国际肿瘤学杂志

国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (7): 455-461.doi: 10.3760/cma.j.cn371439-20250217-00079

• 质子放疗剂量学特点 • 上一篇    下一篇

腹盆部肿瘤3例质子放疗剂量学特点分析

段敬豪1,2, 岳金波3, 陶城1,2, 吴仕章1,2, 李成强1,2, 戴天缘1,2, 陈进琥1,2, 白曈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）腹部放疗一病区，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:2025-05-05 出版日期:2025-07-08 发布日期:2025-07-23
  • 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 abdominal and pelvic tumors

Duan Jinghao1,2, Yue Jinbo3, Tao Cheng1,2, Wu Shizhang1,2, Li Chengqiang1,2, Dai Tianyuan1,2, Chen Jinhu1,2, Bai Tong1,2, Zhu Jian1,2()   

  1. 1Department of Radiological 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 （Abdominal Section 1），Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
  • Received:2025-02-17 Revised:2025-05-05 Online:2025-07-08 Published:2025-07-23
  • 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）和光子固定野调强放疗（IMRT）应用于典型腹盆部肿瘤的剂量学特点。方法 以2024年1月至6月山东省肿瘤防治研究院（山东省肿瘤医院）收治的3例腹盆部肿瘤（肝癌、宫颈癌和前列腺癌各1例）患者为研究对象，根据临床靶区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）和梯度指数（GI）及危及器官剂量学参数，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例患者IMPT计划的CI值（分别为0.61、0.62和0.43）、HI值（分别为0.053、0.075和0.020）、GI值（分别为3.45、2.63和3.80）均小于IMRT计划（CI分别为0.82、0.81和0.86；HI分别为0.060、0.120和0.080；GI分别为7.28、4.76和4.66）。与IMRT计划相比，在肝癌患者中，IMPT计划可使正常肝组织和右肾的Dmean及脊髓的Dmax分别降低37.8%、78.5%和13.2%；在宫颈癌患者中，IMPT计划可使小肠的V30，膀胱、直肠、骨髓的Dmean和脊髓的Dmax分别降低22.0%、15.7%、14.3%、12.6%和4.8%；在前列腺癌患者中，IMPT计划可使膀胱和直肠的Dmean分别降低14.9%和36.5%，但IMPT计划使左侧股骨头的Dmean及V40分别升高了35.3%和6.1%，使右侧股骨头的Dmean及V40分别升高了23.6%和10.8%。3例患者体内10%、30%和50%的处方剂量区域所占的体积，IMPT计划比IMRT计划减少了48.9%~64.8%、22.0%~47.0%、22.0%~57.7%。结论 腹盆部肿瘤的IMPT和IMRT计划比较，IMPT计划在降低正常肝脏、肾脏、脊髓、小肠、直肠和膀胱等器官的剂量方面有优势；对于股骨头的剂量，IMPT计划优势并不明显；IMPT计划可显著减少患者体内额外的剂量沉积。

关键词: 腹部肿瘤, 盆腔肿瘤, 放射疗法, 质子疗法, 放射治疗剂量

Abstract:

Objective To explore the dosimetric characteristics of intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） for typical abdominal and pelvic tumors. Methods Three patients with abdominal and pelvic tumors （one case each of liver cancer，cervical cancer，and prostate cancer） admitted to Shandong Cancer Hospital and Institute from January to June 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on clinical target volume （CTV） and organs at risk （OARs） constraints. Dosimetric parameters，including conformity index （CI），homogeneity index （HI），and gradient index （GI） for target coverage，as well as OARs dose metrics，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 plan demonstrated higher CI values （0.82，0.81，and 0.86） compared to IMPT plan （0.61，0.62，and 0.43）. IMPT plan yielded lower HI values （0.053，0.075，and 0.020） than IMRT plan （0.060，0.120，and 0.080） and lower GI values （3.45，2.63，and 3.80 vs. 7.28，4.76，and 4.66 for IMRT plan）. In liver cancer，IMPT plan reduced the Dmean of normal liver tissues and right kidney by 37.8% and 78.5%，respectively，and decreased the Dmax of spinal cord by 13.2%. For cervical cancer，IMPT plan reduced the V30 of the small bowel by 22.0%，Dmean of the bladder，rectum and bone marrow by 15.7%，14.3% and 12.6%，and spinal cord Dmax by 4.8%. In prostate cancer，IMPT plan lowered bladder and rectal Dmean by 14.9% and 36.5%，respectively，but resulted in an increase of 35.3% and 6.1% in the Dmean and V40 of the left femoral head，respectively，and an increase of 23.6% and 10.8% in the Dmean and V40 of the right femoral head，respectively. IMPT plan reduced the volumes receiving 10%，30%，and 50% of the prescription dose by 48.9%-64.8%，22.0%-47.0%，and 22.0%-57.7%，respectively，compared to IMRT plan. Conclusions Comparison between IMPT and IMRT plans for abdominopelvic tumors： IMPT plan offers advantages in reducing doses to normal organs such as the liver，kidneys，spinal cord，small intestine，rectum，and bladder. However，its advantage is less pronounced regarding the dose to the femoral heads. IMPT plan notably minimizes additional dose deposition within the body.

Key words: Abdominal neoplasms, Pelvic neoplasms, Radiotherapy, Proton therapy, Radiotherapy dosage