留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码
x

宫颈癌术后不同射野数量对盆骨保护的调强放射治疗技术剂量学研究

郝丽霞 程欢欢 王晓贞

郝丽霞, 程欢欢, 王晓贞. 宫颈癌术后不同射野数量对盆骨保护的调强放射治疗技术剂量学研究[J]. 分子影像学杂志, 2018, 41(1): 16-22. doi: 10.3969/j.issn.1674-4500.2018.01.04
引用本文: 郝丽霞, 程欢欢, 王晓贞. 宫颈癌术后不同射野数量对盆骨保护的调强放射治疗技术剂量学研究[J]. 分子影像学杂志, 2018, 41(1): 16-22. doi: 10.3969/j.issn.1674-4500.2018.01.04
Lixia HAO, Huanhuan CHENG, Xiaozhen WANG. Dosimetric analysis for the number of IMRT beams to pelvic bone for postoperative pelvic tumors[J]. Journal of Molecular Imaging, 2018, 41(1): 16-22. doi: 10.3969/j.issn.1674-4500.2018.01.04
Citation: Lixia HAO, Huanhuan CHENG, Xiaozhen WANG. Dosimetric analysis for the number of IMRT beams to pelvic bone for postoperative pelvic tumors[J]. Journal of Molecular Imaging, 2018, 41(1): 16-22. doi: 10.3969/j.issn.1674-4500.2018.01.04

宫颈癌术后不同射野数量对盆骨保护的调强放射治疗技术剂量学研究

doi: 10.3969/j.issn.1674-4500.2018.01.04
详细信息
    作者简介:

    郝丽霞,主管技师,E-mail: 1064426348@qq.com

    通讯作者:

    王晓贞,主任医师,E-mail: wxzflk@126.com

Dosimetric analysis for the number of IMRT beams to pelvic bone for postoperative pelvic tumors

  • 摘要: 目的 探讨在调强放射治疗技术(IMRT)中将盆骨作为危机器官进行计划设计的剂量学优势,研究不同射野数量对盆骨保护的IMRT的剂量学影响。 方法 18例宫颈癌术后患者均进行CT扫描并勾画靶区。采用6MV X线,多野共面照射,每个患者设计4个IMRT计划,两个7野计划IMRT7f和BMS-IMRT7f,1个5野BMS-IMRT5f计划和9野BMS-IMRT9f计划。IMRT7f为未对盆骨限量的7野调强计划,BMS-IMRT5f、BMS-IMRT7f和BMS-IMRT9f分别是将盆骨视为危机器官的5野、7野、9野调强计划。IMRT7f和BMS-IMRT7f比较,旨在分析对盆骨限量的计划对PTV适形性、均匀性和其他危机器官的剂量分布的影响。BMS-IMRT5f、BMS-IMRT7f和BMS-IMRT9f相互比较,研究不同射野数量对盆骨保护的剂量差异。 结果 BMS-IMRT7f与IMRT7f相比,等剂量线在盆骨处分布更加紧凑。BMS-IMRT7f与IMRT7f在PTV适形性和均匀性上差异无统计意义(P>0.05),但是BMS-IMRT7f在盆骨保护上明显优于IMRT7fP<0.05)。BMS-IMRT9f和BMS-IMRT7f计划靶区的均匀性和适形性明显优于BMS-IMRT5fP<0.05);在盆骨和小肠保护方面,BMS-IMRT5f和BMS-IMRT7f差异无统计意义(P>0.05);BMS-IMRT9f在低剂量区照射面积最大,而在高剂量区照射面积最小。在直肠保护方面,BMS-IMRT7f对直肠的照射面积最小。BMS-IMRT9f对膀胱的保护最好,BMS-IMRT7f次之。从跳数MU上分析,BMS-IMRT5f跳数最少,BMS-IMRT9f跳数最多。 结论 BMS-IMRT7f在不牺牲计划靶区的适形性和均匀性的基础上,较好的保护了盆骨,但略微增大直肠、小肠和膀胱的高剂量区。BMS-IMRT7f在PTV适形性、均匀性和危机器官保护上,优于BMS-IMRT5f,略差于BMS-IMRT9f。BMS-IMRT9f跳数较多,治疗时间较长。从剂量和实际执行效率来说,BMS-IMRT7f更适合临床应用。

     

  • 图  1  等剂量线分布图

    A: 7野调强计划, 未将盆腔视为危机器官; B: 7野调强计划, 将盆腔视为危机器官.

