CAJ | 학술논문

目的:对比旋转容积调强技术(RapidArc)和固定野适形调强放疗(intensity modulated radiation therapy,IMRT)治疗鼻咽癌剂量学方面的差异,探索不同T分期从何种技术获益最大.方法:选取60例无远处转移鼻咽癌患者,按鼻咽癌2008分期T1~2期20例,T3期20例,T4期20例.使用瓦里安公司Eclipse系统,每例患者分别制定RapidArc和固定野IMRT计划,比较两者靶区覆盖、危机器官剂量、跳数和治疗时间的差别.结果:IMRT和RapidArc均能满足临床要求,靶区剂量分布差异无统计学意义(P>0.05),均匀性和适形性相当.按T分期分层比较,T4期患者RapidArc组PGTV、PTV1、PTV2的靶区剂量较高(P<0.05),PGTV均匀指数较好(P=0.059).RapidArc组视神经、晶体、颞叶、腮腺V20、喉、颞颌关节受照剂量均较低(P<0.05).按T分期分层比较,脑干剂量T1~2期、T3期两组比较差异无统计学意义(P>0.05),T4期患者脑干D1%、Dmax剂量RapidArc组较IMRT组低(P<0.05).RapidArc和IMRT相比,治疗跳数节省65%,治疗时间节省63%.结论:RapidArc和9野IMRT治疗鼻咽癌均可满足临床要求,Rap?idArc可明显降低正常器官剂量,缩短治疗时间,减少治疗跳数.对局部早、中期(T1~3期)患者,两者有相似的靶区剂量分布,但对局部晚期(T4期)患者,RapidArc更具有将高剂量区集中在靶区而减少正常器官受照剂量的优势.
목적:대비선전용적조강기술(RapidArc)화고정야괄형조강방료(intensity modulated radiation therapy,IMRT)치료비인암제량학방면적차이,탐색불동T분기종하충기술획익최대.방법:선취60례무원처전이비인암환자,안비인암2008분기T1~2기20례,T3기20례,T4기20례.사용와리안공사Eclipse계통,매례환자분별제정RapidArc화고정야IMRT계화,비교량자파구복개、위궤기관제량、도수화치료시간적차별.결과:IMRT화RapidArc균능만족림상요구,파구제량분포차이무통계학의의(P>0.05),균균성화괄형성상당.안T분기분층비교,T4기환자RapidArc조PGTV、PTV1、PTV2적파구제량교고(P<0.05),PGTV균균지수교호(P=0.059).RapidArc조시신경、정체、섭협、시선V20、후、섭합관절수조제량균교저(P<0.05).안T분기분층비교,뇌간제량T1~2기、T3기량조비교차이무통계학의의(P>0.05),T4기환자뇌간D1%、Dmax제량RapidArc조교IMRT조저(P<0.05).RapidArc화IMRT상비,치료도수절성65%,치료시간절성63%.결론:RapidArc화9야IMRT치료비인암균가만족림상요구,Rap?idArc가명현강저정상기관제량,축단치료시간,감소치료도수.대국부조、중기(T1~3기)환자,량자유상사적파구제량분포,단대국부만기(T4기)환자,RapidArc경구유장고제량구집중재파구이감소정상기관수조제량적우세.
Objective:To compare the dosimetric differences between volumetric modulated arc radiotherapy with RapidArc and fixed-field intensity modulation radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), and identify the techniques from which patients of different T stages can gain the maximum benefit. Methods:Sixty non-metastatic patients with NPC were randomly selected. According to the T staging of 2008 Chinese Classification, T1-T2 stage cases were observed in 20 of the 60 patients, whereas T3 and T4 stage cases were seen with 20 patients each. RapidArc and IMRT treatment plans were managed by the Eclipse treatment planning sys-tem of Varian Co., US. The dosimetry of the target volume coverage, organs at risk (OARs), monitor unit (MU) per second, and deliv-ery time were evaluated. Results:Both techniques reached the requirement of clinical treatment. The coverages of planning target vol-ume, conformity index, and homogeneity index were similar. However, the stratified analysis of T staging indicated that RapidArc plans led to an increased dose to the tumor target (P<0.05) and an improved homogeneity index (P=0.059) in the T4 stage cases. RapidArc al-lowed a statistical dose reduction to the OARs, including optic nerves, lens, temporal lobe, V20 of the parotids, larynx, and temporo-mandibular joint (P<0.05). In the T-stage stratified analysis, the D1%and Dmax of brain stem in T1-T3 stages were similar but statistical-ly low in T4 stage in the RapidArc group (P<0.05). Compared with those in IMRT group, the MUs and the delivery time in RapidArc group were reduced by 65%and 63%, respectively. Conclusion:Both RapidArc and IMRT attained the clinical requirement for NPC. RapidArc technique showed improvements in the OARs and reduction in MUs and delivery time. The target volume coverages were similar for T1-T3 stage. However, RapidArc delivered an increased dose to the tumor target in T4 stage cases, and the dose to OARs was reduced.