本文選題：鼻咽癌 + 多劑量水平�。� 參考：《生物醫(yī)學(xué)工程學(xué)雜志》2017年06期

【摘要】：本研究目的為系統(tǒng)地比較雙弧容積旋轉(zhuǎn)調(diào)強(qiáng)放射治療(VMAT)與動(dòng)態(tài)調(diào)強(qiáng)放射治療(d-IMRT)兩種技術(shù)方法在多劑量水平鼻咽癌(NPC)計(jì)劃質(zhì)量和傳輸效能上的異同,分析靶體積與計(jì)劃質(zhì)量差異的相關(guān)性。為20例2014年—2015年在本機(jī)構(gòu)進(jìn)行過(guò)4~5劑量水平全頸同步加量(SIB)調(diào)強(qiáng)放療的NPC患者重新設(shè)計(jì)雙弧VMAT計(jì)劃,其逆向優(yōu)化條件與設(shè)計(jì)IMRT計(jì)劃時(shí)相同。然后對(duì)兩組計(jì)劃的靶區(qū)和危及器官(OAR)的劑量參數(shù)、傳輸效能進(jìn)行了比較,用三維劑量驗(yàn)證系統(tǒng)進(jìn)行了質(zhì)量保證驗(yàn)證,分析腫瘤靶體積與計(jì)劃質(zhì)量差異的相關(guān)性。結(jié)果顯示,雙弧VMAT靶區(qū)的適形度指數(shù)(CI)優(yōu)于d-IMRT(P0.05),未發(fā)現(xiàn)兩者差異與靶體積明顯相關(guān)(P0.05)。VMAT在靶區(qū)PTV1、PGTVnd和PTV3的劑量分布與d-IMRT相似或前者略好。VMAT降低了PTV2劑量,均勻指數(shù)(HI)變差。對(duì)脊髓、腦干等,VMAT有更好的保護(hù)作用,但會(huì)增加腮腺劑量。d-IMRT計(jì)劃跳數(shù)為VMAT計(jì)劃的3.32倍,出束時(shí)間為VMAT計(jì)劃的2.19倍。在COMPASS?質(zhì)量保證(QA)驗(yàn)證中,VMAT與IMRT計(jì)劃的靶區(qū)γ(3 mm,3%)通過(guò)率均大于97%。本研究結(jié)果表明,VMAT和d-IMRT兩種技術(shù)對(duì)多水平處方劑量NPC患者的治療效果相差不大,VMAT能提高靶區(qū)的適形度,但使除頸部轉(zhuǎn)移淋巴結(jié)外的頸部靶區(qū)劑量覆蓋率和劑量分布變差。VMAT的QA優(yōu)于d-IMRT,且VMAT在傳輸效率上也明顯高于d-IMRT。
[Abstract]:The purpose of this study was to systematically compare the differences and similarities between the two techniques of dual arc volume rotational intensity modulated radiotherapy (VMATT) and dynamic intensity modulated radiotherapy (DIMRT) in planning quality and transmission efficiency of NPCs at multiple dose levels for nasopharyngeal carcinoma (NPC). The correlation between target volume and planned quality difference is analyzed. A double-arc VMAT plan was redesigned for 20 NPC patients who underwent 4 ~ 5 doses of SIB-IMRT from 2014 to 2015, and the conditions of reverse optimization were the same as those of IMRT. Then, the dose parameters and transmission efficiency of the target area and the OARs of the two groups were compared. The quality assurance verification was carried out by using the three-dimensional dose verification system, and the correlation between the tumor target volume and the planned quality difference was analyzed. The results showed that the conformability index (CI) of double arc VMAT was better than that of d-IMRTT. There was no significant correlation between the difference and the target volume. The dose distribution of PGnd and PTV3 in the target region was similar to that of d-IMRT or that the former decreased the dose of PTV2, and the variation of homogeneity index was lower than that of d-IMRT. VMAT in spinal cord, brain stem and so on had better protective effect, but increased the parotid gland dose. D-IMRT had 3.32 times of VMAT and 2.19 times of VMAT. At compass? The pass rates of VMAT and IMRT targets were higher than 97 mm / 3. The results showed that the effect of VMAT and d-IMRT on patients with NPC with multi-level prescription dose was not different. VMAT could improve the conformability of target area. However, the dose coverage and dose distribution of the cervical target area except cervical metastatic lymph nodes became worse. The QA of VMAT was superior to d-IMRTT, and the transmission efficiency of VMAT was significantly higher than that of d-IMRTT.
【作者單位】： 南通大學(xué)附屬醫(yī)院腫瘤放療科;南通大學(xué)醫(yī)學(xué)院;
【分類號(hào)】：R730.55;R739.63

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