    图  2  IMRT7f和BMS-IMRT7f计划DVH图

    图  3  BMS-IMRT5f、BMS-IMRT7f和BMS-IMRT9f的DVH图

    表  1  IMRT7f和BMS-IMRT7f剂量学比较

    分类 IMRT7 BMS-IMRT7 P
    中位数 最小值-最大值 中位数 最小值-最大值
    HI 0.079 0.068-0.112 0.085 0.076-0.124 0.001
    CI 0.859 0.8045-0.8596 0.85 0.81-0.87 0.004
    Bone
     V5 99.76 97.88-100 98.65 95.15-100 0.000
     V10 93.09 90.06-99.2 91.85 89.2-99.29 0.000
     V20 85.86 81.02-91.8 73.95 68.37-75.84 0.000
     V30 59.25 54.07-84.79 49.5 43.61-55.66 0.000
     V40 31.81 19.76-40.07 29.64 19.05-35.92 0.001
     V45 21.96 12.58-28.84 20.59 11.75-26.26 0.001
     D2% 5227 5150-5295.5 5234.5 5140-5327 0.286
     Dmean 3287.25 3006.1-3498 3057.3 2198.6-3241.1 0.000
    Rectum
     V5 100 100-100 100 100-100 1.000
     V10 100 100-100 100 100-100 1.000
     V20 100 94.28-100 100 97.71-100 0.310
     V30 90.43 45.91-100 90.43 45.91-100 0.140
     V40 39.48 23.05-49.9 39.48 23.05-49.90 0.044
     V45 22.65 11.13-29.08 22.74 11.17-29.08 0.001
     D2% 5151.5 5039-5243 5193 5056-5299 0.020
     Dmean 3773.5 3162.8-4146.8 2813.4 3305.7-4164.5 0.811
    Small Bowel
     V5 98.46 53.31-99.8 98.30 53.33-99.88 0.306
     V10 84.56 46.37-93.9 84.94 46.35-95.55 0.286
     V20 68.76 34.61-73.92 67.8 33.86-76.84 0.286
     V30 36.31 4.54-39.5 37.79 4.97-40.51 0.000
     V40 16.58 0-28.78 16.77 0.25-29.04 0.003
     V45 11.33 0-23.87 11.58 0.03-24.18 0.002
     D2% 5213 3396-5407.5 5232. 3344-5449 0.008
     Dmean 2655 1458.2-2894.9 2689.3 1477-2925.3 0.003
    Bladder
     V5 100 100-100 100 100-100 1.000
     V10 100 100-100 100 100-100 1.000
     V20 99.76 94.98-100 99.9 97.53-100 0.068
     V30 72.49 54.04-79.48 71.36 54.36-86.63 0.472
     V40 31.4 19.33-42.72 31.41 19.89-43.62 0.035
     V45 21.85 12.09-31.69 22.230 12.25-33.04 0.002
     D2% 5245.5 5167-5326 5276.5 5164-5404 0.000
     Dmean 3643.6 3254.8-3819.5 3626 3293.5-3896.4 0.028
    下载: 导出CSV

