| 舒小镭,邱 大,周 宪.中段食管癌放疗时靶区与肺的体积比与肺受照剂量的相关性分析[J].肿瘤学杂志,2016,22(6):487-491. |
| 中段食管癌放疗时靶区与肺的体积比与肺受照剂量的相关性分析 |
| Correlation Between the Ratio of Target Volume to Lung and Lung Dose?鄄volume Histogram in Middle Esophageal Cancer |
| 投稿时间：2016-03-09 |
| DOI：10.11735/j.issn.1671-170X.2016.06.B011 |
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| 中文关键词: 食管肿瘤 危及器官 调强放疗 剂量学 个体化 |
| 英文关键词:esophageal neoplasms organ at risk intensity-modulated radiation therapy dosimetry individualization |
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| 中文摘要: |
| 摘 要：［目的］ 比较中段食管癌三维适形放疗（3DCRT）中三野与四野、固定野调强放疗(IMRT)、容积弧形调强放疗（VMAT）的剂量学差异，并研究肺与靶区的体积比对肺受照剂量的影响，从而探索有效的个体化临床放疗方法。［方法］ 选取10 例中段食管癌患者，在Varian Eclipse 11.0计划系统中分别制定4种放疗计划（VMAT/IMRT/3F-3DCRT/4F-3DCRT），所有计划均使 95%靶区达到处方剂量。比较不同计划的靶区、脊髓、肺等的剂量—体积直方图(DVH)。［结果］ 与3DCRT相比，VMAT、IMRT计划的脊髓最大剂量及肺V5、V10、V20、V30都有显著降低(P<0.05)；而VMAT、IMRT计划之间各危及器官的受照剂量无统计学差异（P>0.05），但VMAT的机器跳数(Mu)及治疗时间有明显优势（P<0.05）；对于靶区剂量VMAT、IMRT的适形指数与均匀指数无统计学意义（P>0.05），但均优于3DCRT计划（P<0.05）。3DCRT的肺V5、V10、V20、V30与体积比具有强相关性(Rs>0.6)，VMAT、IMRT计划中肺的DVH与体积比具有弱相关性(Rs>0.3)。［结论］ 对于中段食管癌放疗患者，VMAT、IMRT在危及器官保护及靶区剂量覆盖方面均优于3DCRT；与IMRT比较，VMAT在缩短治疗时间、降低机器跳数上有优势。不同计划随肺与靶区的体积比的变化，其危及器官受量表现出不同的优势，这些差异同体积比具有相关性，而这种相关性为个体化制定中段食管癌放疗计划提供了参考。 |
| 英文摘要: |
| Abstract：［Objective］ To compare the dosimetry of four different radiotherapy plans including thee-dimensional conformal radiation therapy (3DCRT) with three or four field (3F-3DCRT/4F-3DCRT)，intensity-modulated radiotherapy(IMRT) and volumetric-modulated arc therapy，and investigate the correlation between the ratio of target volume to lung and lung dose-volume histogram (DVH)，then to obtain the individualized radiotherapy. ［Methods］ Ten cases with middle esophageal cancer were chosen. Four kinds of radiotherapy plans were designed in Varian Eclipse V11.0. The 95% of target volume was covered by prescribed dose in all plans. The target coverage，the DVHs of spinal cord and lung were compared among different plans. ［Results］ Compared to 3DCRT，VMAT/IMRT had lower maximum dose to spinal cord and the V5，V10，V20，V30 of lung(P<0.05)，but there was no significant difference in the dose to organs at risk between IMRT and VMAT(P>0.05). It had obvious advantage in machine unit and treatment time for VMAT (P<0.05). The statistical significance was not found in the target dose，conformal index and homogeneity index between IMRT and VMAT(P>0.05)，but they were better than 3DCRT(P<0.05). There was a strong correlation between volume ratio and lung V5，V10，V20，V30 for 3DCRT(Rs>0.6)，but it became weak in VMAT，IMRT plans(Rs>0.3). ［Conclusion］ For patients with esophageal cancer，IMRT and VMAT are better than 3DCRT in the risk of organ protection and target dose coverage. Compared with IMRT，VMAT can shorten the treatment time，and reduce machine units. Different plan shows a different advantage in organ protection depending on the ratio of lung volume to target volume. These differences are correlated with the ratios，and it provides a guideline of individualized radiotherapy for patients with esophageal carcinoma. |
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