肝肿瘤%放射疗法,适形%放射治疗计划,计算机辅助
肝腫瘤%放射療法,適形%放射治療計劃,計算機輔助
간종류%방사요법,괄형%방사치료계화,계산궤보조
Liver neoplasms%Radiotherapy,conformal%Radiotherapy planning,computerassisted
目的 对质子束治疗(PBT)与X线三维适形放射治疗(3D-CRT)及调强放射治疗(IMRT)在肝细胞肝癌患者治疗时的剂量分布进行对比研究,以评价PBT的潜在优势.方法 选用Ⅰ期肝癌患者10例(肿瘤直径≤5.0 cm),总剂量为66 Gy和86 Gy,ⅡA期肝癌患者12例(肿瘤直径5.1～10.0 cm),总剂量为60 Gy和72 Gy,分别设计3D-CRT、IMRT和PBT治疗计划,通过剂量体积直方图(DVH)比较其正常肝脏和危及器官(OARs)的剂量分布差异.结果 Ⅰ期肝癌患者3D-CRT的总剂量为66 Gy时,其肝脏平均剂量(Dmean)为13.01 Gy,其V10、V20和V30分别为51.89%、36.13%和21.24%,而PBT总剂量为66 Gy时,其Dmean、V10、V20和V30则分别为6.34 Gy、30.23%、17.86%和10.66%(P＜0.002).当总剂量提高至86 Gy时,3D-CRT的Dmean、V10、V20和V30分别为16.91 Gy、67.51%、46.84%和27.61%;而PBT的Dmean、V10、V20和V30则分别为8.26Gy、39.31%、23.22%和13.86%(P＜0.002).与3D-CRT总剂量为66 Gy时相比,PBT在总剂量提升至86 Gy时,其Dmean、V10、V20和V30仍明显低于3D-CRT(P＜0.042).ⅡA期患者3D-CRT总剂量为60 Gy时,其Dmean、V10、V20和V30分别为29.18 Gy、72.25%、58.17%和44.01%;IMRT的Dmean、V10、V20和V30分别为24.92 Gy、73.32%、56.15%和37.75%,而PBT则分别为16.28 Gy、43.93%、33.54%和22.78%(P＜0.002).当总剂量提高至72 Gy时,3D-CRT的Dmean、V10、V20和V30分别为35.02 Gy、86.70%、69.80%和52.81%;IMRT的Dmean、V10、V20和V30分别为29.90Gy,87.98%,67.74% and 45.30%,而PBT的Dmean、V10、V20和V30分别为19.54 Gy、52.72%、40.25%和27.34%(P＜0.002).与3D-CRT总剂量为60 Gy时相比,PBT在总剂量提升至72 Gy时,其Dmean、V10、V20和V30仍明显低于3D-CRT和IMRT(P＜0.05).22例患者采用PBT可使肝外OARs(脊髓、右侧肾脏和胃)的照射剂量明显低于3D-CRT(P＜0.002).与IMRT相比,PBT降低了右侧肾脏和胃的受量(P＜0.05),脊髓的受量两者差异无统计学意义(P＞0.05).结论 与3D-CRT相比,PBT可使肝脏的平均剂量和肝外OARs的照射剂量明显降低.当PBT的总剂量较3D-CRT提升20.0%-30.3%时,其肝脏的平均剂量仍明显低于3D-CRT.与IMRT相比,PBT使ⅡA期患者的Dmean、V10、V20、V30、右侧肾脏和胃的受量明显降低,脊髓的受量两者无显著性差异.
