摘要
目的容积旋转调强放射技术在腮腺癌中广泛应用。对于偏单侧的肿瘤治疗时弧度选择是否应偏向于单侧是一个值得探讨的问题。本研究通过比较各种弧度的计划结果,探讨偏单侧腮腺癌在容积旋转放射治疗时弧度选择的方向性以及可行性。方法选取上海交通大学医学院附属第九人民医院2017-02-01-2018-05-30收治的15例偏单侧腮腺癌患者入组,由同一位物理师根据同一位经验丰富医生勾画的临床靶区对入组患者在Monaco计划系统中做不同弧度的放疗计划,弧度的分类包括360°、360°+360°、360°+X,其中360°+X分别为360°+180°、360°+210°、360°+240°、360°+270°、360°+300°和360°+330°。治疗计划仅针对弧度的选择不同,靶区及正常器官的限量及优化参数保持一致,优化结束后统一对靶区95%的计算结果进行归一化处理。比较120个计划的跳数(monitor unit,MU)、控制点个数、靶区适形度(conformity index,CI)、剂量均匀性指数(heterogeneous index,HI)和靶区D98、D50、D5、D2的剂量,以及危及器官脊髓、脑干的最大剂量(Dmax),喉、下颌骨、口腔、咽缩肌、对侧腮腺、同侧中耳、同侧颞颌关节的平均剂量(Dmean)用配对t检验方法统计靶区和危及器官的剂量学参数。结果相对于单弧双弧的计划,360°+X计划在靶区上存在一定的优势,同时降低了控制点跟机器跳数,提高机器的利用率。尤其是360°+240°,其MU为639.24±70.10(P<0.01),控制点为202.12±11.65(P<0.01),相对于其他360°+X角度,在靶区剂量学表现优异的情况下,MU数和控制点数更少。而在危及器官保护方面,360°+X的弧度在脑干以及脊髓最大量有一定的优势。尤其是360°+270°的脊髓受量为(33.90±1.53)Gy(P<0.05),脑干受量为(25.91±2.79)Gy(P<0.01),为360°+X中最低。而对于并联危及器官,双弧计划与360°+X计划没有区别。相对于单弧计划,360°+X计划对于靶区同侧的并联器官的平均剂�
OBJECTIVE Volumetric modulated arc therapy is widely used in salivary gland cancer.For the unilateral tumor,whether the arc should be biased to one side remains controversial.This study compared the plan results of various arcs to explore the directionality and feasibility of arc selection in unilateral salivary gland carcinom during volumetric modulated arc therapy.METHODS Fifteen patients with unilateral salivary gland carcinoma admitted to the Ninth People’s Hospital in 2017-02-01-2018-05-30 were enrolled in this study.The target areas of these patients were outlined by the same experienced doctor and planned by the same experienced medical physicist in the Monaco planning system.The classification of arcs included:360°,360°+360°and 360°+X,360°+X were consisted of 360°+180°,360°+210°,360°+240°,360°+270°,360°+300°,360°+330°.The arcs of volumetric modulated arc therapy plans were different,at the same time,the limit and optimization parameters of the target areas and the normal organs were consistent in the volumetric modulated arc therapy plans.After the plans optimization,95%of the calculation results of the target area are unified and normalized.The results of 120 plans were analyzed,such as monitor unit(MU),control points,target area conformity index(CI),heterogeneous index(HI),target area D98,D50,D5,D2 dose,and the maximum dose(Dmax)of the spinal cord and brain stem of the organ,and the average dose of the larynx,mandible,oral cavity,pharyngeal muscle,contralateral parotid gland,ipsilateral middle ear and ipsilateral temporomandibular joint(Dmean).The dosimetric parameters of the target areas and organ at risk(OAR)were analyzed by using the paired t-test method of SPSS software.RESULT Compared to single/double arc plans,the 360°+X plan had its own advantages in the target areas.At the same time,the 360°+X plan reduces the control points and machine MU,and improves the utilization rate of the machine.Especially for the 360°+240°,which indicated better target dosimetry,while having less
作者
樊文慧
石慧烽
胡海生
毕帆
冯琨
涂文勇
FAN Wen-hui;SHI Hui-feng;HU Hai-sheng;BI Fan;FENG Kun;TU Wen-yong(Department of Oral and Maxillofacial-Head and Neck Oncology,Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第11期880-885,895,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
上海交通大学医学院技术转移推广项目(ZT201807)。
关键词
弧度选择
容积旋转调强
偏单侧腮腺癌
剂量
放射治疗
arc selection
volumetric modulated arc therapy
unilateral salivary gland carcinoma
dose
radiation therapy