    表  2  BMS-IMRT5f、BMS-IMRT7f和BMS-IMRT9f剂量学比较

    分类 BMS-IMRT5 BMS-IMRT7 BMS-IMRT9 5 vs 7 P 7 vs 9 P 5 vs 9 P
    中位数 最小值-最大值 中位数 最小值-最大值 中位数 最小值-最大值
    MU 705 628-1010 696 648-974 922 731-1094 0.770 0.010 0.001
    HI 0.103 0.071-0.191 0.085 0.076-0.124 0.08 0.007-0.114 0.002 0.003 0.000
    CI 0.81 0.73-0.84 0.85 0.81-0.87 0.87 0.83-0.89 0.001 0.012 0.000
    Bone
     V5 98.92 96.16-99.94 98.65 95.15-100 99.96 98.51-100 0.557 0.000 0.000
     V10 92.12 87.44-95.29 91.85 89.2-99.29 97.86 92.48-99.2 0.943 0.000 0.000
     V20 74.46 71.79-76.24 73.95 68.37-75.84 72.57 71.18-75.09 0.085 0.006 0.001
     V30 50.18 49.12-51.19 49.5 43.61-55.66 49.77 43.57-50.89 0.286 0.446 0.035
     V40 29.85 23.15-86.02 29.64 19.05-35.92 28.42 17.88-33.51 0.058 0.001 0.000
     V45 21.10 14.51-25.82 20.59 11.75-26.26 19.77 11.7-24.82 0.157 0.002 0.003
     D2% 5323 5254-5543 5234.5 5140-5327 5230 5143-5328 0.000 0.446 0.000
     Dmean 3090.4 2958.5-3192.6 3057.3 2198.6-3241.1 3099.2 2865.9-3204.9 0.061 0.022 0.711
    Rectum
     V30 93.2 41.42-100 90.43 45.91-100 78.69 41.48-100 0.088 0.055 0.000
     V40 46.85 24.93-50.93 39.48 23.05-49.9 36.89 19.03-50.64 0.014 0.049 0.010
     V45 29. 12.94-37.28 22.74 11.17-29.08 24.44 8.64-33.30 0.005 0.267 0.030
     D2% 5353 5158-5551 5193 5056-5299 5220.5 4975-5331 0.000 0.931 0.000
     Dmean 4042.3 2985-4266 2813.4 3305.7-4164.5 3718.2 3045.6-4128.8 0.005 0.064 0.000
    Small Bowel
     V5 96.31 53.46-99.71 98.3 53.33-99.88 98.77 52.98-99.98 0.039 0.064 0.004
     V10 82.95 44.79-93.12 84.94 46.35-95.55 85.46 46.2-95.76 0.003 0.215 0.005
     V20 63.1 34.01-73.05 67.8 33.86-76.84 64.45 34.06-74.07 0.006 0.001 0.231
     V30 39.54 11.49-40.55 37.79 4.97-40.51 36.03 5.49-40.17 0.001 0.002 0.001
     V40 18.02 0.42-27.09 16.77 0.25-29.04 16.38 0.28-27.53 0.016 0.039 0.002
     V45 12.55 0.08-22.79 11.58 0.03-24.18 10.85 0.05-22.62 0.002 0.004 0.000
     D2% 5262 3575-5535 5232 3344-5449 5216.5 3244-5356 0.000 0.015 0.000
     Dmean 2663.5 1489.7-2884.5 2689.3 1477-2925.3 2525.6 1454.6-2925.1 0.071 0.001 0.557
    Bladder
     V30 71.36 54.36-86.63 71.36 54.36-86.63 68.47 53.12-100 0.001 0.043 0.001
     V40 31.40 19.89-43.62 31.41 19.89-43.62 31.01 17.56-70.47 0.001 0.043 0.005
     V45 22.26 12.25-33.04 22.23 12.25-33.04 20.35 10.78-31.86 0.001 0.006 0.000
     D2% 5276.5 5164-5404 5276.5 5164-5404 5260.5 5131-5411 0.004 0.006 0.002
     Dmean 3626 3293.5-3896.4 3626 3293.5-3896.4 3616.2 3241.4-3863.1 0.000 0.004 0.000
    下载: 导出CSV
  • [1] Torres MA, Jhingran A, Thames HD, et al. Comparison of treatment tolerance and outcomes in patients with cervical cancer treated with concurrent chemoradiotherapy in a prospective randomized trial or with standard treatment[J]. Int J Radiat Oncol Biol Phys, 2008, 70(1): 118-25. doi: 10.1016/j.ijrobp.2007.05.028
    [2] Vale C, Tierney JF, Stewart LA, et al. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and Meta-Analysis of individual patient data from 18 randomized trials[J]. J Clin Oncol, 2008, 26(35): 5802-12. doi: 10.1200/JCO.2008.16.4368
    [3] Giangreco DT, Albuquerque K, Norton J, et al. Predictors of hematologic toxicity and implications for Bone-Marrow sparing pelvic IMRT for cervical cancer[J]. Int J Radiat Oncol Biol Phys, 2007, 69(3): S399-402. doi: 10.1016/j.ijrobp.2007.07.1524
