CAJ | 학술논문

目的探讨调强放疗(IMRT)技术治疗非小细胞肺癌3～5个脑转移瘤的优势.方法选择30例已完成IMRT的非小细胞肺癌1～5个脑转移病例,设计全脑放疗(WBRT)加三维适形放疗(3DCRT)、WBRT加立体定向放疗(SRT)计划,用剂量体积直方图分析3种技术之间的优势并Wilcoxon非参数检验.结果全组患者IMRT计划靶体积(PTV)肩部的D99％明显高于WBRT+3DCRT和WBRT+ SRT(Z=-4.72、P=0.000和Z=-4.72、P=0.000);对3～5个脑转移瘤的13例患者IMRT的PTV斜坡的D10％和尾部的D5％明显低于WBRT+3DCRT与WBRT+ SRT[ (35.1 +1.42)Gy、(36.5 ±2.86) Gy与(36.2+2.57) Gy(Z=-3.18、-3.18,P=0.001、0.001)和(37.7±2.91)Gv、(39.1±3.56) Gy与(38.7±3.67)Gy(Z=-4.11、-3.02,P=0.000、0.002)].全组患者WBRT+ SRT总机器跳数比IMRT减少达38.7％,IMRT、WBRT +3DCRT与WBRT+ SRT的分别为14756.3、9614.8、9043.2 MU(Z=-4.78、-4.78,P=0.000、0.000).3种技术对1～2个转移瘤的周围脑组织剂量相似,3～5个转移瘤的则调强技术最优.结论 IMRT技术能提高靶区最小剂量和降低周围脑组织受量,特别对3～5个转移瘤的优势更突出.
목적 탐토조강방료(IMRT)기술치료비소세포폐암3～5개뇌전이류적우세.방법 선택30례이완성IMRT적비소세포폐암1～5개뇌전이병례,설계전뇌방료(WBRT)가삼유괄형방료(3DCRT)、WBRT가입체정향방료(SRT)계화,용제량체적직방도분석3충기술지간적우세병Wilcoxon비삼수검험.결과 전조환자IMRT계화파체적(PTV)견부적D99％명현고우WBRT+3DCRT화WBRT+ SRT(Z=-4.72、P=0.000화Z=-4.72、P=0.000);대3～5개뇌전이류적13례환자IMRT적PTV사파적D10％화미부적D5％명현저우WBRT+3DCRT여WBRT+ SRT[ (35.1 +1.42)Gy、(36.5 ±2.86) Gy여(36.2+2.57) Gy(Z=-3.18、-3.18,P=0.001、0.001)화(37.7±2.91)Gv、(39.1±3.56) Gy여(38.7±3.67)Gy(Z=-4.11、-3.02,P=0.000、0.002)].전조환자WBRT+ SRT총궤기도수비IMRT감소체38.7％,IMRT、WBRT +3DCRT여WBRT+ SRT적분별위14756.3、9614.8、9043.2 MU(Z=-4.78、-4.78,P=0.000、0.000).3충기술대1～2개전이류적주위뇌조직제량상사,3～5개전이류적칙조강기술최우.결론 IMRT기술능제고파구최소제량화강저주위뇌조직수량,특별대3～5개전이류적우세경돌출.
Objective This study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1 -5 brain metastases from non-small cell lung cancer (NSCLC).Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively.Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT + 3DCRT) and WBRT plus stereotactic radiotherapy ( WBRT + SRT) plans were generated.Planning target volume ( PTV ) and organs at risk dose were measured and compared by dose volume histogram.Differences were analyzed in the three techniques by Wilcoxon Z -test.Results D99％ of the shoulder ( D99％-D90％ ) from IMRT were higher than from WBRT +3DCRT and WBRT+SRT in all cases.From D15％ of slope (D90％-D10％) to D5％ of tail (D10％ -D1％ ),IMRT were lower than WBRT + 3DCRT and WBRT + SRT ( Z =- 4.72,P =0.000 and Z =- 4.72,P =0.000).D10％ and D5％ of IMRT were (35.1 ±1.42) Gy and (37.7 ±2.91) Gy,WBRT +3DCRT were (36.5±2.86) Gy and ( 39.1 ± 3.56) Gy ;WBRT + SRT were (36.2 ± 2.57) Gy and ( 38.7 ± 3.67) Gy.IMRT vs WBRT+ 3DCRT and WBRT + SRT were significant ( Z=-3.18,-3.18,P=0.001,0.001 and Z=- 4.11,- 3.02,P =0.000,0.002) in 13 patients with 3 - 5 brain metastases.The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT,WBRT +3DCRT and WBRT + SRT plans,respectively,with a 38.7％ reduction from IMRT to WBRT + SRT (Z =-4.78,-4.78,P =0.000,0.000).The brain doses around metastases were similar in the three techniques with 1 -2 metastases,but IMRT was the best with 3 -5 metastases.Conclusions IMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases.Only IMRT is the best choice for just sparing the dose around brain metastases among 3 -5 brain metastases.