CAJ | 학술논문

目的：比较颈段、胸上段食管癌常规放疗（CRT）、三维适形放疗（3D-CRT）、调强放疗（IMRT）累及野放疗中靶区和危及器官（ OAR）的剂量学差异，进而为临床治疗选择最优放射治疗方案；比较不同大小肿瘤（直径＜3 cm及＞5 cm）不同放疗计划对危及器官的影响，进而选择较优的放疗计划。方法选择12例颈段及胸上段食管癌患者，应用三维治疗计划系统（ TPS）分别为每位患者设计三种治疗计划（ A．常规放疗；B三维适形放疗；C调强适形放疗），在规定CTV至少达到95％处方剂量前提下根据剂量体积直方图（ DVH）、等剂量曲线比较三种计划靶区剂量分布及脊髓、气管、肺正常组织受量的差异；同时比较不同大小的肿瘤三种放疗计划对脊髓的剂量学影响。结果三种计划的靶区的平均剂量以IMRT计划为好，IMRT同时减少了脊髓及气管的剂量，差异有统计学意义（P＜0．05）；不管肿瘤直径大小，以IMRT计划最好。结论颈段及胸上段食管癌采用调强适形放疗，能在提高靶区剂量的同时更好的保护周围正常组织及器官，较三维适形放疗有剂量学优势，是目前较好的一种放疗方法。
목적：비교경단、흉상단식관암상규방료（CRT）、삼유괄형방료（3D-CRT）、조강방료（IMRT）루급야방료중파구화위급기관（ OAR）적제량학차이，진이위림상치료선택최우방사치료방안；비교불동대소종류（직경＜3 cm급＞5 cm）불동방료계화대위급기관적영향，진이선택교우적방료계화。방법선택12례경단급흉상단식관암환자，응용삼유치료계화계통（ TPS）분별위매위환자설계삼충치료계화（ A．상규방료；B삼유괄형방료；C조강괄형방료），재규정CTV지소체도95％처방제량전제하근거제량체적직방도（ DVH）、등제량곡선비교삼충계화파구제량분포급척수、기관、폐정상조직수량적차이；동시비교불동대소적종류삼충방료계화대척수적제량학영향。결과삼충계화적파구적평균제량이IMRT계화위호，IMRT동시감소료척수급기관적제량，차이유통계학의의（P＜0．05）；불관종류직경대소，이IMRT계화최호。결론경단급흉상단식관암채용조강괄형방료，능재제고파구제량적동시경호적보호주위정상조직급기관，교삼유괄형방료유제량학우세，시목전교호적일충방료방법。
Objective To compare the dosimetry differences of CRT ,3-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy ( IMRT) for choosing the best treatment program for patients with cervical and upper esophageal carcinoma , and to compare effects of radiotherapy of different tumor sizes (diameter <3 cm and >5 cm) on organs for selection of the optimum plan.Methods Twelve patients with cervical and upper esophageal carcinoma were treated with three kinds of treatment programs (CRT,3-dimensional conformal radiation therapy and intensity modulated radiation therapy ) within the same TPS.The differences of exposure dose between target area and critical organ were compared with dose volume histogram ( DVH) and isodose ,with the clinical target volume (CTV) up to above 95%of the prescription dose;At the same time,the effects on the spinal cord were compared among three kinds of radiation dosimetry program for different sizes of the tumor .Results IMRT plan was the best in the average dose in tar-get area,which showed significant difference in reducing the dose at the spinal cord and trachea (P<0.05).IMRT was the best plan regardless of the size of the tumor diameter .Conclusions Cervical and upper thoracic esophageal cancer using intensity modulated conformal radiotherapy can better protect the surrounding normal tissues and organs when the target dose increases ,which has dosimetry advantage over three-dimensional conformal radiotherapy and becomes a better radiotherapy .