直肠癌术后固定剂量率容积调强放射治疗的初步研究

doi:10.11904/j.issn.1002-3070.2018.04.008

实用肿瘤学杂志 ›› 2018, Vol. 32 ›› Issue (4): 327-332.doi: 10.11904/j.issn.1002-3070.2018.04.008

直肠癌术后固定剂量率容积调强放射治疗的初步研究

陈祥^1,2, 周剑良¹, 王彬冰², 李浦², 单国平²

1.南华大学核科学技术学院(衡阳 421001);
2.浙江省肿瘤医院放射物理室;浙江省肿瘤放射治疗重点实验室

收稿日期:2018-04-01 出版日期:2018-08-20 发布日期:2018-09-06
通讯作者: 单国平,E-mail:shang3118@163.com
作者简介:陈祥,女,(1992-),硕士研究生,从事肿瘤放射治疗的研究。
基金资助:
基于大数据和人工智能的远程放疗服务模式研究(编号:2017YFC0113201)

Preliminary study on fixed dose rate volumetric modulated intensity radiotherapy in postoperative patients with rectal cancer

CHEN Xiang^1,2,ZHOU Jianliang¹,WANG Binbing²,LI Pu²,SHAN Guoping²

1.Department of Nuclear Science and Technolory,University of South China,Hengyang 421001,China;
2.Department of Radiotherapy Physics/Key Laboratory of Tumor Radiation Therapy,Zhejiang Cancer Hospital

Received:2018-04-01 Online:2018-08-20 Published:2018-09-06

摘要/Abstract

摘要： 目的初步探讨固定剂量率容积调强在直肠癌术后盆腔放射治疗中的可行性。方法选取10例直肠癌放疗患者,利用RayStation计划系统为每例患者制定可变剂量率容积调强(VDR-VMAT)、固定剂量率容积调强(CDR-VMAT)和5野静态调强(5F-sIMRT)计划。运用剂量体积直方图评估三种计划的靶区、危及器官和正常组织剂量学参数,评估机器总跳数(MU)和计划执行时间。结果靶区剂量方面,三种计划的靶区D2%、D_mean、D98%、HI和CI在总体上均有差异(P＜0.001)。CDR-VMAT与VDR-VMAT相比较,D2%、D_mean、D98%、HI、CI差异均无统计学意义;CDR-VMAT与5F-sIMRT相比较,D2%减小1.55 Gy(P=0.005)、D_mean减小0.99 Gy(P=0.005)、D98%增大0.60 Gy(P=0.03)、HI值减小(P=0.008)、CI值增大(P=0.008)。危及器官方面,三种计划的膀胱D_mean、V₄₅、V₄₀,小肠D_mean、D_max、V₄₅,左右股骨头D_mean在总体上均有差异(P＜0.05);小肠V₄₀、V₃₅,左右股骨头V₄₅、V₄₀在总体上均无差异(P＞0.05)。CDR-VMAT与VDR-VMAT相比较,膀胱、小肠、左右股骨头的各剂量学参数差异无统计学意义;CDR-VMAT与5F-sIMRT相比较,膀胱D_mean减小3.05 Gy(P=0.005)、V₄₀减小0.88%(P=0.042),小肠D_mean减小1.75 Gy(P=0.002)、D_max减小1.70 Gy(P＜0.001),左、右股骨头D_mean减小(P=0.008,0.042)。正常组织低剂量受照体积方面,三种计划的正常组织受照低剂量体积除V₁₀(P=0.497)之外,V₅、V₁₅、V₂₀、V₂₅和V₃₀在总体上均有差异(P＜0.001)。CDR-VMAT与VDR-VMAT相比,V₅、V₁₀、V₁₅、V₂₀、V₂₅和V₃₀差异无统计学意义;与5F-sIMRT相比,CDR-VMAT的V₅减小1.18%(P=0.005)、V₁₅减小0.61%(P=0.022)、V₃₀减小0.80%(P=0.022),V₁₀、V₂₀和V₂₅差异无统计学意义。CDR-VMAT计划的MU为(668.51±45.92),比VDR-VMAT(574.13±50.20)增加16.44%,比5F-sIMRT(537.19±37.34)增加24.45%;CDR-VMAT计划执行时间(3.34±0.22)min是VDR-VMAT(1.76±0.04)min的近两倍,比5F-sIMRT(4~6)min稍短。结论 CDR-VMAT可形成与VDR-VMAT一样高质量的计划,较5F-sIMRT有更优的靶区覆盖率、危及器官保护和正常组织低剂量受照体积。但CDR-VMAT计划的MU比VDR-VMAT和5F-sIMRT增多;执行时间比VDR-VMAT长,比5F-sIMRT稍短。CDR-VMAT初始成本较低,有望为不具备可变剂量率的直线加速器提供额外的旋转放疗的选择。

