前列腺癌同步加量放疗dIMRT和RapidArc比较研究

发布时间：2018-06-03 11:18

  本文选题：固定野动态调强 + 快速旋转调强　； 参考：《中华肿瘤防治杂志》2017年06期

【摘要】：目的前列腺大分割照射与盆腔常规分割预防照射相结合的同步加量放疗可提高前列腺癌临床疗效,本研究比较固定野动态调强(dynamic intensity modulated radiotherapy,dIMRT)与快速旋转调强(RapidArc)在前列腺癌同步加量放疗中的剂量分布、治疗效率和执行精度的差异,为临床应用提供参考。方法选取2013-01-04-2013-12-31在中山大学肿瘤防治中心行放疗的10例前列腺癌高危风险患者,靶区包括前列腺、精囊和盆腔淋巴结。以相同的剂量目标和优化参数分别设计9野dIMRT、单弧和双弧RapidArc同步加量治疗计划,分别用9F、1ARC和2ARC表示。比较分析3种计划的靶区剂量学特点,直肠、膀胱、小肠和双侧股骨头等危及器官的受照剂量及体积,机器跳数,治疗时间以及剂量验证通过率。结果对于PTV1,9F的D2%为(69.37±0.89)Gy,D50%为(66.92±0.63)Gy,HI为0.09±0.02,CI为0.83±0.05;1ARC的D2%为(71.13±1.21)Gy,D50%为(68.50±0.76)Gy,HI为0.12±0.02,CI为0.74±0.07;9F均优于1ARC,差异均有统计学意义,P0.05;9F与2ARC的各参数差异均无统计学意义,P0.05。对于PTV2,9F的V95%为(99.45±0.78)%,优于1ARC的(99.35±1.28)%,差异有统计学意义,P0.05;9F与2ARC各参数的差异均无统计学意义,P0.05。对于膀胱D_(mean),3组计划差异无统计学意义,P0.05;对于直肠V67.5Gy,9F与2ARC的差异无统计学意义,P0.05;对于左右股骨头D_(mean),1ARC和2ARC低于9F,差异有统计学意义,P0.05;各OAR其余评价指标9F均低于1ARC和2ARC,差异均有统计学意义,P0.05。1ARC和2ARC相比于9F机器跳数平均减少了70.0%和67.2%,治疗时间平均缩短了81.7%和61.0%。9F、1ARC和2ARC的3%/3 mm标准的γ通过率分别为97.8%、98.9%和99.4%,差异均具有统计学意义,P0.05。结论相比于dIMRT,RapidArc可显著提高治疗效率,其双弧计划具有相仿的靶区覆盖,但对膀胱、直肠和小肠的保护更差,dIMRT更适用于前列腺癌同步加量放射治疗。
[Abstract]:Objective to improve the clinical efficacy of prostatic cancer treated by combined hypersegmented prostatic irradiation and conventional pelvic fractionation radiation combined with simultaneous dose radiotherapy. The purpose of this study was to compare the dose distribution, therapeutic efficiency and executive accuracy of dynamic intensity modulated radiotherapymetric RT and rapid rotational intensity modulation in simultaneous dose radiotherapy for prostate cancer, and to provide a reference for clinical application. Methods Ten patients with high risk of prostate cancer, including prostate gland, seminal vesicle and pelvic lymph nodes, were selected from 2013-01-04-2013-12-31 to receive radiotherapy at the Cancer Center of Sun Yat-sen University. According to the same dose target and optimized parameters, 9 field dIMRT, single arc and double arc RapidArc simultaneous dosing treatment plan were designed respectively, which were expressed in 9FU 1ARC and 2ARC, respectively. The dosimetric characteristics of the target area of the three plans were compared and analyzed, including the dose and volume of the endangered organs such as rectum, bladder, small intestine and bilateral femoral head, the number of machine jumps, the treatment time and the rate of dose verification. Results for PTV1 + 9F, the D2% was 69.37 卤0.89 Gyru D50%, which was 66.92 卤0.63Gy (HI = 0.09 卤0.02CI = 0.83 卤0.051C = 0.83 卤0.051 CI = 71.13 卤1.21 Gy / D 50% vs 68.50 卤0.76 Gy CI = 0.74 卤0.079F, respectively). There was no significant difference between P0.059F and 2ARC (P0.059F) and 2ARC (P 0.05). The V95% of PTV2 + 9F was 99.45 卤0.78, which was better than that of 1ARC (99.35 卤1.28). There was no significant difference between P0.05 and 2ARC. There was no significant difference among the three groups (P0.05, P 0.05); there was no significant difference (P0.05) between the rectum V67.5 Gy 9F and 2ARC; for the right and left femoral head, the difference was significant (P0.05); for the right and left femoral head, the difference was significant (P 0.05); the other evaluation indexes of OAR were all lower than that of 1ARC and 2ARC (P 0.05). 2ARC, there were significant differences between P0.05.1 ARC and 2ARC by 70.0% and 67.2%, and the average treatment time was shortened by 81.7% and 61.0.9F1ARC and 2ARC's 3R / 3 mm standard 纬 pass rate was 97.898.9% and 99.4mm, respectively. The difference was statistically significant (P 0.05). Conclusion compared with dIMRT RapidArc, the double arc plan has similar target coverage, but the protection of bladder, rectum and small intestine is worse than that of dIMRT. It is more suitable for simultaneous radiotherapy of prostate cancer.
【作者单位】： 中山市中医院医学影像科;华南肿瘤学国家重点实验室中山大学肿瘤防治中心放射治疗科;
【分类号】：R445.2;R737.25
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