中国癌症杂志
中國癌癥雜誌
중국암증잡지
CHINA ONCOLOGY
2010年
3期
212-217
,共6页
邹中华%史建平%吴锦昌%周莉钧%朱国培
鄒中華%史建平%吳錦昌%週莉鈞%硃國培
추중화%사건평%오금창%주리균%주국배
腮腺癌%三维适形放疗%适形调强放疗%正向多子野调强放疗
腮腺癌%三維適形放療%適形調彊放療%正嚮多子野調彊放療
시선암%삼유괄형방료%괄형조강방료%정향다자야조강방료
parotid cancer%3DCRT%IMRT%MSRT
背景与目的:腮腺癌靶区位于头部的一侧,形状凹形,用何种照射方法可以更有效的使靶区剂量均匀及保护危及的器官,是目前讨论的热点.本研究通过比较采用二维常规、三维适形、正向和逆向调强放疗技术对腮腺癌术后靶区进行放疗计划设计,重点分析比较调强技术在保护正常器官和改善靶区适形度的作用,为临床治疗提供依据.方法:比较5种腮腺癌术后靶区照射技术,包括二野对穿照射(2F-2D)、二维电子线+X线混合照射(X+E)、三维适形放疗(3-dimensional conformal radiotherapy,3DCRT)、适形调强放疗(intensity-modulated radiotherapy,IMRT)正向多子野调强放疗(multi-segment radiotherapy,MSRT)照射.随机选择8例腮腺癌术后患者,为每位患者设计上述5种照射技术的治疗计划.处方剂量为60 Gy,2 Gy/次,共30次.分别比较这5种计划的剂量分布、剂量体积直方图(dose volume histogram,DVH)、靶区剂量均匀度以及正常器官受照剂量,同时比较2种调强技术放疗计划时间和实施治疗时间.结果:在靶区覆盖方面,3DCRT的V_(95%)和适形指数(CI)(97.5%和0.78)明显优于二维照射(77.9%和0.45)(P＜0.01),但劣于IMRT(99.1%和0.85)和MSRT(99.7%和0.81)(P＜0.01);两调强技术相比差异无统计学意义(P均＞0.05),但MSRT的实施时间(平均治疗时间5 min)明显短于IMRT(平均治疗时间15 min).在正常器官保护方面,脑干、脊髓和对侧腮腺的受照剂量,IMRT(19.4、28.1和8.5 Gy)和MSRT(17.0、28.O和0.8 Gy)优于3DCRT(25.4、37.7和1.8 Gy)更优于二维(51.7、58.8和54.6 Gy),但同侧中耳、眼球、眼晶体和下颌骨的受照剂量5种计划差异无统计学意义(P值均＞0.05).结论:3DCRT、MSRT和IMRT技术无论从靶区覆盖还是对正常器官保护方面均优于二维照射技术,而调强计划(包括IMRT和MSRT)优于3DCRT计划,但MSRT在靶区覆盖、正常器官的保护上与IMRT之间差异无统计学意义,且计划的执行效率优于IMRT技术.
揹景與目的:腮腺癌靶區位于頭部的一側,形狀凹形,用何種照射方法可以更有效的使靶區劑量均勻及保護危及的器官,是目前討論的熱點.本研究通過比較採用二維常規、三維適形、正嚮和逆嚮調彊放療技術對腮腺癌術後靶區進行放療計劃設計,重點分析比較調彊技術在保護正常器官和改善靶區適形度的作用,為臨床治療提供依據.方法:比較5種腮腺癌術後靶區照射技術,包括二野對穿照射(2F-2D)、二維電子線+X線混閤照射(X+E)、三維適形放療(3-dimensional conformal radiotherapy,3DCRT)、適形調彊放療(intensity-modulated radiotherapy,IMRT)正嚮多子野調彊放療(multi-segment radiotherapy,MSRT)照射.隨機選擇8例腮腺癌術後患者,為每位患者設計上述5種照射技術的治療計劃.處方劑量為60 Gy,2 Gy/次,共30次.分彆比較這5種計劃的劑量分佈、劑量體積直方圖(dose volume histogram,DVH)、靶區劑量均勻度以及正常器官受照劑量,同時比較2種調彊技術放療計劃時間和實施治療時間.結果:在靶區覆蓋方麵,3DCRT的V_(95%)和適形指數(CI)(97.5%和0.78)明顯優于二維照射(77.9%和0.45)(P＜0.01),但劣于IMRT(99.1%和0.85)和MSRT(99.7%和0.81)(P＜0.01);兩調彊技術相比差異無統計學意義(P均＞0.05),但MSRT的實施時間(平均治療時間5 min)明顯短于IMRT(平均治療時間15 min).在正常器官保護方麵,腦榦、脊髓和對側腮腺的受照劑量,IMRT(19.4、28.1和8.5 Gy)和MSRT(17.0、28.O和0.8 Gy)優于3DCRT(25.4、37.7和1.8 Gy)更優于二維(51.7、58.8和54.6 Gy),但同側中耳、眼毬、眼晶體和下頜骨的受照劑量5種計劃差異無統計學意義(P值均＞0.05).結論:3DCRT、MSRT和IMRT技術無論從靶區覆蓋還是對正常器官保護方麵均優于二維照射技術,而調彊計劃(包括IMRT和MSRT)優于3DCRT計劃,但MSRT在靶區覆蓋、正常器官的保護上與IMRT之間差異無統計學意義,且計劃的執行效率優于IMRT技術.
