野中野正向调强与固定野逆向调强在全脑放疗中的剂量学差异

潘香; 李娅; 朱思瑾; 杨毅

doi:10.7619/jcmp.201919003

野中野正向调强与固定野逆向调强在全脑放疗中的剂量学差异

昆明医科大学第三附属医院, 云南省肿瘤医院放射治疗科, 云南昆明, 650118

详细信息

通讯作者:
李娅, E-mail: 1438954061@qq.com

中图分类号: R815
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出版历程
- 收稿日期: 2019-07-14
- 录用日期: 2019-09-24
- 网络出版日期: 2021-02-28
- 发布日期: 2019-10-14

Dosimetry difference between field-in-field intensity modulated radiation therapy and fixed field inversely optimized intensity modulated radiation therapy in whole brain radiotherapy

Department of Radiotherapy, Yunnan Provincial Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118

摘要

摘要:
目的比较全脑放疗的野中野正向静态调强(FIF-IMRT)与固定野逆向优化调强(FFIO-IMRT)技术的剂量学差异。
方法选取需行全脑放疗患者20例，采用Pinnacle³ 9.10治疗计划系统进行计划设计, 2种计划均用6 MV X射线, 处方剂量均为40 Gy, 2 Gy/次，共20次。FIF-IMRT计划选270 °、90 °为主野，适当调整准直器角度，使双眼球重叠，在每个主野方向手动添加1~2个子野降低高剂量。FFIO-IMRT计划7野均分调强，通过反复改变优化参数来达到临床要求的剂量分布。比较2种放疗计划的剂量学参数。
结果 ① 靶区方面:与FFIO-IMRT计划相比, FIF-IMRT计划的计划靶区(PTV)的V_105%、D_50%升高, D_min、D_max、V_95%、V_110%、D_2%、D_98%降低，差异均有统计学意义(P < 0.05); FIF-IMRT计划的CI低于FFIO-IMRT, HI却高于FFIO-IMRT, 差异均有统计学意义(P < 0.05); FIF-IMRT计划子野数、机器跳数MU、治疗时间、计划设计时间均较FFIO-IMRT显著降低(P < 0.05)。②危及器官左右晶体、左右眼球、脊髓、左右视神经方面, FIF-IMRT计划低于FFIO-IMRT计划，晶体尤为明显，除左右视神经外，其他差异均有统计学意义(P < 0.05)。
结论 ① 2种计划的靶区均达到临床剂量学要求。② FIF-IMRT计划在靶区的适形性上虽差于FFIO-IMRT计划，但在危及器官的保护方面远好于FFIO-IMRT计划。③由于FIF-IMRT计划的单次治疗时间显著减少，因此降低了器官运动带来的误差，同时减少了机器的损耗，提高了机器执行效率。④ FIF-IMRT计划设计简单易行，在基层医院也较容易实现。故全脑放疗推荐野中野正向静态调强的方式。
- 全脑放疗 /
- 野中野正向调强放射治疗 /
- 固定野逆向调强放射治疗 /
- 剂量学
Abstract:
Objective To compare dosimetry difference between field-in-field intensity modulated radiation therapy (FIF-IMRT) and fixed field inversely optimized intensity modulated radiation therapy (FFIO-IMRT) in whole brain radiotherapy.
Methods Totally 20 patients with whole brain radiotherapy were selected. The Pinnacle³ 9.10 treatment planning system was used to design plan. 6 MV X-ray was used for both two plans, and the prescription dosage was 40 Gy, with 2 Gy per time for 20 times totally. FIF-IMRT plans to select 270 and 90 degrees as the main fields, adjust the collimator angle appropriately to make the eyes overlap, and manually add 1 or 2 sub-fields in each main field direction to reduce the high dose. FFIO-IMRT plans to equalize the intensity of 7 fields and achieve the clinical dose distribution by repeatedly changing the optimized parameters. The dosimetric parameters of two radiotherapy schemes were compared.
Results Compared with FFIO-IMRT, the V_105% and D_50% of the planned target area (PTV) in FIF-IMRT increased significantly, while D_min, D_max, V_95%, V_110%, D_2%, D_98% decreased significantly (P < 0.05). CI of FIF-IMRT was significantly lower than that of FFIO-IMRT, but HIV was significantly higher than that of FFIO-IMRT (P < 0.05). The number of planned subfields, machine hops MU, treatment time and planning design time of FIF-IMRT were significantly lower than those of FFIO-IMRT (P < 0.05). The FIF-IMRT plan was significantly lower than the FFIO-IMRT plan in terms of organ-threatening left and right crystals, right and left eyeballs, spinal cord and right optic nerves, especially in crystals. There were significant differences except for left and right optic nerves between two plans (P < 0.05).
Conclusions ① Both treatment plans could meet the requirements of clinical dosimetry. ② Although the CI of FIF-IMRT is worse than FFIO-IMRT, but FIF-IMRT is better in protection of organs. ③ Since the single treatment time of FIF-IMRT significantly shorten, the errors caused by organ movement are reduced, the loss of MLC is reduced, and the execution efficiency of the machine is improved. ④ The FIF-IMRT plan is simple designed and easy to implement in primary hospitals. Therefore, the FIF-IMRT is recommended for whole brain radiotherapy.
- whole brain radiotherapy /
- field-in-field intensity modulated radiation therapy /
- fixed field inversely intensity modulated radiation therapy /
- dosimetry

