Effect of field arrangement on dosimetric of pancreatic cancer intensity-modulated plan
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摘要:
目的 比较胰腺癌5野调强放射治疗技术的3种射野布野方式对靶区剂量及其周围正常组织受量的差异，为临床选择放疗技术提供参考。 方法 选取9例胰腺癌患者，经CT扫描后在Eclipse8.6治疗计划系统中进行靶区勾画。对每位患者设计3种不同角度的5野调强计划。3种射野分布分别为，Ⅰ：5野均分共面布野；Ⅱ：Varian Eclipse计划系统角度自动优化布野；Ⅲ：物理师经验共面布野。在满足计划靶体积达到95%处方剂量时，比较靶区适形指数、均匀指数及周围正常组织受量之间的差异。 结果 3种布野的调强计划，靶区适形指数及均匀指数差异无统计学意义；正常组织受量差异均无统计学意义（P>0.05）。 结论 3种调强布野方式对于胰腺癌靶区及正常组织无明显剂量差异，但5野均分更简单直观，可减少布野时间，提高计划设计效率。 Abstract:Objective To compare the differences in doses distribution among three field arrangements of pancreatic cancer intensity-modulated plan on target volumes and surrounding normal tissues. Methods Nine patients with pancreatic cancer were selected. The target volumes were delineated in the Varian Eclipse after CT scan. Three different field arrangements of 5-field Intensity-modulated plan were designed on each patient.The three field arrangements intensity-modulated plan were as follows: Ⅰwas an average angle 5-filed coplanar plan, Ⅱwas the coplanar plan with the field arrangement from automatic optimization of Eclipse planning system, the field arrangement of Ⅲ was from the experiences of physicists. All the plans satisfied the standard that 95 percent of target volume meet the prescribed dose. The differences of conformal index (CI), heterogeneous index (HI) of target volumes and dose differences of surrounding normal tissues were compared. Results There was no significant difference in the conformal index and heterogeneous index of the target volumes among the three field arrangements of intensity-modulated plans; The dose differences of normal tissures was not statistically significant. Conclusion There are no significant dose differences of pancreatic cancer’s target volumes and normal tissures among three field arrangement of 5-field intensity-modulated plan.The average angle 5-filed coplanar plan is more simple, which can reduce the time of optimization process. -
Key words:
- pancreatic cancer /
- radiotherapy /
- intensive radiation therapy /
- angle optimization
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表 1 计划危及器官的剂量体积限值
危及器官 剂量体积限值（Gy） 肝脏 V40<40 十二指肠 Dmax<50 小肠 Dmax<52 胃 Dmax<52 肾脏 V30<20 脊髓 Dmax<40 Dmax为1%体积所接受的照射剂量. 
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表 2 不同射野布野方式靶区PTV剂量参数比较（Mean±SD）
治疗计划 HI CI Dmean（Gy） Ⅰ 0.055±0.007 0.799±0.078 57.862±1.359 Ⅱ 0.065±0.021 0.762±0.045 57.921±1.503 Ⅲ 0.058±0.007 0.764±0.049 57.950±1.244 F 1.117 1.120 0.01 P 0.344 0.343 0.99 Ⅰ: 5野均分计划; Ⅱ: 射野角度优化逆向调强布野计划; Ⅲ: 人工经验布野计划.
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表 3 不同射野布野方式靶区CTV剂量参数比较（Mean±SD）
治疗计划 HI CI Dmean（Gy） Ⅰ 0.231±0.028 0.787±0.039 61.764±0.291 Ⅱ 0.250±0.029 0.778±0.043 61.819±0.390 Ⅲ 0.245±0.028 0.776±0.036 61.955±0.435 F 1.107 0.209 0.612 P 0.347 0.813 0.550 Ⅰ: 5野均分计划; Ⅱ: 射野角度优化逆向调强布野计划; Ⅲ: 人工经验布野计划.
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表 4 不同角度优化方式正常组织受量比较（Mean±SD）
治疗计划 肝脏V40 左肾V20 右肾V20 脊髓Dmax 十二指肠V30 十二指肠V40 十二指肠Dmax 胃V40 胃Dmean 小肠Dmax NTDmean Ⅰ 0.074±0.100 12.041±7.439 11.458±9.504 16.159±7.608 15.866±17.947 3.780±5.683 41.482±8.599 0.316±0.529 41.577±6.229 41.482±8.599 2.728±1.268 Ⅱ 0.401±0.462 8.960±10.942 7.018±7.679 20.283±10.026 16.726±15.640 3.824±5.714 41.261±5.753 0.206±0.371 39.895±7.982 41.261±5.753 2.295±0.573 Ⅲ 0.978±0.171 4.614±8.032 7.681±12.978 19.581±12.988 17.171±22.190 4.731±7.020 44.581±5.625 0.915±2.156 42.781±6.234 44.581±5.625 2.289±0.633 F 0.538 1.569 0.487 0.402 0.011 0.203 0.859 0.776 0.401 0.859 0.734 P 0.591 0.229 0.620 0.673 0.989 0.817 0.436 0.471 0.674 0.436 0.491 Ⅰ: 5野均分计划; Ⅱ: 射野角度优化逆向调强布野计划; Ⅲ: 人工经验布野计划.
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