目的 對質子束治療(PBT)與X線三維適形放射治療(3D-CRT)及調彊放射治療(IMRT)在肝細胞肝癌患者治療時的劑量分佈進行對比研究,以評價PBT的潛在優勢.方法 選用Ⅰ期肝癌患者10例(腫瘤直徑≤5.0 cm),總劑量為66 Gy和86 Gy,ⅡA期肝癌患者12例(腫瘤直徑5.1～10.0 cm),總劑量為60 Gy和72 Gy,分彆設計3D-CRT、IMRT和PBT治療計劃,通過劑量體積直方圖(DVH)比較其正常肝髒和危及器官(OARs)的劑量分佈差異.結果 Ⅰ期肝癌患者3D-CRT的總劑量為66 Gy時,其肝髒平均劑量(Dmean)為13.01 Gy,其V10、V20和V30分彆為51.89%、36.13%和21.24%,而PBT總劑量為66 Gy時,其Dmean、V10、V20和V30則分彆為6.34 Gy、30.23%、17.86%和10.66%(P＜0.002).噹總劑量提高至86 Gy時,3D-CRT的Dmean、V10、V20和V30分彆為16.91 Gy、67.51%、46.84%和27.61%;而PBT的Dmean、V10、V20和V30則分彆為8.26Gy、39.31%、23.22%和13.86%(P＜0.002).與3D-CRT總劑量為66 Gy時相比,PBT在總劑量提升至86 Gy時,其Dmean、V10、V20和V30仍明顯低于3D-CRT(P＜0.042).ⅡA期患者3D-CRT總劑量為60 Gy時,其Dmean、V10、V20和V30分彆為29.18 Gy、72.25%、58.17%和44.01%;IMRT的Dmean、V10、V20和V30分彆為24.92 Gy、73.32%、56.15%和37.75%,而PBT則分彆為16.28 Gy、43.93%、33.54%和22.78%(P＜0.002).噹總劑量提高至72 Gy時,3D-CRT的Dmean、V10、V20和V30分彆為35.02 Gy、86.70%、69.80%和52.81%;IMRT的Dmean、V10、V20和V30分彆為29.90Gy,87.98%,67.74% and 45.30%,而PBT的Dmean、V10、V20和V30分彆為19.54 Gy、52.72%、40.25%和27.34%(P＜0.002).與3D-CRT總劑量為60 Gy時相比,PBT在總劑量提升至72 Gy時,其Dmean、V10、V20和V30仍明顯低于3D-CRT和IMRT(P＜0.05).22例患者採用PBT可使肝外OARs(脊髓、右側腎髒和胃)的照射劑量明顯低于3D-CRT(P＜0.002).與IMRT相比,PBT降低瞭右側腎髒和胃的受量(P＜0.05),脊髓的受量兩者差異無統計學意義(P＞0.05).結論 與3D-CRT相比,PBT可使肝髒的平均劑量和肝外OARs的照射劑量明顯降低.噹PBT的總劑量較3D-CRT提升20.0%-30.3%時,其肝髒的平均劑量仍明顯低于3D-CRT.與IMRT相比,PBT使ⅡA期患者的Dmean、V10、V20、V30、右側腎髒和胃的受量明顯降低,脊髓的受量兩者無顯著性差異.
목적 대질자속치료(PBT)여X선삼유괄형방사치료(3D-CRT)급조강방사치료(IMRT)재간세포간암환자치료시적제량분포진행대비연구,이평개PBT적잠재우세.방법 선용Ⅰ기간암환자10례(종류직경≤5.0 cm),총제량위66 Gy화86 Gy,ⅡA기간암환자12례(종류직경5.1～10.0 cm),총제량위60 Gy화72 Gy,분별설계3D-CRT、IMRT화PBT치료계화,통과제량체적직방도(DVH)비교기정상간장화위급기관(OARs)적제량분포차이.결과 Ⅰ기간암환자3D-CRT적총제량위66 Gy시,기간장평균제량(Dmean)위13.01 Gy,기V10、V20화V30분별위51.89%、36.13%화21.24%,이PBT총제량위66 Gy시,기Dmean、V10、V20화V30칙분별위6.34 Gy、30.23%、17.86%화10.66%(P＜0.002).당총제량제고지86 Gy시,3D-CRT적Dmean、V10、V20화V30분별위16.91 Gy、67.51%、46.84%화27.61%;이PBT적Dmean、V10、V20화V30칙분별위8.26Gy、39.31%、23.22%화13.86%(P＜0.002).여3D-CRT총제량위66 Gy시상비,PBT재총제량제승지86 Gy시,기Dmean、V10、V20화V30잉명현저우3D-CRT(P＜0.042).ⅡA기환자3D-CRT총제량위60 Gy시,기Dmean、V10、V20화V30분별위29.18 Gy、72.25%、58.17%화44.01%;IMRT적Dmean、V10、V20화V30분별위24.92 Gy、73.32%、56.15%화37.75%,이PBT칙분별위16.28 Gy、43.93%、33.54%화22.78%(P＜0.002).당총제량제고지72 Gy시,3D-CRT적Dmean、V10、V20화V30분별위35.02 Gy、86.70%、69.80%화52.81%;IMRT적Dmean、V10、V20화V30분별위29.90Gy,87.98%,67.74% and 45.30%,이PBT적Dmean、V10、V20화V30분별위19.54 Gy、52.72%、40.25%화27.34%(P＜0.002).여3D-CRT총제량위60 Gy시상비,PBT재총제량제승지72 Gy시,기Dmean、V10、V20화V30잉명현저우3D-CRT화IMRT(P＜0.05).22례환자채용PBT가사간외OARs(척수、우측신장화위)적조사제량명현저우3D-CRT(P＜0.002).여IMRT상비,PBT강저료우측신장화위적수량(P＜0.05),척수적수량량자차이무통계학의의(P＞0.05).결론 여3D-CRT상비,PBT가사간장적평균제량화간외OARs적조사제량명현강저.당PBT적총제량교3D-CRT제승20.0%-30.3%시,기간장적평균제량잉명현저우3D-CRT.여IMRT상비,PBT사ⅡA기환자적Dmean、V10、V20、V30、우측신장화위적수량명현강저,척수적수량량자무현저성차이.