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图 1 FIF-IMRT计划(粗线)和FFIO-IMRT计划(细线)的靶区DVH对比

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图 2 FIF-IMRT计划(1)和FFIO-IMRT(2)的等剂量线对比

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图 3 FIF-IMRT计划和FFIO-IMRT的危及器官DVH对比

1表示FIF-IMRT计划结果; 2表示FFIO-IMRT计划结果

下载: 全尺寸图片幻灯片

表 1 2种计划的靶区剂量学对比(x±s)(n=20)

指标	FIF-IMRT	FFIO-IMRT
V_95%/%	98.60±0.68	99.00±0.73^*
V_105%/%	28.30±5.64	21.05±10.04^*
V_110%/%	0.00±0.00	1.15±0.99^*
D_2%/cGy	4 258.48±34.35	4 350.41±53.37^*
D_50%/cGy	4 151.72±38.34	4 122.93±33.48^*
D_98%/cGy	3 824.59±74.76	3 874.83±55.76^*
CI	0.79±0.05	0.81±0.05^*
HI	0.11±0.02	0.12±0.02^*
与FIF-IMRT比较, *P < 0.05。

下载: 导出CSV

表 2 2种计划的危及器官剂量学对比(x±s)(n=20)

指标	FIF-IMRT	FFIO-IMRT
左晶体D_max/cGy	361.18±31.90	673.27±60.15^*
右晶体D_max/cGy	383.59±30.32	671.59±47.57^*
左眼球D_max/cGy	1 066.70±239.89	1 585.15±185.46^*
右眼球D_max/cGy	1 229.50±265.41	1 568.24±195.97^*
脊髓D_max/cGy	3 154.81±658.45	3 695.71±83.05^*
左视神经D_max/cGy	3 706.76±819.67	3 949.10±667.95
右视神经D_max/cGy	4 014.18±174.37	4 043.01±105.39
与FIF-IMRT比较, *P < 0.05。

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表 3 2种计划的机器参数对比(x±s)(n=20)

指标	FIF-IMRT	FFIO-IMRT
子野数/个	4.75±0.79	66.25±6.19^*
机器跳数/MU	226.65±2.08	553.15±10.15^*
治疗时间/min	0.60±0.00	1.39±0.09^*
计划设计时间/min	12.57±0.46	28.21±1.31^*
与FIF-IMRT比较, *P < 0.05。

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