关键词: 直肠癌, 容积调强, 静态调强, 可变剂量率, 固定剂量率

Abstract: Objective The objective of this study was to investigate the feasibility of fixed dose rate volumetric modulation in pelvic radiotherapy after rectal cancer surgery. Methods Ten patients with rectal cancer radiotherapy were enrolled in this study.The RayStation planning system was used to establish a variable dose rate volumetric modulation(VDR-VMAT),a fixed dose rate volume modulation(CDR-VMAT),and a 5-field static intensity modulated radiation therapy(5F-sIMRT)plans for each patient.Dose volume histograms were used to evaluate the dosimetric parameters of the three planned target area,endangered organs and normal tissue,and to assess the total machine hop count(MU)and planned execution time. Results In terms of target area dose,CDR-VMAT compared to VDR-VMAT,D2%,D_mean,D98%,HI and CI were similar;CDR-VMAT compared to 5F-sIMRT D2%,D_mean,D98%,HI and CI all had statistically significant differences(P＜0.05).In the aspect of OARs,CDR-VMAT compared with VDR-VMAT,all parameters of bladder,small intestine,left and right femoral head were similar;CDR-VMAT compared with 5F-sIMRT,D_mean,V₄₀ of the bladder,D_mean,D_max of the small intestine,D_mean of the left and right femoral head all had statistically significant differences(P＜0.05).For the normal tissue,CDR-VMAT compared with VDR-VMAT,V₅,V₁₀,V₁₅,V₂₀,V₂₅ and V₃₀,were similar;CDR-VMAT compared with 5F-sIMRT,V₅,V₁₅ and V₃₀ all had statistically significant differences(P＜0.05).The MU of the CDR-VMAT plan was 16.44% higher than that of VDR-VMAT and 24.45% higher than that of 5F-sIMRT.The execution time of the CDR-VMAT plan was nearly double than that of VDR-VMAT but shorter than that of 5F-sIMRT. Conclusion CDR-VMAT can form a high quality plan as VDR-VMAT with better target coverage,endangering organ protection and low dose exposure volume of normal tissue than 5F-sIMRT.However,the CDR-VMAT plan has more MU than VDR-VMAT and 5F-sIMRT.The execution time of CDR-VMAT is longer than VDR-VMAT and slightly shorter than 5F-sIMRT.The lower initial cost of the CDR-VMAT is expected to provide additional options for rotating radiotherapy for linear accelerators that do not have variable dose rate.

Key words: Rectal cancer, Volumetric modulated arc therapy, Step and shot intensity modulated, Variable dose rate, Constant dose rate

中图分类号:

R735.3⁺7

陈祥, 周剑良, 王彬冰, 李浦, 单国平. 直肠癌术后固定剂量率容积调强放射治疗的初步研究[J]. 实用肿瘤学杂志, 2018, 32(4): 327-332.

CHEN Xiang,ZHOU Jianliang,WANG Binbing,LI Pu,SHAN Guoping. Preliminary study on fixed dose rate volumetric modulated intensity radiotherapy in postoperative patients with rectal cancer[J]. PRACTICAL ONCOLOGY JOURNAL, 2018, 32(4): 327-332.

参考文献

1 Duthoy W,Gersem WD,Vergote K,et al.Whole abdominopelvic radiotherapy(WAPRT)using intensity-modulated arc therapy(IMAT):first clinical experience[J].Int J Radiat Oncol Biol Phys,2003,57(4):1019-1032.
2 Duthoy W,De GW,Vergote K,et al.Clinical implementation of intensity-modulated arc therapy(IMAT)for rectal cancer[J].Int J Radiat Oncol Biol Phys,2004,60(3):794-806.
3 Otto K.Volumetric modulated arc therapy:IMRT in a single gantry arc[J].Med Phys,2008,35(1):310-317.
4 Hodapp N.The ICRU report 83:prescribing,recording,and reporting photon-beam intensity-modulated radiation therapy(IMRT)[J].Strahlenther Onkol,2012,188(1):97-99.
5 Yu CX.Intensity-modulated arc therapy with dynamic multileaf collimation:an alternative to tomotherapy[J].Phys Med Biol,1995,40(9):1435.
6 杜锋磊,赵凯,史国栋,等.Varian Clinical 23EX加速器固定剂量率容积调强技术的MapCheck剂量验证[J].中国医学物理学杂志,2017,34(8):776-782.
7 商海焦,陈利,王学涛,等.鼻咽癌CDR-VMAT与ss-IMRT剂量学比较评估[J].中国医学物理学杂志,2014,31(1):4612-4616.
8 Yu W,Shang H,Xie C,et al.Feasibility of constant dose rate VMAT in the treatment of nasopharyngeal cancer patients[J].Radia Oncol,2014,9(1):235.
9 Zhang R,Fan X,Bai W,et al.Poster-Thur Eve-36:Implementation of constant dose rate and gantry speed arc therapy(CDR‐CAS‐IMAT)for thoracic esophageal carcinoma on Varian 23EX[J].Med Phys,2014,41(8):14.
10 Hatanaka S,Tamaki S,Endo H,et al.Utility of smart arc CDR for intensity-modulated radiation therapy for prostate cancer[J].J Radia Research,2014,55(4):774-779.
11 David P,Emily V,Kerry J,et al.Volumetric modulated arc therapy for delivery of prostate radiotherapy:comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy[J].Int J Radiation Oncol Biol Phys,2008,72(4):996-1001.
12 Zhang RH,Fan XM,Bai WW,et al.Implementation of constant dose rate and constant angular spacing intensity-modulated arc therapy for cervical cancer by using a conventional linear accelerator[J].Chin Med J,2016,129(3):284-288.
13 Tang G,Earl MA,Yu CX.Variable dose rate single-arc IMAT delivered with a constant dose rate and variable angular spacing[J].Phys Med Biol,2009,54(21):6439-6456.

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直肠癌术后固定剂量率容积调强放射治疗的初步研究

Preliminary study on fixed dose rate volumetric modulated intensity radiotherapy in postoperative patients with rectal cancer

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