Objective A comparative dose distribution study has been undertaken between proton beam therapy (PBT),3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in the treatment of hepatocellular carcinoma (HCC),so as to assess the potential advantages of PBT.Methods Dose volume histograms (DVHs) were compared between PBT and 3D-CRT or IMRT planning at total dose of 66 Gy and 86 Gy in stage Ⅰ patients (n=10,diameter≤5 cm),60 Gy and 72 Gy in stage Ⅱ A patients (n=12,diameter=5.1-10 cm).Results For patients with stage Ⅰ,the mean liver dose (Dmean),V10,V20 and V30 were 13.01 Gy,51.89%,36.13% and 21.24% for 3DCRT,whereas they were 6.34 Gy,30.23%,17.86% and 10.66%,respectively,for PBT(P＜0.002).With dose escalation to 86 Gy,the Dmean,V10,V20 and V30 were 16.91 Gy,67.51%,46.84% and 27.61% for 3D-CRT,whereas they were 8.26 Gy,39.31%,23.22% and 13.86%,respectively,for PBT (P＜0.002).Compared with 3D-CRT with dose of 66 Gy,PBT reduced the Dmean,V10,V20 and V30 even with dose escalation to 86 Gy (P＜0.042).For patients with stage Ⅱ A,the Dmean,V10,V20 and V30 were 29.18 Gy,72.25%,58.17%,44.01% and 24.92 Gy,73.32%,56.15%,37.75% for 3DCRT and IMRT,respectively,with dose of 60 Gy,whereas they were 16.28 Gy,43.93%,33.54% and 22.78%,respectively,for PBT(P＜0.002).With dose escalation to 72 Gy,the Dmean,V10,V20,V30 were 35.02 Gy,86.70%,69.80%,52.81% and 29.90 Gy,87.98%,67.74% and 45.30% for 3D-CRT and IMRT,respectively,whereas they were 19.54 Gy,52.72%,40.25% and 27.34%,respectively,for PBT (P＜0.002).Compared with 3D-CRT and IMRT with total dose of 60 Gy,PBT reduced the Dmean,V10,V20 and V30 even with dose escalation to 72 Gy(P＜0.05).In all of the 22 cases,compared with 3D-CRT,PBT reduced the doses to the nonliver OARs(organs at risks) including spinal cord,right kidney and stomach(P＜0.002).Compared with IMRT,PBT also reduced the dose to the right kidney and stomach significantly,while no significant difference was found respect to the dose to spinal cord (P＞0.05).Conclusion Compared with 3D-CRT,PBT reduced the dose to the normal liver tissues and nonliver OARs significantly,even with 20 to 30.3 percent of dose escalation.Compared with IMRT,PBT reduced the dose to the normal liver tissues significantly,even with 20 to 30.3 percent of dose escalation.PBT reduced the dose to the right kidney and stomach significantly.No significant difference was observed respect to the dose to spinal cord.
