徐桂琼, 李珍, 叶奕菁, 雷风李, 民英, 白玉海, 欧阳玉秀. 鼻咽癌容积调强旋转放疗和固定野适形调强放疗的剂量学对比[J]. 中国肿瘤临床, 2015, 42(22): 1090-1095. DOI: 10.3969/j.issn.1000-8179.2015.22.025
引用本文: 徐桂琼, 李珍, 叶奕菁, 雷风李, 民英, 白玉海, 欧阳玉秀. 鼻咽癌容积调强旋转放疗和固定野适形调强放疗的剂量学对比[J]. 中国肿瘤临床, 2015, 42(22): 1090-1095. DOI: 10.3969/j.issn.1000-8179.2015.22.025
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Guiqiong XU, Zhen LI, Yijing YE, Feng LEI, Minying LI, Yuhai BAI, Yuxiu OUYANG. Dosimetric comparison between volumetric modulated arc therapy with RapidArc and fixed-field intensity modulation radiation therapy for nasopharyngeal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2015, 42(22): 1090-1095. DOI: 10.3969/j.issn.1000-8179.2015.22.025
Citation: Guiqiong XU, Zhen LI, Yijing YE, Feng LEI, Minying LI, Yuhai BAI, Yuxiu OUYANG. Dosimetric comparison between volumetric modulated arc therapy with RapidArc and fixed-field intensity modulation radiation therapy for nasopharyngeal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2015, 42(22): 1090-1095. DOI: 10.3969/j.issn.1000-8179.2015.22.025
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鼻咽癌容积调强旋转放疗和固定野适形调强放疗的剂量学对比

Dosimetric comparison between volumetric modulated arc therapy with RapidArc and fixed-field intensity modulation radiation therapy for nasopharyngeal carcinoma

    摘要
  • 摘要: 目的：对比旋转容积调强技术（RapidArc ）和固定野适形调强放疗（intensity modulated radiation therapy ，IMRT）治疗鼻咽癌剂量学方面的差异，探索不同T 分期从何种技术获益最大。方法：选取60例无远处转移鼻咽癌患者，按鼻咽癌2008分期T 1～2期20例，T 3 期20例，T 4 期20例。使用瓦里安公司Eclipse 系统，每例患者分别制定RapidArc 和固定野IMRT 计划，比较两者靶区覆盖、危机器官剂量、跳数和治疗时间的差别。结果：IMRT 和RapidArc 均能满足临床要求，靶区剂量分布差异无统计学意义（P >0.05），均匀性和适形性相当。按T 分期分层比较，T 4 期患者RapidArc 组PGTV、PTV 1、PTV 2 的靶区剂量较高（P < 0.05），PGTV 均匀指数较好（P = 0.059）。 RapidArc 组视神经、晶体、颞叶、腮腺V 20、喉、颞颌关节受照剂量均较低（P < 0.05）。 按T 分期分层比较，脑干剂量T 1～2 期、T 3 期两组比较差异无统计学意义（P > 0.05），T 4 期患者脑干D 1% 、Dmax剂量RapidArc 组较IMRT 组低（P < 0.05）。RapidArc 和IMRT 相比，治疗跳数节省65% ，治疗时间节省63% 。结论：RapidArc 和9 野IMRT 治疗鼻咽癌均可满足临床要求，Rap?idArc 可明显降低正常器官剂量，缩短治疗时间，减少治疗跳数。对局部早、中期（T 1～3 期）患者，两者有相似的靶区剂量分布，但对局部晚期（T 4 期）患者，RapidArc 更具有将高剂量区集中在靶区而减少正常器官受照剂量的优势。

     

    Abstract: Objective:To compare the dosimetric differences between volumetric modulated arc radiotherapy with RapidArc and fixed-field intensity modulation radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), and identify the techniques from which patients of different T stages can gain the maximum benefit.Methods:Sixty non-metastatic patients with NPC were randomly selected. According to the T staging of2008Chinese Classification, T1-T 2 stage cases were observed in 20of the 60patients, whereas T 3 and T4 stage cases were seen with 20patients each. RapidArc and IMRT treatment plans were managed by the Eclipse treatment planning sys-tem of Varian Co., US. The dosimetry of the target volume coverage, organs at risk (OARs), monitor unit (MU) per second, and deliv -ery time were evaluated. Results: Both techniques reached the requirement of clinical treatment. The coverages of planning target vol-ume, conformity index, and homogeneity index were similar. However, the stratified analysis of T staging indicated that RapidArc plans led to an increased dose to the tumor target (P<0.05) and an improved homogeneity index ( P=0.059) in the T 4 stage cases. RapidArc al -lowed a statistical dose reduction to the OARs, including optic nerves, lens, temporal lobe, V 20of the parotids, larynx, and temporo -mandibular joint (P<0.05). In the T-stage stratified analysis, the D1% and Dmax of brain stem in T1-T 3 stages were similar but statistical-ly low in T4 stage in the RapidArc group (P<0.05). Compared with those in IMRT group, the MUs and the delivery time in RapidArc group were reduced by 65% and 63%, respectively.Conclusion:Both RapidArc and IMRT attained the clinical requirement for NPC. RapidArc technique showed improvements in the OARs and reduction in MUs and delivery time. The target volume coverages were similar for T1-T 3 stage. However, RapidArc delivered an increased dose to the tumor target in T 4 stage cases, and the dose to OARs was reduced.

     

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