侯俊, 冯林春, 蔡博宁, 王运来, 徐寿平, 戴相昆, 葛瑞刚, 巩汉顺, 解传滨. 脑转移癌螺旋断层放疗、调强及三维适形放疗计划的剂量学研究[J]. 解放军医学院学报, 2012, 33(4): 342-347. DOI: CNKI:11-3275/R.20111116.1109.004
引用本文: 侯俊, 冯林春, 蔡博宁, 王运来, 徐寿平, 戴相昆, 葛瑞刚, 巩汉顺, 解传滨. 脑转移癌螺旋断层放疗、调强及三维适形放疗计划的剂量学研究[J]. 解放军医学院学报, 2012, 33(4): 342-347. DOI: CNKI:11-3275/R.20111116.1109.004
HOU Jun, FENG Lin-chun, CAI Bo-ning, WANG Yun-lai, XU Shou-ping, DAI Xiang-kun, GE Rui-gang, GONG Han-shun, JIE Chuan-bin. Planning of helical tomotherapy,intensity modulation radiation therapy and 3-dimensional conformal radiation therapy for cerebral metastatic cancer:A dosimetric study[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2012, 33(4): 342-347. DOI: CNKI:11-3275/R.20111116.1109.004
Citation: HOU Jun, FENG Lin-chun, CAI Bo-ning, WANG Yun-lai, XU Shou-ping, DAI Xiang-kun, GE Rui-gang, GONG Han-shun, JIE Chuan-bin. Planning of helical tomotherapy,intensity modulation radiation therapy and 3-dimensional conformal radiation therapy for cerebral metastatic cancer:A dosimetric study[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2012, 33(4): 342-347. DOI: CNKI:11-3275/R.20111116.1109.004

脑转移癌螺旋断层放疗、调强及三维适形放疗计划的剂量学研究

Planning of helical tomotherapy,intensity modulation radiation therapy and 3-dimensional conformal radiation therapy for cerebral metastatic cancer:A dosimetric study

  • 摘要: 目的 评估多发脑转移癌的螺旋断层放疗(tomotherapy,TOMO)、静态逆向调强(intensity modulation radiation therapy,IMRT)与三维适形放射治疗(three dimensional conformal radiation therapy,3D-CRT)的剂量学特性,为临床选择提供依据。 方法 选取1、2、3及多个病灶的脑转移癌患者的CT/MRI图像各10例,勾画靶区及正常器官后,分别传输至Precise plan、Pinancle及TOMO计划系统,给予全脑(PTVwb)40Gy/20F,同步给予局部转移灶(pGTVS)加量至60Gy/20F。根据RTOG02-25标准限制危及器官(organs at risk,OAR)剂量,三组计划完成后,分别对靶区的均匀性指数(homogeneity Index,HI)、不均匀性指数(heterogeneity index,UI)、等剂量曲线覆盖程度、剂量体积直方图(dose volume histogram,DVH)分布和正常器官受量最大剂量及平均剂量进行评估。 结果 三种计划都能达到处方剂量需要和危及器官受量限制。TOMO计划对脑转移病灶及全脑的计划靶区均匀性、适形度、靶区覆盖程度和对3个以上病灶患者的晶体保护优于3D-CRT和IMRT计划;对中耳、内耳、1-2个转移病灶患者的视神经、3个以上转移病灶患者的脑干保护优于3D-CRT计划。IMRT计划对全脑的计划靶区的均匀性、适形度、靶区覆盖程度均和对中耳、1-2个转移病灶患者的视神经、3个以上转移病灶患者的脑干优于3D-CRT计划,且在3个以上转移灶患者更明显。3D-CRT计划针对转移灶的均匀性优于IMRT计划,且在3个以上转移灶患者更明显,对于眼球和1-2个转移灶患者晶体的保护优于IMRT和TOMO计划。 结论 针对多发脑转移癌放疗,螺旋断层放疗计划优于静态调强放疗计划,静态调强放疗计划优于三维适形放疗计划且对于3个以上转移灶患者优势更明显。

     

    Abstract: Objective To provide the scientific evidence for the selection of helical tomotherapy(TOMO),intensity modulation radiation therapy(IMRT) and 3-dimensional conformal radiation therapy planning(3D-CRT) for cerebral metastatic cancer by assessing their dosimetric characteristics. Methods Ten patients with 1,2,3 and more foci of cerebral metastatic cancer respectively on CT/MRI images were selected.Their target areas and normal organs were underlined and transmitted to the Precise,Pinancle and TOMO planning systems.Prescribed dose for the whole brain(PTVwb) was 40Gy/20F,while doses for the cerebral metastases(pGTVs) were boosted to 60Gy/20F.Treatment plans for the cerebral metastatic cancer were made with the 3D-CRT,IMRT and TOMO planning systems,respectively.Homogeneity index,heterogeneity index,dose coverage of targets,dose volume histograph(DVH),and other dosimetric index were compared according to the RTOG 02-25 standards and organs at risk(OAR).Maximum tolerant dose and average dose for normal organs were assessed. Results The three plans could meet the needs of prescribed doses and the limit of acceptable doses for the involved organs.The dose distribution,conformity,uniformity of TOMO plan were better than those of IMRT and 3D-CRT plans(P<0.05).The TOMO plan was better for the protection of lenses in patients with over 3 cerebral metastases than the IMRT and 3D-CRT plans(P<0.05),for the protection of optic nerves in patients with 1-2 metastases in middle and inner ears,and for the protection of brain stem in patients with more than 3 metastases than the 3D-CRT plan(P<0.05).The dose distribution,conformity,uniformity of PTVwb of IMRT plan were better than those of 3D-CRT plan(P<0.05).The 3D-CRT plan was better for the protection of optic nerves in middle ear of patients with 1-2 metastases and brain stem of patients with over 3 metastases,especially for the protection of brain stem of those with over 3 metastases than the IMRT plan(P<0.05),for the protection of eyes and lenses of patients with 1-2 metastases than the TOMO and IMRT plans(P<0.05). Conclusion The TOMO plan has better dose uniformity and conformality than the IMRT plan for cerebral metastases,and the IMRT plan is better than the 3D-CRT plan for cerebral metastases,especially for those with over 3 metastases.

     

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