CAJ | 학술논문

目的：观察和分析局部晚期非小细胞肺癌三维适型放射治疗和动态多叶准直器调强放射治疗在肿瘤靶区和剂量分布，比较两种治疗方法在剂量学上的优势性。方法入选2012年7月～2013年7月就诊于我院的未手术的IIIa期和IIIb期非小细胞肺癌患者52例，按随机抽样法分为两组各26例，分别给予三维适型放射治疗（Three Dimensional Conformal Radiation Therapy ，3DCRT）和动态多叶准直器调强放射治疗（Intensity－modulated radiation therapy，IMRT），根据CT分别勾画大体肿瘤体积（Gross Tumor Volume，GTV）、临床靶体积（ Clinical Target Volume ，CTV）、计划靶体积（ Planning Target Volume ，PTV）和危害气管，两种治疗方法剂量均为66Gy，标准为处方剂量至少覆盖95％的PTV，危害器官剂量均在耐受剂量范围内，通过靶区等剂量分布、适型指数和均数指数等对比肿瘤靶区剂量的差异。结果两组均能得到满足标准的剂量分布，两种治疗方法PTV剂量比较提示平均剂量和最大剂量组间差异显著，p＜0.05，最小剂量组间差异无显著性，p＞0.05；CI和HI值组间差异显著，p＜0.05。结论 IMRT较3DCRT能够提高肿瘤靶区适型性，在保护正常组织器官上有显著优势，但均匀性下降。
목적：관찰화분석국부만기비소세포폐암삼유괄형방사치료화동태다협준직기조강방사치료재종류파구화제량분포，비교량충치료방법재제량학상적우세성。방법입선2012년7월～2013년7월취진우아원적미수술적IIIa기화IIIb기비소세포폐암환자52례，안수궤추양법분위량조각26례，분별급여삼유괄형방사치료（Three Dimensional Conformal Radiation Therapy ，3DCRT）화동태다협준직기조강방사치료（Intensity－modulated radiation therapy，IMRT），근거CT분별구화대체종류체적（Gross Tumor Volume，GTV）、림상파체적（ Clinical Target Volume ，CTV）、계화파체적（ Planning Target Volume ，PTV）화위해기관，량충치료방법제량균위66Gy，표준위처방제량지소복개95％적PTV，위해기관제량균재내수제량범위내，통과파구등제량분포、괄형지수화균수지수등대비종류파구제량적차이。결과량조균능득도만족표준적제량분포，량충치료방법PTV제량비교제시평균제량화최대제량조간차이현저，p＜0.05，최소제량조간차이무현저성，p＞0.05；CI화HI치조간차이현저，p＜0.05。결론 IMRT교3DCRT능구제고종류파구괄형성，재보호정상조직기관상유현저우세，단균균성하강。
Objective To observe and analyze the tumor target sections and dose distribution of 3DCRT and IMRT in the treatment of local advanced non -small cell lung cancer (LANSCLC) and compare the advantages of the 2 treatment methods on dosimetry .Methods 52 patients with IIIa and IIIb stage non -small cell lung cancer were given both 3DCRT and IMRT.GTV, CTV, PTV and harmed trachea were sketched by CT .Dose of both treatment methods was 66Gy, and the criterion was that prescribed dose at least covered 95%PTV.Organ harmful doses were all within tolerable doses .Differences of tumor target section doses were compared according to dose distribution , conformity index and mean index of target section .Results Both groups got dose distributions satisfying criteria . PTV dose comparison of the 2 treatment methods showed that differences of mean dose and max dose group were sig -nificant (p<0.05), but between-group difference of min dose group was not significant (p>0.05).Differences of CI and HI values were significant (p<0.05).Conclusion IMRT and 3DCRT can improve tumor target formability , but reduce uniformity .