三维适形、固定野动态调强和容积旋转调强在宫颈癌术后放疗中的剂量学比较

发布时间：2018-05-25 19:16

本文选题：宫颈癌 + 容积旋转调强　；参考：《中国妇产科临床杂志》2015年01期

【摘要】：目的宫颈癌术后放疗中,比较三维适形(CRT)、固定野调强(IMRT)和容积旋转调强(VMAT)靶区剂量分布和危及器官受照剂量,为临床治疗技术的选择提供依据。方法顺序选取北京大学第三医院2013年10例宫颈癌术后放疗的患者,分别进行CRT、IMRT和VMAT计划设计并比较计划靶区的剂量-体积直方图(DVH)、适形度指数(CI)、均匀性指数(HI)和危及器官的受照剂量。结果三种技术CI分别为0.462、0.855和0.875,IMRT和VMAT均优于CRT,VMAT较IMRT有较小的优势(P0.05,t=-2.189);HI分别为1.084、1.063和1.046,VMAT均匀性略低于IMRT(P0.05,t=5.127)。在危及器官的受量上,CRT普遍高于IMRT和VMAT。对于低剂量区的受照体积,如小肠、结直肠、膀胱和骨髓的V10、V20,IMRT比VMAT可以获得更低的受照剂量(P0.05);对于高剂量区的体积V40、V50,直肠和膀胱的受照体积IMRT要小于VMAT(P0.05),其他如小肠、结肠和股骨头、骨髓的IMRT和VMAT差异无统计学意义(P0.05)。结论对于宫颈癌术后放疗的患者,CRT、IMRT和VMAT均可以达到靶区处方剂量覆盖的要求,但是在靶区的各项指标中,IMRT和VMAT均优于CRT。IMRT和VMAT相比,在HI上有优势,但是在CI指数上略小于VMAT;对于危及器官而言,低剂量体积和高剂量体积的IMRT和VMAT各自表现了不同的特点,在临床治疗中要根据要求选择不同的技术。
[Abstract]:Objective to compare the dose distribution in the target area of CRT, IMRTT and VMATT in postoperative radiotherapy for cervical cancer and to provide evidence for the selection of clinical treatment techniques. Methods Ten patients with cervical cancer received postoperative radiotherapy in the third Hospital of Peking University in 2013 were selected. The dose-volume histogram (DVH), conformability index (CI), homogeneity index (HI) of the planned target area were designed and compared with the radiation dose of the organ in danger by CRT IMRT and VMAT respectively. Results the CI values of the three techniques were 0.462t 0.855 and 0.875U IMRT and VMAT, respectively, which were lower than that of CRTV-VMAT (P 0.05) and IMRT (P < 0.05). The uniformity of VMAT was slightly lower than that of IMRT (0.05t5.127) compared with IMRT (1.084 卤1.063 and 1.046), respectively. CRT was generally higher than that of IMRT and VMATT in the acceptance of endangered organs. For low-dose areas, such as small intestine, colorectal, bladder and bone marrow, V10 V20IMRT can obtain a lower dose of irradiation than VMAT, and for high dose area of V40V 50, IMRT of rectum and bladder is smaller than that of VMATP0.05, other small intestine, and small intestine. There was no significant difference in IMRT and VMAT between colon and femoral head and bone marrow (P 0.05). Conclusion both CRTIMRT and VMAT can meet the requirement of prescription dose coverage for patients with cervical cancer after postoperative radiotherapy, but in the target area, both IMRT and VMAT are superior to CRT.IMRT and VMAT, and have advantages in HI. However, the CI index is slightly smaller than that of VMATT. For the organs at risk, IMRT and VMAT with low dose volume and high dose volume have different characteristics, so different techniques should be chosen according to the requirements in clinical treatment.
【作者单位】：北京大学第三医院肿瘤放疗科;
【分类号】：R737.33

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