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

doi: 10.3969/j.issn.2095-5227.2023.04.006

1.
解放军总医院第一医学中心放射治疗科，北京　100853
2.
青岛市中心医院放射物理科，山东青岛　266042
3.
首都医科大学附属潞河医院放射治疗科，北京　101149

详细信息

作者简介:
曾铭玥，女，硕士，主治医师。研究方向：恶性肿瘤精准放疗。Email: zengmingyue301@163.com

通讯作者:
冯林春，男，硕士，主任医师。Email: 301flc@163.com

中图分类号: R735.37
计量
- 文章访问数: 104
- HTML全文浏览量: 52
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-29
- 网络出版日期: 2023-03-23
- 刊出日期: 2023-04-28

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

1.
Department of Radiation Oncology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
2.
Department of Radiation Physics, Qingdao Central Hospital, Qingdao 266042, Shandong Province, China
3.
Department of Radiation Oncology, Beijing Luhe Hospital affiliated to Capital Medical University, Beijing 101149, China

More Information

Corresponding author: FENG Linchun. Email: 301flc@163.com

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。
- 直肠癌 /
- 放射治疗 /
- 国产加速器 /
- 靶区剂量 /
- 放疗计划
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.
- rectal cancer /
- radiotherapy /
- domestic accelerator /
- target dose /
- treatment planning

HTML全文

表 1 两组PTV剂量、体积及HI、CI比较

Table 1. Comparison of PTV dose, volume, HI and CI between the two groups

指标	A组(n=10)	B组(n=10)	t值	P值
D_2%/Gy	56.27 ± 0.64	54.28 ± 0.54	7.384	0.000
D_5%/Gy	56.01 ± 0.67	54.14 ± 0.52	6.539	0.000
D_95%/Gy	50.00 ± 0.00	50.07 ± 0.14	1.605	0.143
D_98%/Gy	48.57 ± 0.39	49.48 ± 0.28	5.145	0.001
V_t/cc	1157.06 ± 101.68	1167.05 ± 106.07	1.578	0.149
V_tref/cc	1139.96 ± 102.03	1118.92 ± 102.99	3.345	0.009
V_ref/cc	1468.53 ± 141.19	1309.82 ± 140.98	6.987	0.000
CI	0.78 ± 0.02	0.82 ± 0.04	2.803	0.021
HI	1.12 ± 0.01	1.08 ± 0.01	6.656	0.000
A组：FonicsPlan计划系统 + 新华XHA1400数字化光子医用电子直线加速器；B组：Pinnacle V9.10计划系统 + Varian IX医用直线加速器。

下载: 导出CSV

表 2 两组危及器官剂量参数比较

Table 2. Dose parameters of involved organs between the two groups

危及器官	指标	A组(n=10)	B组(n=10)	t值	P值
小肠	D_mean/Gy	25.48 ± 5.52	25.84 ± 3.36	0.384	0.710
	V₅₀/cc	100.73 ± 56.10	112.18 ± 59.14	4.714	0.001
	V₄₀/cc	179.01 ± 76.54	225.75 ± 89.64	6.749	0.000
	V₃₀/%	37.87 ± 10.537	38.71 ± 6.158	0.277	0.788
	V₃₀/cc	331.05 ± 138.69	336.08 ± 107.87	0.277	0.849
	V₂₀/cc	477.76 ± 162.72	516.57 ± 177.62	1.981	0.079
	V₁₅/cc	523.32 ± 172.53	470.99 ± 283.39	0.677	0.515
	V₁₀/cc	551.17 ± 178.60	641.82 ± 195.33	6.203	0.000
膀胱	D_mean/Gy	38.84 ± 1.99	36.52 ± 2.13	4.365	0.002
	V₅₀/%	26.37 ± 24.82	20.79 ± 7.89	0.702	0.500
	V₄₀/%	39.96 ± 6.90	41.64 ± 6.87	2.291	0.048
	V₃₀/%	83.12 ± 9.66	63.30 ± 9.58	5.237	0.001
	V₂₀/%	96.41 ± 3.58	86.65 ± 13.38	2.164	0.059
	V₁₀/%	99.92 ± 0.12	95.2 ± 15.06	0.980	0.353
股骨头	D_mean/Gy	20.80 ± 4.26	23.97 ± 2.63	-3.604	0.006
	V₄₅/%	1.02 ± 2.42	0.38 ± 0.23	0.863	0.411
	V₄₀/%	3.66 ± 5.59	3.32 ± 1.13	0.204	0.843
	V₃₀/%	21.02 ± 10.74	28.16 ± 9.50	2.400	0.040
	V₂₀/%	56.01 ± 17.06	64.99 ± 13.93	3.401	0.008
	V₁₀/%	72.56 ± 15.71	93.32 ± 6.29	5.161	0.001

