食管癌自动容积旋转调强放疗计划策略的优化选择

巩汉顺; 谷珊珊; 杨涛; 陈高翔; 韩亚楠; 戴相昆

doi:10.3969/j.issn.2095-5227.2022.06.007

食管癌自动容积旋转调强放疗计划策略的优化选择

Optimization of planning strategy of automated volumetric modulated arc therapy for esophageal cancer

摘要

摘要:
背景食管癌放疗计划设计过程中需要考虑多个危及器官受量限制，自动计划可以有效降低人为主观因素对计划质量的影响。
目的对基于自动计划技术的食管癌双弧与单弧自动容积旋转调强放疗计划(automated volumetric modulated arc therapy，A-VMAT)的优化性能与临床应用价值进行综合评估，以实现自动计划设计策略的优选。
方法选取2018年10月- 2020年12月16例在我中心接受治疗食管癌患者，采用Pinnacle³计划系统手动设计双弧容积旋转调强计划(double arc manual-VMAT，DA-M-VMAT)，采集其剂量体积直方图参数作为自动计划的优化参数分别设计双弧A-VMAT计划(DA-A-VMAT)和单弧A-VMAT计划(SA-A-VMAT)，对各组计划靶区和危及器官的各项参数进行比较，以评估不同弧自动计划技术的优化性能。
结果 DA-M-VMAT计划和DA-A-VMAT计划中靶区的均匀性指数(homogeneity index，HI)参数结果均优于SA-A-VMAT计划，但仅靶区pGTV差异有统计学意义(P=0.010)。DA-A-VMAT计划的平均机器跳数高于DA-M-VMAT计划，而SA-A-VMAT计划则低于DA-M-VMAT计划，但差异无统计学意义(P=0.278)。全肺：V₅和V₁₀等低剂量区体积参数A-VMAT计划均高于DA-M-VMAT计划；而V₂₀及以上的各参数则均呈现相反趋势，且SA-A-VMAT较DA-A-VMAT计划具有更好的肺组织保护能力；差异均无统计学意义(P＞0.05)。心脏：对于V₂₀及以上的各剂量体积参数呈现出与全肺一致的分析结果。
结论对于食管癌患者，与DA-M-VMAT计划相比，DA-A-VMAT和SA-A-VMAT计划均能实现最佳的靶区剂量分布和较低的正常组织受量；而SA-A-VMAT计划则具有更高的临床执行效率，更适用于临床治疗。

Abstract:
Background In the process of radiotherapy planning for esophageal cancer, it is necessary to consider the dose constraints of multiple organs at risk. Automatic planning can effectively reduce the influence of human subjective factors on the quality of the plan.
Objective To comprehensively evaluate the optimization performance and clinical application value of double arc and single arc automatic volume modulated arc therapy (A-VMAT) for esophageal cancer based on auto planning technology, so as to realize the optimization of automatic plan design strategy.
Methods Sixteen patients with esophageal cancer who received treatment in our hospital from October 2018 to December 2020 were selected. Double arc manual VMAT (DA-M-VMAT) was designed manually by pinnacle³ planning system. The dose volume histogram parameters were collected as the optimization parameters of auto-planning to design the double arc A-VMAT (DA-A-VMAT) and single arc A-VMAT (SA-A-VMAT), respectively. The parameters of target areas and organs at risk of each plan were analyzed and compared statistically in order to evaluate the optimization performance of AP techniques in different radiation fields.
Results Target’s HI results of DA-M-VMAT plan and DA-A-VMAT plan were better than SA-A-VMAT plan, but only the pGTV had statistical difference (F=5.101; P=0.010). The average MUs of DA-A-VMAT plan was higher than that of DA-M-VMAT plan, while that of SA-A-VMAT plan was lower than that of DA-M-VMAT plan, without significant difference (F=1.317; P=0.278). For the total lung, the volume parameters of V₅, V₁₀ and other low-dose areas in A-VMAT plan were higher than those in DA-M-VMAT plan. The parameters of V₂₀ and above showed the opposite trend, and SA-A-VMAT had better lung tissue protection than DA-A-VMAT, but there was no significant difference (P > 0.05). For heart, the analysis results were consistent with those of the total lung for each dose volume parameter of V₂₀ and above.
Conclusion Compared with DA-M-VMAT, both DA-A-VMAT and SA-A-VMAT can achieve the best target dose distribution and lower normal tissue dose in patients with esophageal cancer. The SA-A-VMAT has a faster clinical delivery efficiency and is more suitable for clinical treatment.

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