中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
10期
41-44,45
,共5页
宫颈癌%骨髓%放射治疗%固定野调强%容积调强
宮頸癌%骨髓%放射治療%固定野調彊%容積調彊
궁경암%골수%방사치료%고정야조강%용적조강
Cervical cancer%Bone marrow%Radiotherapy%Static intensity-modulated radiation therapy%Volumetric-modulated arc radiation therapy
目的：分析比较固定野调强技术和不同弧数的旋转容积调强在宫颈癌骨髓保护根治性全盆腔放射治疗的剂量学特点，寻找更优的治疗方案。方法：选取在汕头大学医学院附属肿瘤医院接受根治性放疗的ⅡA~ⅢB期宫颈癌患者9例，针对每例患者分别设计九野固定野调强（FF-IMRT）计划、双弧、三弧和四弧旋转容积调强（2A-VMAT、3A-VMAT、4VMAT）计划，比较四者靶区、骨盆骨髓，其他危及器官的剂量学差异和加速器跳数和照射时间。结果：IMRT、2A-VMAT、3A-VMAT和4A-VMAT四组计划均具有良好的靶区覆盖率，靶区适形度和均匀性以及骨盆骨髓受照剂量和受照体积（V10，V20，V40）无差异。三组VMAT计划在危及器官的保护上无差异。VMAT计划的小肠均略低于FF-IMRT计划（P<0.008），在直肠的保护上，FF-IMRT计划略优于3弧VMAT计划（P<0.008）。IMRT、2A-VMAT、3A-VMAT和4A-VMAT计划的加速器跳数分别为（1850.3±227.8）MU、（848.4±58.8）MU、（835.0±76.2）MU和（910.8±43.3）MU，照射时间分别为（353.2±25.1）s、（136.2±3.6）s、（211.2±3.5）s和（286.2±3.4）s。各组的加速器跳数和照射时间比较差异有统计学意义，调强计划的跳数和照射时间最多，两弧VMAT最少。结论：综合考虑各种物理和生物因素，在宫颈癌骨髓保护根治性放疗计划中，双弧VMAT技术照射为最优选择。
目的：分析比較固定野調彊技術和不同弧數的鏇轉容積調彊在宮頸癌骨髓保護根治性全盆腔放射治療的劑量學特點，尋找更優的治療方案。方法：選取在汕頭大學醫學院附屬腫瘤醫院接受根治性放療的ⅡA~ⅢB期宮頸癌患者9例，針對每例患者分彆設計九野固定野調彊（FF-IMRT）計劃、雙弧、三弧和四弧鏇轉容積調彊（2A-VMAT、3A-VMAT、4VMAT）計劃，比較四者靶區、骨盆骨髓，其他危及器官的劑量學差異和加速器跳數和照射時間。結果：IMRT、2A-VMAT、3A-VMAT和4A-VMAT四組計劃均具有良好的靶區覆蓋率，靶區適形度和均勻性以及骨盆骨髓受照劑量和受照體積（V10，V20，V40）無差異。三組VMAT計劃在危及器官的保護上無差異。VMAT計劃的小腸均略低于FF-IMRT計劃（P<0.008），在直腸的保護上，FF-IMRT計劃略優于3弧VMAT計劃（P<0.008）。IMRT、2A-VMAT、3A-VMAT和4A-VMAT計劃的加速器跳數分彆為（1850.3±227.8）MU、（848.4±58.8）MU、（835.0±76.2）MU和（910.8±43.3）MU，照射時間分彆為（353.2±25.1）s、（136.2±3.6）s、（211.2±3.5）s和（286.2±3.4）s。各組的加速器跳數和照射時間比較差異有統計學意義，調彊計劃的跳數和照射時間最多，兩弧VMAT最少。結論：綜閤攷慮各種物理和生物因素，在宮頸癌骨髓保護根治性放療計劃中，雙弧VMAT技術照射為最優選擇。
목적：분석비교고정야조강기술화불동호수적선전용적조강재궁경암골수보호근치성전분강방사치료적제량학특점，심조경우적치료방안。방법：선취재산두대학의학원부속종류의원접수근치성방료적ⅡA~ⅢB기궁경암환자9례，침대매례환자분별설계구야고정야조강（FF-IMRT）계화、쌍호、삼호화사호선전용적조강（2A-VMAT、3A-VMAT、4VMAT）계화，비교사자파구、골분골수，기타위급기관적제량학차이화가속기도수화조사시간。결과：IMRT、2A-VMAT、3A-VMAT화4A-VMAT사조계화균구유량호적파구복개솔，파구괄형도화균균성이급골분골수수조제량화수조체적（V10，V20，V40）무차이。삼조VMAT계화재위급기관적보호상무차이。VMAT계화적소장균략저우FF-IMRT계화（P<0.008），재직장적보호상，FF-IMRT계화략우우3호VMAT계화（P<0.008）。IMRT、2A-VMAT、3A-VMAT화4A-VMAT계화적가속기도수분별위（1850.3±227.8）MU、（848.4±58.8）MU、（835.0±76.2）MU화（910.8±43.3）MU，조사시간분별위（353.2±25.1）s、（136.2±3.6）s、（211.2±3.5）s화（286.2±3.4）s。각조적가속기도수화조사시간비교차이유통계학의의，조강계화적도수화조사시간최다，량호VMAT최소。결론：종합고필각충물리화생물인소，재궁경암골수보호근치성방료계화중，쌍호VMAT기술조사위최우선택。
Objective: To compare static intensity-modulated radiation therapy (IMRT) technique with various arcs of volumetric-modulated arc radiation therapy (VMAT) techniques in patients with cervical cancer treated with definitive bone morrow-sparing whole pelvic radiotherapy, and to explore a better treatment management.Method: 9 CT image sets of staged ⅡA-ⅢB cervical cancer patients, treated in Cancer Hospital of Shantou University Medical College, were included. Nine fixed-field IMRT (FF-IMRT) plans and two arcs, three arcs, four arcs VMAT plans (2A-VMAT, 3A-VMAT, 4A-VMAT) were created and compared for each patient. Plans were evaluated on parameters of tumor target volume, pelvic bone marrow (PBM), other pelvic organs, plan MUs and delivery time.Result: Four groups of 2A-VMAT, 3A-VMAT, 4A-VMAT and IMRT plans provide equivalent tumor target volume coverage, conformity, homogeneity and sparing of PBM respected to V10,V20,V40. Three VMAT plans demonstrate the similar organs sparing. VMAT was slightly superior to FF-IMRT with the sparing of bowel. However, FF-IMRT showed better rectum sparing than that of 3A-VMAT. The monitor units of IMRT, 2A-VMAT, 3A-VMAT and 4A-VMAT were (1850.3±227.8)MU, (848.4±58.8)MU, (835.0±76.2)MU and (910.8±43.3)MU, respectively, while delivery time were (353.2±25.1) s, (136.2±3.6)s, (211.2±3.5)s and (286.2±3.4)s, respectively. There were significant differences of monitor units (MUs) and treatment time among four plans. IMRT plan had more MUs and treatment time than that of VMAT plans, and two arcs VMAT plan had the least MUs and treatment time.Conclusion: Considering the physical factors and biological effects during the cervical cancer definitive radiotherapy with pelvic bone marrow-sparing, 2 arcs VMAT plan would be the best choice for the treatment planning.