    [4] Albuquerque K, Giangreco D, Morrison CA, et al. Radiation-related predictors of hematologic toxicity after concurrent chemoradiation for cervical cancer and implications for bone marrow-sparing pelvic IMRT[J]. Int J Radiat Oncol Biol Phys, 2011, 79(4): 1043-7. doi: 10.1016/j.ijrobp.2009.12.025
    [5] Bazan JG, Luxton G, Kozak MM, et al. Normal tissue complication probability modeling of acute hematologic toxicity in patients receiving pelvic IMRT and concurrent chemotherapy[J]. Int J Radiat Oncol Biol Phys, 2012, 84(3, S): S350-3.
    [6] Bazan JG, Luxton G, Mok EC, et al. Normal tissue complication probability modeling of acute hematologic toxicity in patients treated with Intensity-Modulated radiation therapy for squamous cell carcinoma of the anal canal[J]. Int J Radiat Oncol Biol Phys, 2012, 84(3): 700-6. doi: 10.1016/j.ijrobp.2011.12.072
    [7] Mell LK, Tiryaki H, Ahn KH, et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 71(5): 1504-10. doi: 10.1016/j.ijrobp.2008.04.046
    [8] Mell LK, Kochanski JD, Roeske JC, et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2006, 66(5): 1356-65. doi: 10.1016/j.ijrobp.2006.03.018
    [9] Lujan AE, Mundt AJ, Yamada SD, et al. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2003, 57(2): 516-21. doi: 10.1016/S0360-3016(03)00521-2
    [10] 赵 起. 宫颈癌盆腔调强放射治疗的计划靶区变化对危险器官受照容积百分比的影响[J]. 河北医药, 2016, 38(11): 1670-2. http://d.wanfangdata.com.cn/Thesis/Y955359
    [11] 黄曼妮, 李明辉, 安菊生, 等. 宫颈癌根治性手术后辅助调强放疗(IMRT)的临床观察[J]. 癌症进展, 2011, 9(1): 89-93. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_azjz201101018
    [12] 周 龙. 宫颈癌术后调强放疗临床应用优化研究[D]. 南宁: 广西医科大学, 2015.
    [13] Lomax NJ, Scheib SG. Quantifying the degree of conformity in radiosurgery treatment planning[J]. Int J Radiat Oncol Biol Phys, 2003, 55(5): 1409-12. doi: 10.1016/S0360-3016(02)04599-6
    [14] Van't RA, Mak AC, Moerland MA, et al. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation:application to the prostate[J]. Int J Radiat Oncol Biol Phys, 1997, 37(3): 731-4. doi: 10.1016/S0360-3016(96)00601-3
    [15] Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 54(5): 1388-96. doi: 10.1016/S0360-3016(02)03801-4
    [16] Mell LK, Kochanski JD, Roeske JC, et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-Phys[J]. Int J Radiat Oncol Biol Phys, 2006, 66(5): 1356-65. doi: 10.1016/j.ijrobp.2006.03.018
    [17] Roeske JC, Lujan A, Reba RC, et al. Incorporation of SPECT bone marrow imaging into intensity modulated whole-pelvic radiation therapy treatment planning for gynecologic malignancies[J]. Radiother Oncol, 2005, 77(1): 11-7. doi: 10.1016/j.radonc.2005.06.017
    [18] 肖 锋, 李云海, 王洪林, 等. 宫颈癌术后保护骨髓的调强放疗剂量学研究[J]. 中国癌症杂志, 2013,45(3): 200-6.
    [19] 蒋 军, 张利文, 廖 珊, 等. 宫颈癌术后三维适形放疗和共面等分设野调强放疗计划的对比分析[J]. 南方医科大学学报, 2012, 32(8): 1201-6.
    [20] 陈文娟, 潘建基, 柏朋刚, 等. 宫颈癌分段调强放射治疗计划的应用研究[J]. 实用癌症杂志, 2014, 29(10): 1253-7.
  • 加载中
图(3) / 表(2)
计量
  • 文章访问数:  671
  • HTML全文浏览量:  289
  • PDF下载量:  8
  • 被引次数: 0
出版历程
  • 收稿日期:  2017-10-08
  • 刊出日期:  2018-01-01

目录

    /

    返回文章
    返回

    关于《分子影像学杂志》变更刊期通知

    各位专家、作者、读者:

    为了缩短出版时滞,促进科研成果的快速传播,我刊自2024年1月起,刊期由双月刊变更为月刊。本刊主要栏目有:基础研究、临床研究、技术方法、综述等。

    感谢各位专家、作者、读者长期以来对我刊的支持与厚爱!

    南方医科大学学报编辑部

    《分子影像学杂志》

    2023年12月27日