CAJ | 학술논문

目的筛选胸上段食管癌不同适形和调强放疗计划优选方案.方法 8例胸上段食管癌cT模拟后参考食管钡餐造影和食管镜结果勾画GTV,按统一标准外扩CTV和PTV,实施3、4、6个野适形治疗计划和3、4、5、7、9、11个野IMRT计划和s-IMRT计划,以95%PTV体积获得6000 cGy处方剂量进行归一,分析各治疗计划靶区剂量分布和危及器官受量,进行剂量学对比研究.结果 3套适形计划之间,PTV剂量参数和体积参数均相近(P＞0.05);6个野适形计划全肺V20高于4个野(P＜0.05),3、6个野适形计划MLD也高于4个野(P＜0.05).6套调强治疗计划中,3个野IMRT计划PTV D100低于9、11个野IMRT计划(P＜0.05);4个野IMRT计划IV高于9、11个野IMRT计划(P＜0.05);9、11个野IMRT计划PTV适形指数CI、剂量参数D95、体积参数V100和V95较57个野IMRT和s-IMRT计划无明显优势(P＞0.05);各IMRT计划之间危及器官受量相近(P＞0.05).胸上段食管癌4个野适形计划PTV CI、PTV剂量参数和体积参数均低于5、7个野IMRT计划和s-IMRT计划(P＜0.05);4个野适形计划全肺V20均高于5、7个野IMRT计划和s-IMRT计划(P＜0.05).结论胸上段食管癌三维适形放疗中4个野适形计划可为优选方案,调强放疗中5、7个野IMRT计划和s-IMRT计划可为优选方案.胸上段食管癌5、7个野IMRT计划和s-IMRT计划优于4个野适形计划.
목적 사선흉상단식관암불동괄형화조강방료계화우선방안.방법 8례흉상단식관암cT모의후삼고식관패찬조영화식관경결과구화GTV,안통일표준외확CTV화PTV,실시3、4、6개야괄형치료계화화3、4、5、7、9、11개야IMRT계화화s-IMRT계화,이95%PTV체적획득6000 cGy처방제량진행귀일,분석각치료계화파구제량분포화위급기관수량,진행제량학대비연구.결과 3투괄형계화지간,PTV제량삼수화체적삼수균상근(P＞0.05);6개야괄형계화전폐V20고우4개야(P＜0.05),3、6개야괄형계화MLD야고우4개야(P＜0.05).6투조강치료계화중,3개야IMRT계화PTV D100저우9、11개야IMRT계화(P＜0.05);4개야IMRT계화IV고우9、11개야IMRT계화(P＜0.05);9、11개야IMRT계화PTV괄형지수CI、제량삼수D95、체적삼수V100화V95교57개야IMRT화s-IMRT계화무명현우세(P＞0.05);각IMRT계화지간위급기관수량상근(P＞0.05).흉상단식관암4개야괄형계화PTV CI、PTV제량삼수화체적삼수균저우5、7개야IMRT계화화s-IMRT계화(P＜0.05);4개야괄형계화전폐V20균고우5、7개야IMRT계화화s-IMRT계화(P＜0.05).결론 흉상단식관암삼유괄형방료중4개야괄형계화가위우선방안,조강방료중5、7개야IMRT계화화s-IMRT계화가위우선방안.흉상단식관암5、7개야IMRT계화화s-IMRT계화우우4개야괄형계화.
Objective To evaluate the optimized conformal and IMRT plans for the upper esophageal carcinoma. Methods Eight patients with upper esophageal carcinoma underwent CT simulation.GTV was contoured on the CT image,referring the esophagogram and endoscopy simuhaneously,then CTV and PTV were also defined using the same criteria.Different conformal radiotherapy plans consisting of 3 fields(F),4F or 6F,IMRT plans consisting of 3F,4F,5F,7F,9F or 11F,and a simplified IMRT(s-IMRT)plan were designed for these patients.The minimum prescription dose that 95%of PTV volume received was 6000 cGy.Dose distributions of the PTV and OARs in different 3 DCRT and IMRT plans were compared and the optimized plans for the upper esophageal carcinoma were then recommended. Resuits Dose and volume parameters of PTV were similar among the 3DCRT plans(P＞0.05).4F 3DCRT plan reduced lung V20 as compared to 6F plan(P＜0.05),and mean lung dose(MLD)of 3F and 6F 3DCRT plans were higher than that of4F plan(P＜0.05).PTV D100 of 3F IMRT plan was lower than that of 9F and 11F plans(P＜0.05).IV of 4F IMRT plan was larger than that of 9F and 11F IMRT plans(P＜0.05).PTV dose and volume parameters of the 9F IMRT and 1 1 F IMRT were similar comparing with 5F.7F and s-IMRT plans,and OARs dose was also similar among IMRT plans(P＞0.05).PTV CI,D100,D95,V100 and V95 of the 4F 3DCRT plan were all lower than those of 5F,7F and s-IMRT plans(P＜0.05).5F,7F and s-IMRT plans reduced lung V20 as compared to 4F 3DCRT plan(P＜0.05).Conclusions For the upper esophageal carcinoma.4F 3DCRT plan is recommended among the 3DCRT plans.5F.7F and s-IMRT plans are recommended among the IMRT plans,which are superior than 4F 3 DCRT plan.