国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (7): 404-409.doi: 10.3760/cma.j.issn.1673-422X.2019.07.003

• 论著 • 上一篇    下一篇

静态IMRT和VMAT计划在淋巴瘤纵隔放疗中的剂量学比较

张文珏1丁真1王越男1郭智2姜威1彭苗1梁军1，3陈志坚1任骅1，3王绿化1，3   

  1. 1国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院深圳医院放疗科，深圳518116； 2国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院深圳医院肿瘤内科，深圳518116； 3国家癌症中心国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院放疗科，北京100021
  • 出版日期:2019-07-08 发布日期:2019-07-16
  • 通讯作者: 任骅 E-mail:renhua2009@hotmail.com
  • 基金资助:

    深圳市医疗卫生三名工程资助项目（SZSM201612063）

Dosimetric comparison of static intensity-modulated radiation therapy and volumetric modulated arc therapy in lymphoma patients received mediastinal radiation

Zhang Wenjue1, Ding Zhen1, Wang Yuenan1, Guo Zhi2, Jiang Wei1, Peng Miao1, Liang Jun1,3, Chen Zhijian1, Ren Hua1,3, Wang Lyuhua1,3   

  1. 1Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; 2Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; 3Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Online:2019-07-08 Published:2019-07-16
  • Contact: Ren Hua E-mail:renhua2009@hotmail.com
  • Supported by:

    Sanming Project of Medicine in Shenzhen (SZSM201612063)

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摘要： 目的通过对比不同射野的静态调强放疗（IMRT）计划和容积旋转调强放疗（VMAT）计划靶区剂量分布与危及器官照射情况，探索行纵隔区域放疗的淋巴瘤患者最佳IMRT施行方式。方法2017年3月至2019年1月中国医学科学院北京协和医学院肿瘤医院深圳医院共11例化疗后行纵隔首程放疗的淋巴瘤患者纳入研究，其中男性8例、女性3例，Ann Arbor分期Ⅰ～Ⅱ期2例、Ⅲ～Ⅳ期9例。霍奇金淋巴瘤（6例）和非霍奇金淋巴瘤患者（5例）分别给予处方剂量36 Gy和50 Gy。每例患者均设计3种调强计划：5野静态调强（5FIMRT）计划、7野静态调强（7FIMRT）计划和VMAT计划，评估各计划靶区剂量分布、危及器官照射剂量和计划实施效率。结果5FIMRT、7FIMRT、VMAT计划靶区（PTV）平均适形指数（CI）和均匀指数（HI）分别为0.64±0.06、0.67±0.05、0.76±0.04（F=17.045，P＜0.001）和1.07±0.01、1.07±0.01、1.09±0.01（F=9.258，P=0.001），VMAT计划CI显著优于静态IMRT计划（均P＜0.001），但HI差于静态IMRT计划（均P＜0.001）。5FIMRT、7FIMRT、VMAT双肺低剂量受照体积（V5）和高剂量受照体积（V30）分别为（43.98±7.77）%、（42.71±4.98）%、（55.92±8.16）%（F=8.281，P=0.001）和（8.19±2.97）%、（8.25±2.87）%、（7.53±3.16）%（F=0.140，P=0.870），VMAT计划双肺低剂量受照体积显著高于5FIMRT和7FIMRT计划（均P＜0.001），高剂量受照体积差异无统计学意义。5FIMRT、7FIMRT、VMAT左侧和右侧乳腺低剂量受照体积（V4）分别为（24.29±8.14）%、（23.87±7.70）%、（80.17±22.92）%（F=14.505，P=0.005）和（22.12±13.28）%、（21.13±13.01）%、（81.77±20.76）%（F=13.938，P=0.006），VMAT计划乳腺的低剂量受照体积高于静态IMRT计划(均P＜0.05)。5FIMRT、7FIMRT、VMAT计划机器跳数和治疗时间分别为（1 622±281）MU、（1 729±286）MU、（411±75）MU（F=105.277，P<0.001）和（6.79±0.93）min、（7.42±0.95）min、（4.98±0.00）min（F=29.545，P＜0.001），VMAT计划机器跳数显著少于静态IMRT（均P＜0.001），治疗时间显著短于静态IMRT（均P＜0.001）。结论对于具有纵隔放疗适应证的淋巴瘤患者，VMAT实施效率高但无明确剂量优势，采用5FIMRT或7FIMRT计划靶区适形性与均匀性好，部分危及器官受量更低。

