本文選題：食管癌　切入點(diǎn)：螺旋斷層放療　出處：《中華腫瘤防治雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的近年來放射治療設(shè)備不斷更新,放療技術(shù)持續(xù)發(fā)展,腫瘤放療方式有了更多的選擇。本研究通過評(píng)估食管癌的螺旋斷層放療(tomotherapy,TOMO)及三維適形調(diào)強(qiáng)放療(intensity modulation radiation therapy,IMRT)的劑量學(xué)特性,為臨床上食管癌放療方式的選擇提供依據(jù)。方法選取2014-07-13-2015-02-25浙江省腫瘤醫(yī)院胸部腫瘤放療科10例食管癌患者,勾畫靶區(qū)及正常器官后,分別傳輸至Raystation及TOMO計(jì)劃系統(tǒng),給予腫瘤原發(fā)灶(PGTV)61.6Gy/28次,計(jì)劃靶區(qū)(PTV)56.0Gy/28次,根據(jù)RTOG 1106標(biāo)準(zhǔn)限制危及器官(organs at risk,OAR)劑量。分別對(duì)靶區(qū)的劑量體積直方圖(dose volume histogram,DVH)、均勻性指數(shù)(homogeneity index,HI)、適形性指數(shù)(conformal index CI)和OAR(肺、心臟、脊髓)受照最大劑量及平均劑量進(jìn)行評(píng)估。結(jié)果兩種計(jì)劃都能滿足處方劑量要求和危及器官受量限制。TOMO計(jì)劃中PGTV的中位均勻性指數(shù)(HI)為0.057 5,優(yōu)于IMRT計(jì)劃的0.073 5,P=0.047。TOMO計(jì)劃中PTV的中位適形性指數(shù)(CI)為0.785,優(yōu)于IMRT計(jì)劃的0.682 5,P=0.009。TOMO計(jì)劃中PGTV的中位最大劑量Dmax為64.9Gy,明顯低于IMRT計(jì)劃的66.5Gy,P=0.005;TOMO計(jì)劃中PTV的中位最大劑量Dmax為64.1Gy,明顯低于IMRT計(jì)劃的64.9Gy,P=0.028。TOMO計(jì)劃的中位總的肺劑量為10.8Gy,低于IMRT計(jì)劃的11.9Gy,P=0.005。TOMO計(jì)劃的中位總的心臟劑量為22.6Gy,明顯低于IMRT計(jì)劃的24.3Gy,P=0.028。TOMO計(jì)劃的中位脊髓最大劑量為40.2Gy,明顯低于IMRT計(jì)劃的41.7Gy,P=0.007。結(jié)論食管癌放療中TOMO放療計(jì)劃對(duì)比IMRT放療計(jì)劃,具有更好的靶區(qū)覆蓋適形性及劑量分布均勻性,同時(shí)明顯減少雙肺、心臟及脊髓的受照劑量。
[Abstract]:Objective in recent years, radiotherapy equipment has been continuously updated, radiotherapy technology has been continuously developed, tumor radiotherapy methods have been more options. This study evaluated the dosimetric characteristics of modulation radiation therapy for esophageal carcinoma by means of spiral tomography radiotherapy (SCT) and three dimensional conformal intensity modulation radiotherapy (IMRT). Methods Ten patients with esophageal cancer were selected from Department of chest tumor radiotherapy, Zhejiang Provincial Cancer Hospital, 2014-07-13-2015-02-25. After drawing target areas and normal organs, they were transferred to Raystation and TOMO planning system, respectively. The primary tumor was given PGTVV 61.6 Gy / 28 times, and the target area was planned to be 56. 0 Gy / 28 times, according to the RTOG 1106 standard to limit the dose of endangering organs at riskbar. The dose histogram of the target area was dose volume histogram, homogeneity index, conformal index and OARR (lung, heart, heart, etc.) and OARA (lung, heart, heart, etc.) respectively. Results both the maximum dose and average dose of spinal cord irradiation could meet the prescribed dose requirement and the median homogeneity index of PGTV in the Tomo program was 0.057 5, which was better than that of the 0.073 5 Pao 0.047 TOMO in the IMRT program. The median conformance index (CI) of PTV in the stroke is 0.785, which is better than that of the maximum dose of PGTV in the IMRT program 0.6825g P0. 009.TOMO is 64.9 Gy, and significantly lower than that of the IMRT program 66.5 Gyp 0.005 TOMO, the median Dmax of PTV is 64.1 Gy, which is significantly lower than that of the IMRT program 64.9Gy P0. 028.TOMO. The median total lung dose was 10.8Gy, which was significantly lower than that of IMRT's 11.9 Gyp 0.005.TOMO plan (22.6Gy), and significantly lower than that of IMRT's 24.3 Gyp 0.028.TOMO plan's maximum spinal cord dose of 40.2Gy / 0.0070.Conclusion TOMO in esophageal cancer radiotherapy is significantly lower than that of IMRT's plan (41.7 Gyp 0.007Gy). Radiotherapy plan versus IMRT radiotherapy plan, It has better target coverage conformability and dose distribution uniformity, and decreases the radiation dose of both lungs, heart and spinal cord.
【作者單位】： 浙江省腫瘤醫(yī)院胸部腫瘤放療科;
【基金】：國(guó)家自然科學(xué)基金(11547178)
【分類號(hào)】：R730.55;R735.1
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本文編號(hào)：1616446