배경여목적:시선암파구위우두부적일측,형상요형,용하충조사방법가이경유효적사파구제량균균급보호위급적기관,시목전토론적열점.본연구통과비교채용이유상규、삼유괄형、정향화역향조강방료기술대시선암술후파구진행방료계화설계,중점분석비교조강기술재보호정상기관화개선파구괄형도적작용,위림상치료제공의거.방법:비교5충시선암술후파구조사기술,포괄이야대천조사(2F-2D)、이유전자선+X선혼합조사(X+E)、삼유괄형방료(3-dimensional conformal radiotherapy,3DCRT)、괄형조강방료(intensity-modulated radiotherapy,IMRT)정향다자야조강방료(multi-segment radiotherapy,MSRT)조사.수궤선택8례시선암술후환자,위매위환자설계상술5충조사기술적치료계화.처방제량위60 Gy,2 Gy/차,공30차.분별비교저5충계화적제량분포、제량체적직방도(dose volume histogram,DVH)、파구제량균균도이급정상기관수조제량,동시비교2충조강기술방료계화시간화실시치료시간.결과:재파구복개방면,3DCRT적V_(95%)화괄형지수(CI)(97.5%화0.78)명현우우이유조사(77.9%화0.45)(P＜0.01),단렬우IMRT(99.1%화0.85)화MSRT(99.7%화0.81)(P＜0.01);량조강기술상비차이무통계학의의(P균＞0.05),단MSRT적실시시간(평균치료시간5 min)명현단우IMRT(평균치료시간15 min).재정상기관보호방면,뇌간、척수화대측시선적수조제량,IMRT(19.4、28.1화8.5 Gy)화MSRT(17.0、28.O화0.8 Gy)우우3DCRT(25.4、37.7화1.8 Gy)경우우이유(51.7、58.8화54.6 Gy),단동측중이、안구、안정체화하합골적수조제량5충계화차이무통계학의의(P치균＞0.05).결론:3DCRT、MSRT화IMRT기술무론종파구복개환시대정상기관보호방면균우우이유조사기술,이조강계화(포괄IMRT화MSRT)우우3DCRT계화,단MSRT재파구복개、정상기관적보호상여IMRT지간차이무통계학의의,차계화적집행효솔우우IMRT기술.
Background and purpose:Now 3-dimensional conformal radiotherapy(3DCRT)and intensitymodulated radiotherapy(IMRT)are widely used in the treatment of head and neck tumor.For the parotid,this target area is located on the side of the head and the tumor has a concave shape.What kind of radiation method can be used more eriectively to achieve dose uniformity and protection organs at risk is the topic of much discussion.The postoperative irradiation of parotid tumor is varied in the techniques used.In this study,3-dimensional conformal radiotherapy (3DCRT),intensity-modulated radiotherapy(IMRT)and simplified forward planned multi-segment radiotherapy (MSRT)were compared to conventional planning techniques in order to investigate the potential advantages of these new treatments.Methods:The conventional planning included the large opposed lateral fields with 2 or 3 weight ratio at the target lateral(2F-2D)and the unilateral field with mixture of 6 MV photon and electron beams(X+E).The 3D techniques included 3DCRT,MSRT and IMRT.Their dose distributions were calculated and compared for 8 patients treated in our center.Different beam arrangements were used for 3D techniques.In each case.the dose of PTV was prescribed to 60 Gy.All plans were compared using dose-volume histogram data.The conformity index(CI)and heterogeneity index(HI)of dose were used to evaluate the dose coverage of the target volume.Dose sparing of brain stem.spinal cord and the contra lateral parotid was also compared.To compare IMRT and MS RT,the timing ofplanning and radiation delivery was recorded.Results:Compared to conventional planning,the 3DCRT,MSRT and IMRT plans produced adequate target coverage,and the CI showed 3DCRT plans(0.78)produced poorer target coverage than MSRT(0.81)and IMRT(0.85).MRST and IMRT plans showed a significant reduction in maximum dose to the spinal cord,brainstem and the contra lateral parotid,compared to the conventional plans,while the 3DCRT plan did not show significant sparing of these structures.MSRT and IMRT plans produced better dose coverage among all the techniques.The efficacy of beam delivery comparing between two modulated planning showed MSRT was better.Conclusion:For postoperative irradiation of parotid cancer,3D planning techniques generated better target dose-coverage,without compromising the dose-sparing advantages of important structures.A satisfactory dose distribution can be obtained using MSRT and such a simple technique may be suitable for replacing IMRT.
