1,2, 范秉杰3, 李成强1,2, 吴仕章1,2, 段敬豪1,2, 戴天缘1,2, 白曈1,2, 陈进琥1,2, 朱健1,2()   

  1. 1山东省肿瘤防治研究院（山东省肿瘤医院）放射物理技术科，山东第一医科大学（山东省医学科学院），济南 250117
    2山东省医药卫生儿童肿瘤精确放疗重点实验室（山东省肿瘤医院），济南 250117
    3山东省肿瘤防治研究院（山东省肿瘤医院）胸部放疗三病区，山东第一医科大学（山东省医学科学院），济南 250117
  • 收稿日期:2025-02-17 修回日期:2025-08-23 出版日期:2025-10-08 发布日期:2025-11-12
  • 通讯作者: 朱健 E-mail:zhujian@sdfmu.edu.cn
  • 基金资助:
    国家科技重大专项(2024ZD0519901);国家自然科学基金(12105160);国家自然科学基金(82172072);山东省重点研发计划(2024CXPT084);山东省自然科学基金(ZR2021QA099);山东省自然科学基金(ZR2022QH188);山东省高等学校青年创新团队发展计划(2024KJJ013);山东省青年科技人才托举工程(SDAST2024QTB034)

Analysis of dosimetric characteristics of proton radiotherapy in 3 cases of lung cancer

Tao Cheng1,2, Fan Bingjie3, Li Chengqiang1,2, Wu Shizhang1,2, Duan Jinghao1,2, Dai Tianyuan1,2, Bai Tong1,2, Chen Jinhu1,2, Zhu Jian1,2()   

  1. 1Department of Radiation Oncology Physics， Shandong Cancer Hospital and Institute， Shandong First Medical University and Shandong Academy of Medical Sciences， Jinan 250117， China
    2Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy （Shandong Cancer Hospital）， Jinan 250117， China
    3Department of Radiation Oncology （Chest Section 3）， Shandong Cancer Hospital and Institute， Shandong First Medical University and Shandong Academy of Medical Sciences， Jinan 250117， China
  • Received:2025-02-17 Revised:2025-08-23 Online:2025-10-08 Published:2025-11-12
  • Contact: Zhu Jian E-mail:zhujian@sdfmu.edu.cn
  • Supported by:
    National Science and Technology Major Project of China(2024ZD0519901);National Natural Science Foundation of China(12105160);National Natural Science Foundation of China(82172072);Key R&D Program of Shandong Province， China(2024CXPT084);Natural Science Foundation of Shandong Province of China(ZR2021QA099);Natural Science Foundation of Shandong Province of China(ZR2022QH188);Youth Innovation Team Development Plan of Shandong Universities(2024KJJ013);Shandong Provincial Young Science and Technology Talent Support Project(SDAST2024QTB034)

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摘要：

目的 探讨质子调强放疗（IMPT）和固定野调强放疗（IMRT）应用于肺癌的剂量学特点。 方法 选取2024年1月至2024年5月山东省肿瘤防治研究院（山东省肿瘤医院）收治的3例肺癌（中央偏下型、中央型和周围型）患者为研究对象，根据临床靶区解剖结构位置和危及器官限值的要求，分别设计IMPT和IMRT两种放疗计划。评估3例患者两种放疗计划的靶区适形指数（CI）、均匀性指数（HI）、梯度指数（GI）以及危及器官的剂量学指标，通过评估体内10%、30%和50%处方剂量区域的体积比较患者体内额外的剂量沉积。 结果 3例肺癌患者IMPT计划的CI值（分别为0.61、0.57和0.34）、HI值（分别为0.07、0.06和0.06）、GI值（分别为2.84、2.47和4.56）均小于IMRT计划（CI分别为0.80、0.60和0.79；HI值分别为0.09、0.15和0.09；GI值分别为4.91、3.09和4.99）。与IMRT计划比较，IMPT计划患侧肺的低剂量区明显减少（IMPT计划V5分别为20.59%、46.29%、10.94%；IMRT计划V5分别为48.91%、60.63%、19.92%），但高剂量区相对IMRT并没有优势（IMPT计划V20分别为12.88%、34.75%、5.21%；IMRT计划V20分别为21.70%、36.50%、5.31%）；健侧肺和心脏的受量均有显著降低[IMPT计划健侧肺Dmean分别为0.08、0.04、0.00 Gy（RBE），IMRT计划分别为3.25、1.18、0.55 Gy；IMPT计划的心脏Dmean分别为6.23、7.04、0.00 Gy（RBE），IMRT计划分别为18.33、10.27、0.08 Gy]。3例患者体内10%的处方剂量区域所占的体积，IMPT计划比IMRT计划分别减少了65.94%、25.57%和72.47%；体内30%的处方剂量区域所占的体积，IMPT计划相对于IMRT计划分别减少了54.97%、26.47%、39.04%；体内50%处方剂量区域所占的体积，IMPT计划相对于IMRT计划分别减少了54.49%、30.43%、28.89%。 结论 IMPT计划在保证肺癌靶区覆盖的情况下显著降低了患侧肺V5、健侧肺Dmean和心脏Dmean；但对于患侧肺V20，IMPT计划并未表现出比IMRT计划更有优势；IMPT计划可以减少患者体内额外受照体积。

