CAJ | 학술논문

目的比较胸段食管癌3种放疗技术( 3D-CRT、IMRT、RapidArc)的剂量学特点,并分析3种技术的优劣及应用特点.方法 15例胸段食管癌患者入组,依据CT图像,勾画靶区,针对患者的同一套CT图像的相同靶区分别制定3D-CRT、5野IMRT(IMRT5)、7野IMRT( IMRT7)、9野IMRT(IMRT9)、单弧Arc( Arc1)、双弧Arc( Arc2)共6套计划.PTV处方剂量为40 Gy分20次4周+19.6 Gy分14次7d.结果 3D-CRT计划各项靶区剂量学参数明显差于IMRT计划及RapidArc计划(t=5.77、3.52,P＜0.05),6套计划的PTV V95(％)分别为:3D-CRT (91.55 ±2.90),IMRT5(96.66±1.05),IMRT7 (96.87±1.23),IMRT (96.81±1.16),Arcl (94.98±1.41),Arc2 (95.93±1.32).RapidArc计划的靶区适形度(CI)最好(t=3.76,10.01,P＜0.05),IMRT计划的靶区均匀性(HI)最好(t =3.93、3.37,P＜0.05).危及器官参数RapidArc与IMRT各计划之间差异无统计学意义.3D-CRT和RapidArc计划的机器跳数明显少于IMRT计划,差异高达75％.结论对于胸段食管癌患者,采用IMRT或RapidArc技术可以在保护正常组织的同时,涵盖临床必需的治疗靶区.3D-CRT计划对降低正常组织低剂量散射区方面优势明显.RapidArc计划靶区剂量学参数与IMRT计划比较未见明显优势.
목적 비교흉단식관암3충방료기술( 3D-CRT、IMRT、RapidArc)적제량학특점,병분석3충기술적우렬급응용특점.방법 15례흉단식관암환자입조,의거CT도상,구화파구,침대환자적동일투CT도상적상동파구분별제정3D-CRT、5야IMRT(IMRT5)、7야IMRT( IMRT7)、9야IMRT(IMRT9)、단호Arc( Arc1)、쌍호Arc( Arc2)공6투계화.PTV처방제량위40 Gy분20차4주+19.6 Gy분14차7d.결과 3D-CRT계화각항파구제량학삼수명현차우IMRT계화급RapidArc계화(t=5.77、3.52,P＜0.05),6투계화적PTV V95(％)분별위:3D-CRT (91.55 ±2.90),IMRT5(96.66±1.05),IMRT7 (96.87±1.23),IMRT (96.81±1.16),Arcl (94.98±1.41),Arc2 (95.93±1.32).RapidArc계화적파구괄형도(CI)최호(t=3.76,10.01,P＜0.05),IMRT계화적파구균균성(HI)최호(t =3.93、3.37,P＜0.05).위급기관삼수RapidArc여IMRT각계화지간차이무통계학의의.3D-CRT화RapidArc계화적궤기도수명현소우IMRT계화,차이고체75％.결론 대우흉단식관암환자,채용IMRT혹RapidArc기술가이재보호정상조직적동시,함개림상필수적치료파구.3D-CRT계화대강저정상조직저제량산사구방면우세명현.RapidArc계화파구제량학삼수여IMRT계화비교미견명현우세.
Objective To compare the dosimetric characteristics of intensity-modulated arc therapy( IMAT ),fixed-gantry intensity-modulated radiotherapy ( IMRT ) and 3-dimensional conformal radiotherapy (3D-CRT) for the thoracic esophageal cancer.Methods A total of 15 patients with thoracic esophageal cancer were enrolled.3D-CRT,5-field IMRT( IMRT5 ),7-field IMRT( IMRT7 ),9-field IMRT ( IMRT9 ),single arc ( Arc1 ) and double arc ( Arc2 ) RapidArc plans were generated for each patient.All plans were prescribed 40 Gy in 20 fractions and 19.6 Gy in 14 fractions to PTV at 95％ isodose line.Results RapidArc and all IMRT treatment plans in dosimetric parameters of target volumes were obviously better compared to 3-dimentional conformal treatments( t =5.77,3.52,P ＜ 0.05 ).The result of V95 of PTV for 3D-CRT,IMRT5,IMRT7,IMRT9,Arc1 and Arc2 plans was 91.55 ±2.90,96.66 ±1.05,96.87 ± 1.23,96.81 ± 1.16,94.98 ± 1.41 and 95.93 ± 1.32,respectively.The best conformation index in PTV was observed in the RapidArc plans ( t =3.76,10.01,P ＜ 0.05 ),and the best homogeneity index in PTV was observed in the IMRT plans( t =3.93,3.37,P ＜ 0.05 ).In terms of organ sparing,no statistical difference was observed between IMRT and RapidArc plans( P ＞ 0.05 ),while 3D-CRT provided the lowest number of V1 cGy and V5 cGy for total lung.Compared with the IMRT treatment plans,the number of monitor units was lower in all 3D-CRT and RapidArc cases with differences of 75％.Conclusions All the IMRT and RapidArc plans could offer high quality treatment for patients.3D-CRT might show advantage in low-dose region to organs at risk.Compared with IMRT,no obvious advantage in PTV dosimetric parameters could be observed in RapidArc plans.