国产与进口精确放疗设备在直肠癌术后放疗中的临床剂量学比较

曾铭玥; 冯林春; 丛小虎; 刘其腾

doi:10.3969/j.issn.2095-5227.2023.04.006

国产与进口精确放疗设备在直肠癌术后放疗中的临床剂量学比较

Comparative clinical dosimetry study of domestic versus imported precision radiotherapy equipment in postoperative radiotherapy of rectal cancer

摘要

摘要:
背景放射治疗是直肠癌主要治疗手段之一，国内放疗设备种类繁多、层次不一，基层医院放疗设备落后，大多以国产放疗设备为主。
目的探讨国产与进口精确放疗设备在直肠癌术后放疗中的临床剂量学特点与治疗实施效率，为临床应用提供选择依据。
方法从解放军总医院第一医学中心放射治疗科2017年7 - 10月治疗患者中选取10例局部进展期直肠癌根治术后放疗患者资料，分别采用国产加速器(A组)和进口加速器(B组)进行放疗计划设计和验证比较。通过剂量体积直方图对靶区及危及器官进行剂量统计，根据相应公式计算靶区适形指数(conformity index，CI)与均匀指数(homogeneity index，HI)，最后统计机器治疗时间和跳数。应用配对t检验进行统计学分析。
结果国产与进口精确放疗设备的治疗计划均能满足靶区处方剂量及危及器官限量要求。两组计划中，B组靶区的D_2%、D_5%、D_98%、CI和HI优于A组(P＜0.05)，但两组的D_95%无统计学差异。在正常器官保护上，两组的小肠V₃₀、双侧股骨头V₄₀无统计学差异，而A组膀胱的V₄₀优于B组(P＜0.05)。两组计划通过率无统计学差异，在计划实施效率上A组略优于B组(P＜0.05)。
结论国产与进口精确放疗设备均能实现直肠癌术后调强放疗的靶区剂量分布要求，剂量学上安全可行，各级别医院可根据临床需求进行选择应用。

Abstract:
Background Radiotherapy is one of the main treatment methods for rectal cancer. There are many types of radiotherapy equipment in China, with different levels. The radiotherapy equipments in grassroots hospitals are backward, and most of them are mainly domestic radiotherapy equipment.
Objective To investigate the clinical dosimetry characteristics and treatment efficiency of domestic and imported precision radiotherapy equipment in postoperative radiotherapy for rectal cancer, so as to provide evidence for clinical application.
Methods Ten patients with postoperative adjuvant radiotherapy for rectal cancer from July to October in 2017 were selected from the Radiotherapy Department of the First Medical Center of Chinese PLA General Hospital, the radiotherapy plan was designed and verified by domestic accelerator (group A) and imported accelerator (group B), and the results were compared. Dose statistics were performed on the target volume and organs at risk through the dose volume histogram, and the target volume conformity index (CI) and homogeneity index (HI) were calculated according to the corresponding formula, and finally the machine treatment time and the number of hops were counted. Statistical analysis was performed using paired t-test.
Results The treatment plans of both domestic and imported precision radiotherapy equipment could meet the requirements of the prescribed dose in the target area and the limit of organs at risk. There was no statistical difference in D_95% of PTV between the two groups, but the D_2%, D_5%, D_98%, CI and HI of PTV in group B were better than those in group A (P<0.05). In the protection of normal organs, there was no significant difference in the V₃₀ of the small intestine and the V₄₀ of the bilateral femoral head between the two groups, while the V₄₀ of the bladder in group A was better than that in group B (P<0.05). There was no statistical difference in the pass rate of the plan between the two groups, while the efficiency of plan implementation in group A was slightly better than that in group B (P<0.05).
Conclusion Both domestic and imported precision radiotherapy equipment can meet the target dose distribution requirements of IMRT after rectal cancer surgery, and it is safe and feasible dosimetrically. Hospitals at all levels can choose and apply them according to clinical needs.

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