發(fā)布時間：2018-06-03 11:18

  本文選題：固定野動態(tài)調(diào)強 + 快速旋轉(zhuǎn)調(diào)強　； 參考：《中華腫瘤防治雜志》2017年06期

【摘要】：目的前列腺大分割照射與盆腔常規(guī)分割預(yù)防照射相結(jié)合的同步加量放療可提高前列腺癌臨床療效,本研究比較固定野動態(tài)調(diào)強(dynamic intensity modulated radiotherapy,dIMRT)與快速旋轉(zhuǎn)調(diào)強(RapidArc)在前列腺癌同步加量放療中的劑量分布、治療效率和執(zhí)行精度的差異,為臨床應(yīng)用提供參考。方法選取2013-01-04-2013-12-31在中山大學(xué)腫瘤防治中心行放療的10例前列腺癌高危風(fēng)險患者,靶區(qū)包括前列腺、精囊和盆腔淋巴結(jié)。以相同的劑量目標(biāo)和優(yōu)化參數(shù)分別設(shè)計9野dIMRT、單弧和雙弧RapidArc同步加量治療計劃,分別用9F、1ARC和2ARC表示。比較分析3種計劃的靶區(qū)劑量學(xué)特點,直腸、膀胱、小腸和雙側(cè)股骨頭等危及器官的受照劑量及體積,機器跳數(shù),治療時間以及劑量驗證通過率。結(jié)果對于PTV1,9F的D2%為(69.37±0.89)Gy,D50%為(66.92±0.63)Gy,HI為0.09±0.02,CI為0.83±0.05;1ARC的D2%為(71.13±1.21)Gy,D50%為(68.50±0.76)Gy,HI為0.12±0.02,CI為0.74±0.07;9F均優(yōu)于1ARC,差異均有統(tǒng)計學(xué)意義,P0.05;9F與2ARC的各參數(shù)差異均無統(tǒng)計學(xué)意義,P0.05。對于PTV2,9F的V95%為(99.45±0.78)%,優(yōu)于1ARC的(99.35±1.28)%,差異有統(tǒng)計學(xué)意義,P0.05;9F與2ARC各參數(shù)的差異均無統(tǒng)計學(xué)意義,P0.05。對于膀胱D_(mean),3組計劃差異無統(tǒng)計學(xué)意義,P0.05;對于直腸V67.5Gy,9F與2ARC的差異無統(tǒng)計學(xué)意義,P0.05;對于左右股骨頭D_(mean),1ARC和2ARC低于9F,差異有統(tǒng)計學(xué)意義,P0.05;各OAR其余評價指標(biāo)9F均低于1ARC和2ARC,差異均有統(tǒng)計學(xué)意義,P0.05。1ARC和2ARC相比于9F機器跳數(shù)平均減少了70.0%和67.2%,治療時間平均縮短了81.7%和61.0%。9F、1ARC和2ARC的3%/3 mm標(biāo)準(zhǔn)的γ通過率分別為97.8%、98.9%和99.4%,差異均具有統(tǒng)計學(xué)意義,P0.05。結(jié)論相比于dIMRT,RapidArc可顯著提高治療效率,其雙弧計劃具有相仿的靶區(qū)覆蓋,但對膀胱、直腸和小腸的保護(hù)更差,dIMRT更適用于前列腺癌同步加量放射治療。
[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 鹵0.89 Gyru D50%, which was 66.92 鹵0.63Gy (HI = 0.09 鹵0.02CI = 0.83 鹵0.051C = 0.83 鹵0.051 CI = 71.13 鹵1.21 Gy / D 50% vs 68.50 鹵0.76 Gy CI = 0.74 鹵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 鹵0.78, which was better than that of 1ARC (99.35 鹵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 緯 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.
【作者單位】： 中山市中醫(yī)院醫(yī)學(xué)影像科;華南腫瘤學(xué)國家重點實驗室中山大學(xué)腫瘤防治中心放射治療科;
【分類號】：R445.2;R737.25
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本文編號：1972595