协和医学杂志

2013, (04)

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宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较
Dosimetric Study of helical tomotherapy for cervix uteri radiotherapy

杨波;庞廷田;刘峡;孙显松;李文博;胡克;邱杰;张福泉

摘要(Abstract):

[摘要]目的 通过对宫颈癌术后患者应用螺旋断层调强(Helical Tomotherapy,HT )和固定野调强技术(Fixed Field IMRT,FF-IMRT)两种计划方式的比较,研究二者在宫颈癌术后放射治疗中的剂量学差异。方法 选择10例宫颈癌术后进行调强放疗的患者CT模拟定位,勾画靶区及危及器官,对同一CT图像设计HT计划和FF-IMRT计划。评估靶区及危及器官的剂量分布。结果 HT计划组和FF-IMRT计划组靶区覆盖度均满足临床处方剂量要求。与FF-IMRT计划组相比,HT组的PTV95、PTV100覆盖度增加,PTV105覆盖度降低、Dmean及Dmax均明显降低(p=0.000),CI和HI均优于FF-IMRT计划组(p=0.000)。与FF-IMRT计划组相比,HT计划组:膀胱V40降低约7%(P =0.000),Dmax平均剂量分别降低1.7Gy(P =0.000);直肠的V40降低约8%(P =0.000);小肠V30、V40分别降低4%、3%(P =0.002,P =0.000),Dmax平均剂量降低2Gy(P =0.000);骨髓V30增加约5%(P =0.001),左右股骨头D5无统计学差异;马尾神经Dmax的平均剂量降低约2Gy(P =0.030)。Body V20、V30、V40分别降低2%、1.3%、0.6%(P <0.050)。结论 宫颈癌患者采用HT技术,靶区均匀性指数及适形度指数均明显提高,进一步降低膀胱、直肠、小肠中高剂量区的体积。故HT技术在宫颈癌术后的临床应用中具有可行性,可以做为一种新的照射方式推广。
[Abstract] Objective:To study dosimetric comparison of Helical Tomotherapy And Fixed Field IMRT For Cervix Uteri Radiotherapy. Methodes:The CT images of 10 patients with cervix uteri cancer were transferred into Eclipse planning system . HT and FF-IMRT plan were performed on an tomotherapy TPS and an Eclipse TPS. Institutional dose-volume constraints used in cervix uteri cancer were kept the same for both techniques.Target and organ at risk were evaluated. Results: The coverages of HT planning group and FF-IMRT planning group meet the clinical requirements of the prescribed dose.Compared with FF-IMRT planning group.PTV95 and PTV100 of HT plan group coverage increased, PTV105 become lower, Dmax and Dmean decreased, CI and HI become better. Compared with the FF-IMRT planning group, V40 and Dmax of the bladder is reduced by about 7% and 1.7Gy respectively; V40 of the rectum reduced by about 8%, V30, V40 of the small intestine were reduced by 4%, 3%, Dmax of the average dose was reduced by 2Gy; V30 of the bone marrow were increased by 2Gy; D5 of the femoral heads have no difference; 2.7Gy, Dmax of the cauda equine was reduced by 2Gy;V20, V30, V400 of the body were reduced by 2%, 1.3%, 0.6%; Conclusion: In summary,cervical uteri cancer patients with HT technology can get superior target homogeneity index and conformity index to the FF-IMRT technology. High-dose region of the bladder, rectum, small intestine volume are lower.Therefore, HT technology is feasible for clinical applications in cervical uteri cancer and can be used as a new method to promote.

关键词(KeyWords): |宫颈癌|放射治疗|剂量学|螺旋断层调强|固定野调强|
|Cervix Uteri Cancer|Radiotherapy|Dosimetric|HT|FF-IMRT|

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作者(Author): 杨波;庞廷田;刘峡;孙显松;李文博;胡克;邱杰;张福泉

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