关键词: 淋巴瘤, 放射治疗计划, 计算机辅助, 放疗计划比较

Abstract: ObjectiveTo compare target dosimetric distribution and normal tissue radiation between different static intensitymodulated radiation therapy (IMRT) plans and volumetric modulated arc therapy (VMAT), and to identify the best IMRT plan for lymphoma patients needed mediastinal radiation. MethodsA total of 11 patients with lymphoma who received first course radiotherapy in the mediastinal region after chemotherapy in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2017 to January 2019 were included in the study. There were 8 males and 3 females, 2 patients were in Ann Arbor stage ⅠⅡ, and 9 cases in ⅢⅣ stage. There were 6 patients with Hodgkin lymphoma (HL) and 5 patients with nonHodgkin lymphoma (NHL). Patients with HL and NHL were given prescript doses of 36 Gy and 50 Gy, respectively. Three plans were designed for each patient: static 5FIMRT, 7FIMRT and VMAT plan. The target dosimetric distribution, normal tissue radiation dose, and efficiency of each plan were evaluated. ResultsThe mean conformity index (CI) and homogeneity index (HI) values of plan target volume (PTV) in 5FIMRT, 7FIMRT, VMAT plan were 0.64±0.06, 0.67±0.05, 0.76±0.04 (F=17.045, P＜0.001) and 1.07±0.01, 1.07±0.01, 1.09±0.01 (F=9.258, P=0.001), respectively. VMAT showed significantly better CI than two static IMRT plans (both P<0.001), but worse HI (both P<0.001). The lungs low dose irradiation volume (V5) and high dose irradiation volume (V30) in 5FIMRT, 7FIMRT, VMAT plan were (43.98±7.77)%, (42.71±4.98)%, (55.92±8.16)% (F=8.281, P=0.001) and (8.19±2.97)%, (8.25±2.87)%, (7.53±3.16)% (F=0.140, P=0.870), respectively. The volume of low dose irradiation in lungs of VMAT plan was significantly higher than 5FIMRT and 7FIMRT plans (both P＜0.001), while high dose volume was no significant difference. The left and right breast low dose irradiation volume (V4) in 5FIMRT, 7FIMRT and VMAT plan were (24.29±8.14)%, (23.87±7.70)%, (80.17±22.92)% (F=14.505, P=0.005) and (22.12±13.28)%, (21.13±13.01)%, (81.77±20.76)% (F=13.938, P=0.006), respectively. VMAT showed significantly higher breast low dose irradiation volume than static IMRT plan (both P＜0.05). The number of monitor units and treatment time in 5FIMRT, 7FIMRT, VMAT plan were (1 622±281) MU, (1 729±286) MU, (411±75) MU (F=105.277, P<0.001) and (6.79±0.93) min, (7.42±0.95) min, (4.98±0.00) min (F=29.545, P＜0.001), respectively. VMAT showed significantly less monitor units than static IMRT (both P<0.001) and shorter treatment time (both P<0.001). ConclusionFor lymphoma patients who have the indication of mediastinal radiotherapy, VMAT is highly efficient and has no definite dose advantage, the static 5FIMRT or 7FIMRT plan has good conformal and uniform target area, and some organs at risk exposure is even lower.

Key words: Lymphoma, Radiotherapy planning, computer-assisted, Radiotherapy plan comparison