关键词: 肺肿瘤, 放射疗法, 质子疗法, 放射治疗剂量

Abstract:

Objective To investigate the dosimetric characteristics of intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） for lung cancers. Methods Three lung cancer patients （central-lower， central， and peripheral types） admitted to Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on the anatomical location of the clinical target volume and the dose constraints for organs at risk （OARs）. Dosimetric parameters， including conformity index （CI）， homogeneity index （HI）， and gradient index （GI） for target coverage， as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%， 30%， and 50% of the prescription dose. Results For all three cases， IMRT plans demonstrated higher CI values （0.80， 0.60， and 0.79） compared to IMPT plans （0.61， 0.57， and 0.34）. IMPT plans yielded lower HI values （0.07， 0.06， and 0.06） than IMRT plans （0.09， 0.15， and 0.09） and lower GI values （2.84， 2.47， and 4.56 vs. 4.91， 3.09， and 4.99 for IMRT plans）. Compared with the IMRT plans， the low-dose region in the ipsilateral lung was significantly reduced in IMPT plans （V5 of the IMPT plans were 20.59%， 46.29%， 10.94%， respectively； V5 of the IMRT plans were 48.91%， 60.63%， 19.92%， respectively）， but there was no significant advantage in the high-dose region compared to IMRT plans （V20 of the IMPT plans were 12.88%， 34.75%， 5.21%， respectively；V20 of the IMRT plans were 21.70%， 36.50%， 5.31%， respectively）. The dose to the contralateral lung and heart was significantly reduced in IMPT plans [the Dmean of the contralateral lung in the IMPT plans were 0.08， 0.04， and 0.00 Gy （RBE）， respectively， and those in the IMRT plans were 3.25， 1.18， and 0.55 Gy， respectively； the heart Dmean in the IMPT plans were 6.23， 7.04， and 0.00 Gy （RBE）， respectively， while those of the IMRT plans were 18.33， 10.27， and 0.08 Gy， respectively）. IMPT plans significantly reduced the volumes receiving 10% of the prescription dose by 65.94%， 25.57% and 72.47%， respectively， compared to IMRT plans. The volumes IMPT plans occupied by 30% of the prescription dose area in the body were reduced by 54.97%， 26.47% and 39.04%， respectively， compared to the IMRT plans. The volumes IMPT plans occupied by 50% of the prescription dose area in the body were reduced by 54.49%， 30.43% and 28.89%， respectively， compared to the IMRT plans. Conclusions IMPT plan significantly reduces the V5 of the ipsilateral lung， the Dmean of the contralateral lung and the heart， while maintaining target coverage compared with IMRT plan for lung cancers. However， IMPT plan does not show much more advantage than IMRT plan in the ipsilateral lung V20. IMPT can reduce the additional exposure volume within the body.

Key words: Lung neoplasms, Radiotherapy, Proton therapy, Radiotherapy dosage