CAJ | 학술논문

目的：比较适形结合调强放疗与单纯调强放疗在胸中段食管癌放疗中的正常组织剂量分布情况，为临床食管癌放疗计划的选择提供参考。方法：选择36例胸中段食管癌患者进行 CT 定位扫描。由主治及以上医师勾画出放疗靶区，设计两组放疗方案。A 组为调强与适形放疗相结合的方式（其中适形放疗10次，调强放疗20次）；B 组为单纯的调强放疗（30次）。最后以95% PTV 体积获得60Gy 处方剂量进行剂量归一，利用剂量体积直方图（DVe）对以上两组计划进行下列参数的比较。两侧肺分别受量为5Gy、10Gy、15Gy、20Gy、25Gy、30Gy、35Gy、40Gy、50Gy 及肺部平均受量 Vlung时的体积值；心脏受量为20Gy、30Gy、40Gy、50Gy 及心脏平均受量 V heart时的体积值；脊髓最大点受量。结果：A 组肺部除 V40及 V50外，其余各组数据均较 B 组降低。A 组心脏受量仅 V 40及 V50较 B 组增加，显示有统计学差异（P≤0.007）。A 组脊髓最大点受量较 B 组增加（P﹤0.05）。结论：食管癌的放疗计划中，使用调强与适形结合的方式，可以在基本不增加心脏和脊髓受量的同时有效减少肺低剂量区受照射体积。
목적：비교괄형결합조강방료여단순조강방료재흉중단식관암방료중적정상조직제량분포정황，위림상식관암방료계화적선택제공삼고。방법：선택36례흉중단식관암환자진행 CT 정위소묘。유주치급이상의사구화출방료파구，설계량조방료방안。A 조위조강여괄형방료상결합적방식（기중괄형방료10차，조강방료20차）；B 조위단순적조강방료（30차）。최후이95% PTV 체적획득60Gy 처방제량진행제량귀일，이용제량체적직방도（DVe）대이상량조계화진행하렬삼수적비교。량측폐분별수량위5Gy、10Gy、15Gy、20Gy、25Gy、30Gy、35Gy、40Gy、50Gy 급폐부평균수량 Vlung시적체적치；심장수량위20Gy、30Gy、40Gy、50Gy 급심장평균수량 V heart시적체적치；척수최대점수량。결과：A 조폐부제 V40급 V50외，기여각조수거균교 B 조강저。A 조심장수량부 V 40급 V50교 B 조증가，현시유통계학차이（P≤0.007）。A 조척수최대점수량교 B 조증가（P﹤0.05）。결론：식관암적방료계화중，사용조강여괄형결합적방식，가이재기본불증가심장화척수수량적동시유효감소폐저제량구수조사체적。
Objective:To study the selection of 3D - CRT in combination with IMRT by comParing the dose distri-bution in the middle esoPhageal cancer Patients. Methods:Thirty - six Patients of middle esoPhageal cancer receive the CT Positioning. Designed two grouPs of radiotheraPy Plan:GrouP A for 3D - CRT in combination with IMRT(re-sPectively 10 fractions and 20 fractions),IMRT for B grouP(30 fractions),and finally after normalizing the 60Gy Pre-scriPtion dose attained by 95% of the PTV volume. ComPare the dose volume histogram(DVe). The volumes of the lungs when given 5Gy,10Gy,15Gy,20Gy,25Gy,30Gy,35Gy,40Gy,50Gy and mean lung dose(Vlung ),the resPective volume of heart when given 20Gy,30Gy,40Gy,50Gy and mean heart dose(Vheart ),the maximum dose of sPinal cord. Results:Besides V40 and V50 in grouP A,the rest were reduced comPared with grouP B. The volumes of heart in grouP A only V40 and V50 were statistically significant comPared with grouP B(P≤0. 007). The maximum dose of sPinal cord in grouP A increased comPared with grouP B(P≤0. 05). Conclusion:Choosing 3D - CRT in combination with IMRT can diminish effectively the area irradiated by low dose in lungs while nearly no increase of the dimensions affected by the irradiation in hearts and sPinal cord.