發(fā)布時間：2018-04-02 13:09

  本文選題：快速容積旋轉(zhuǎn)調(diào)強(qiáng)　切入點：腦轉(zhuǎn)移瘤　出處：《中華腫瘤防治雜志》2017年06期

【摘要】：目的在腦轉(zhuǎn)移瘤放射治療中,對海馬體的保護(hù)得到了越來越多的重視和研究。本研究探討容積旋轉(zhuǎn)調(diào)強(qiáng)放療在腦轉(zhuǎn)移瘤局部病灶加量對海馬體保護(hù)的劑量學(xué)特點。方法隨機(jī)選取2013-12-01-2015-12-01在秦皇島市第一醫(yī)院放療科治療的15例腦轉(zhuǎn)移患者,每例患者分別設(shè)計兩種治療計劃,劑量體積約束條件相同,容積旋轉(zhuǎn)調(diào)強(qiáng)放療(volume-modulated arc therapy,VMAT)計劃使用2個全弧,固定野調(diào)強(qiáng)放療(fixed-field intensity modulated radiation therapy,ff-IMRT)計劃使用9個共面射野。在處方劑量要求相同情況下,比較兩種計劃的靶區(qū)和海馬體的劑量學(xué)參數(shù)、機(jī)器跳數(shù)差異。結(jié)果靶區(qū)劑量學(xué)參數(shù)中,VMAT計劃的計劃靶區(qū)體積(planning tumor volume,PTV)適形指數(shù)(0.82±0.07)好于ff-IMRT計劃(0.78±0.08),t=2.457,P=0.028;對于海馬體,左側(cè)海馬體最大值兩計劃差異無統(tǒng)計學(xué)意義,t=-1.175,P=0.260;VMAT計劃的左側(cè)海馬體平均值為(1 186.43±1 358.29)cGy,右側(cè)海馬體最大值為(1 209.14±498.22)cGy,右側(cè)海馬體平均值為(738.16±422.70)cGy,雙側(cè)海馬體最大值為(2 037.12±1 771.21)cGy,雙側(cè)海馬體平均值為(940.68±765.00)cGy,低于ff-IMRT計劃,差異有統(tǒng)計學(xué)意義,P0.05;對于正常組織(全身減計劃靶體積,即B-P),VMAT計劃的V5(36.69±15.39)%,V15(18.61±9.87)%,V20(13.09±7.45)%小于ff-IMRT計劃,差異有統(tǒng)計學(xué)意義,P0.05,其他正常組織指標(biāo)無差異;VMAT計劃的機(jī)器跳數(shù)(426±74)顯著低于ff-IMRT計劃(1 122±317),t=-8.446,P0.001。結(jié)論 VMAT在腦轉(zhuǎn)移瘤局部病灶加量與ff-IMRT相比,明顯的減少了海馬體的受量和機(jī)器跳數(shù),靶區(qū)適形度較好,并部分減少了周圍正常組織的低劑量區(qū)受量,具有一定的劑量學(xué)優(yōu)勢。
[Abstract]:Objective in radiotherapy of brain metastases, more and more attention has been paid to the protection of hippocampus.The purpose of this study was to investigate the dose characteristics of volume rotation intensity modulated radiotherapy (VIMRT) in the protection of hippocampal body from brain metastases.Methods Fifteen patients with brain metastases were randomly selected from the Department of radiotherapy, first Hospital of Qinhuangdao City, 2013-12-01-2015-12-01. Two treatment plans were designed for each patient with the same dose and volume constraint conditions. Volume rotated intensity modulated radiotherapy (VRT) volume-modulated arc therapeutic therapy (VMATT) was used for two full arcs.Fixed-field intensity modulated radiation therapy was planned to use nine coplanar fields.Under the same prescription dose requirement, the difference of dosimetry parameters and machine hops between the target area and the hippocampus of the two plans were compared.Results in the dosimetric parameters of the target area, the planning volume of tumor volume in the target area was 0.82 鹵0.07, which was better than that in the ff-IMRT plan (0.78 鹵0.08), and that in the hippocampal body was 0.78 鹵0.08, 2.457 and 0.028, respectively, and the conformability index of the target area was 0.82 鹵0.07, which was better than that of the ff-IMRT plan (0.78 鹵0.08).The mean value of hippocampal body was 940.68 鹵765.00 cGy, which was lower than that of ff-IMRT plan.Conclusion compared with ff-IMRT, the dosage of VMAT in brain metastases can significantly reduce the hippocampal receptivity and the number of machine jumps, the conformal degree of the target area is better, and partly reduce the low dose area of the surrounding normal tissue, so it has some dosimetric advantages.
【作者單位】： 秦皇島市第一醫(yī)院放療科;中南大學(xué)湘雅醫(yī)院腫瘤科;
【分類號】：R730.55

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