下载: 导出CSV

表 3 两组计划的剂量验证通过率、机器跳数和治疗时间的比较

Table 3. Comparison of passing rate in dose verification, monitor unit and treatment time between the two groups

指标	A组(n=10)	B组(n=10)	t值	P值
机器跳数/MU	501.90 ± 41.19	714.10 ± 33.99	13.166	0.000
治疗时间/min	1.12 ± 0.09	1.19 ± 0.06	2.341	0.046
伽马通过率/%	96.13 ± 1.58	97.40 ± 1.58	1.948	0.083

下载: 导出CSV

参考文献(19)

[1]	Chen W,Zheng R,Baade PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2): 115-132.
[2]	全力. 我国医用直线加速器发展现状与进展[J]. 中国科技信息,2017(5): 93-94. doi: 10.3969/j.issn.1001-8972.2017.23.031
[3]	郭成中,陈春丽,戴兰. 我国医用直线加速器发展现状分析[J]. 饮食保健,2019,6(30): 298
[4]	冀天楠,赵志飞,丛小虎,等. 国产和进口鼻咽癌精确放疗设备的临床剂量学比较研究[J]. 医疗卫生装备,2018,39(12): 41-45.
[5]	谢晓烨,冀天楠,丛小虎,等. 国产和进口医用直线加速器及治疗计划系统在肺癌调强放疗中的临床剂量学研究[J]. 医疗卫生装备,2022,43(2): 47-50. doi: 10.19745/j.1003-8868.2022032
[6]	曾铭玥,冯林春,贾宝庆,等. 局部进展期中低位直肠癌患者术前同期加量调强放疗联合化疗的疗效观察[J]. 解放军医学院学报,2020,41(10): 953-958. doi: 10.3969/j.issn.2095-5227.2020.10.001
[7]	曾铭玥,冯林春. 局部进展期直肠癌新辅助放化疗策略的选择及研究进展[J]. 中国医疗设备,2021,36(4): 127-131. doi: 10.3969/j.issn.1674-1633.2021.12.030
[8]	Prabhakaran S,Yang TWW,Johnson N,et al. Latest evidence on the management of early-stage and locally advanced rectal cancer:a narrative review[J]. ANZ J Surg,2022,92(3): 365-372.
[9]	Glynne-Jones R,Wyrwicz L,Tiret E,et al. Rectal cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J]. Ann Oncol,2017,28(Suppl_4): iv22-iv40.
[10]	王一琳,李璐,方鹏骞. 我国医院进口与国产医用直线加速器配置及使用情况分析[J]. 医学与社会,2019,32(6): 69-72. doi: 10.13723/j.yxysh.2019.06.019
[11]	陈吉祥,郞锦义,胡静,等. 基层医院国产和进口加速器使用情况比较[J]. 中华放射肿瘤学杂志,2017,26(3): 251-254.
[12]	杨小龙,陈惠贤,陈继朋,等. 医用质子重离子加速器应用现状及发展趋势[J]. 中国医疗器械杂志,2019,43(1): 37-42. doi: 10.3969/j.issn.1671-7104.2019.01.011
[13]	丛小虎,宋伟男,解传滨,等. 基于国产与进口精确放疗设备在原发性肝癌与胰腺癌的临床剂量学评价研究[J]. 中国医疗设备,2021,36(4): 90-93. doi: 10.3969/j.issn.1674-1633.2021.12.022
[14]	李全义,戴相昆,方春锋. 国产医用直线加速器在早期乳腺癌术后放疗的剂量学特性分析[J]. 临床肿瘤学杂志,2016,21(9): 805-809.
[15]	金丽媛,付春鹏,丁静静,等. 基于国产和进口直线加速器实施前列腺癌调强放射治疗的临床剂量学评估[J]. 中国医疗设备,2021,36(4): 86-89. doi: 10.3969/j.issn.1674-1633.2021.09.020
[16]	Roels S,Duthoy W,Haustermans K,et al. Definition and delineation of the clinical target volume for rectal cancer[J]. Int J Radiat Oncol Biol Phys,2006,65(4): 1129-1142.
[17]	中国医师协会结直肠肿瘤专委会放疗专委会,唐源,金晶,等. 直肠癌术前/术后适形/调强放疗靶区勾画共识与图谱[J]. 中华放射肿瘤学杂志,2018,27(3): 227-234. doi: 10.3760/cma.j.issn.1004-4221.2018.03.001
[18]	Holyoake DLP,Partridge M,Hawkins MA. Systematic review and meta-analysis of small bowel dose-volume and acute toxicity in conventionally-fractionated rectal cancer radiotherapy[J]. Radiother Oncol,2019,138: 38-44. doi: 10.1016/j.radonc.2019.05.001
[19]	崔彦莉,王晓贞. 宫颈癌调强放疗不良反应物理性影响因素分析[J]. 河北医科大学学报,2017,38(11): 1340-1344. doi: 10.3969/j.issn.1007-3205.2017.11.024