[1]辜石勇,陈利,马燕,等. 体位固定装置对鼻咽癌调强计划的剂量学影响[J].中国医学物理学杂志,2019,36(3):271-276.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.005]
　GU Shiyong,CHEN Li,MA Yan,et al. Dosimetric effects of immobilization device on intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].Chinese Journal of Medical Physics,2019,36(3):271-276.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.005]
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 体位固定装置对鼻咽癌调强计划的剂量学影响()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第3期
页码:
271-276
栏目:
医学放射物理
出版日期:
2019-03-25

文章信息/Info

Title:
 Dosimetric effects of immobilization device on intensity-modulated radiotherapy for nasopharyngeal carcinoma
文章编号:
1005-202X（2019）03-0271-06
作者:
 辜石勇1; 陈利2; 马燕1; 余义贞1
 1.中山大学附属第六医院放疗科， 广东 广州 510655； 2.中山大学肿瘤防治中心放疗科/华南肿瘤学国家重点实验室/肿瘤医学协同创新中心， 广东 广州 510060
Author(s):
 GU Shiyong1;  CHEN Li2;  MA Yan1;  YU Yizhen1
 1. Department of Radiation Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
关键词:
 ; 鼻咽癌; 头颈体位固定装置; 调强放射治疗; 剂量学差异
Keywords:
Keywords: nasopharyngeal carcinoma;  head and neck immobilization device;  intensity-modulated radiotherapy;  dosimetric effect
分类号:
R815.6
DOI:
DOI:10.3969/j.issn.1005-202X.2019.03.005
文献标志码:
A
摘要:
 目的：研究头颈体位固定装置对鼻咽癌调强放射治疗计划的剂量影响。方法：随机选取9例鼻咽癌患者，对每例患者勾画两套外轮廓集合，一套仅勾画患者正常外轮廓（Planwithout），另一套勾画包含固定装置的外轮廓（Planwith）。对每例患者的两套轮廓分别设计9野调强和单弧VMAT计划。通过比较计划间的DVH参数结果、两个计划结果相减来评估头颈固定装置引起的剂量学差异。结果：对9野调强计划，Planwith的靶区覆盖和平均剂量（Dmean）相对Planwithout计划均有所减小。鼻咽部肿瘤靶区（GTVnx）、颈部淋巴结肿瘤靶区（GTVnd）、临床靶区与高危淋巴引流区（CTV1）以及预防照射淋巴引流区（CTV2）外扩3 mm得到的PTVnx、PTVnd、PTV1和PTV2处方剂量覆盖分别降低2.14%、10.34%、0.88%、2.86%（P<0.01、P<0.01、P=0.15、P<0.01），Dmean减小0.96%、1.94%、1.07%、1.26%（P值均<0.01）；除脑干外各危及器官Dmean均有减小（最大偏差1.69%），且P值均≤0.01；后颈的皮肤剂量增加约10~15 Gy。对于VMAT，Planwith的靶区覆盖和Dmean均减小：PTVnx、PTVnd、PTV1和PTV2处方剂量覆盖分别降低2.56%、22.42%、0.66%、1.30%（P<0.01、P=0.57、P<0.01、P=0.02），平均剂量分别减小了0.86%、2.45%、0.93%、1.59%（P=0.01、P<0.01、P<0.01、P<0.01）；各危及器官的Dmean均有减小（最大1.60%），且P值均<0.01；同时，体位固定装置的存在使得入射固定装置的射线的散射和体表建成发生变化，后颈的皮肤剂量增加约6~14 Gy。结论：头颈固定装置会引起射线的衰减和建成效应变化，使得鼻咽癌计划靶区的覆盖和Dmean均有降低，在计划设计时需要将其包括到外轮廓内，以保证剂量计算的准确性。
Abstract:
 Abstract: Objective To investigate the dosimetric effects of head and neck immobilization device on the dose distribution of intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC). Methods Nine patients with NPC were randomly selected. Two sets of body contours were established for each patient. One of the body contours did not contain the immobilization device, and the other contained the immobilization device. For the two sets of contours of each patient, 9-field IMRT plan and VMAT plan were designed, and the plans for different sets of contours were recorded as Planwithout and Planwith. The dose differences caused by the head and neck immobilization devices were assessed by the comparative analysis on dose-volume histogram (DVH) parameters and differences in the results of different plans. Results For 9-field IMRT plans, Planwith had lower PTV dose coverage and average dose than Planwithout. Compared with those in Planwithout, the dose coverage of PTVnx, PTVnd, PTV1 and PTV2 in Planwith were decreased by 2.14%, 10.34%, 0.88%, 2.86% (P<0.01, P<0.01, P=0.15, P<0.01), respectively, and their average doses were decreased by 0.96%, 1.94%, 1.07%, 1.26% (all P<0.01). In addition, the mean dose of organs-at-risk except for brainstem was reduced in Planwith (with a maximum deviation of 1.69%, P<0.01) and the back neck skin dose was increased by 10-15 Gy in Planwith. For VMAT plans, the PTV dose coverage and mean dose of Planwith were lower than those of Planwithout. The PTVnx, PTVnd, PTV1 and PTV2 dose coverage in Planwith were decreased by 2.56%, 22.42%, 0.66%, 1.30% (P<0.01, P=0.57, P<0.01, P=0.02), respectively, and their average doses were decreased by 0.86%, 2.45%, 0.93%, 1.59% (P=0.01, P<0.01, P<0.01, P<0.01). The mean doses of organs-at-risk were decreased by 0.52%-1.60% (P<0.01). Meanwhile, back neck skin dose was increased by approximately 6-14 Gy for the immobilization device had changed the scattering of X-ray and surface build-up effects. Conclusion The head and neck immobilization device can cause the attenuation of X-ray and changes in build-up effects, which reduces the dose coverage rate and average dose of the planning target volumes in radiotherapy for nasopharyngeal carcinoma. During treatment planning and dose calculation, the immobilization device should be included within body contour to ensure the accuracy of dose calculation.

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备注/Memo

备注/Memo:
 【收稿日期】2018-09-12
【作者简介】辜石勇，硕士，研究实习员，研究方向：放射物理及放射技术，E-mail: gsy_17@126.com
【通信作者】陈利，硕士，助理研究员，研究方向：放射物理，E-mail: chenli@sysucc.org.cn
更新日期/Last Update: 2019-03-25