[1]朱志鹏,刘文其,朱蕙君,等.宫颈癌术后调强计划稳健性研究[J].中国医学物理学杂志,2020,37(1):22-28.[doi:DOI:10.3969/j.issn.1005-202X.2020.01.005]
　ZHU Zhipeng,LIU Wenqi,ZHU Huijun,et al.Robustness of postoperative intensity-modulated radiotherapy plan for cervical cancer[J].Chinese Journal of Medical Physics,2020,37(1):22-28.[doi:DOI:10.3969/j.issn.1005-202X.2020.01.005]
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宫颈癌术后调强计划稳健性研究()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
37
期数:
2020年第1期
页码:
22-28
栏目:
医学放射物理
出版日期:
2020-01-25

文章信息/Info

Title:
Robustness of postoperative intensity-modulated radiotherapy plan for cervical cancer
文章编号:
1005-202X（2020）01-0022-07
作者:
朱志鹏; 刘文其; 朱蕙君; 黄继钦; 廖锡宏; 黎桂华
广西医科大学第二附属医院放射治疗科， 广西 南宁 530000
Author(s):
ZHU Zhipeng;  LIU Wenqi;  ZHU Huijun;  HUANG Jiqin;  LIAO Xihong;  LI Guihua
Department of Radiation Oncology, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530000, China
关键词:
宫颈癌; 稳健性; 摆位误差; 调强放射治疗
Keywords:
Keywords: cervical cancer;  robustness;  setup error;  intensity-modulated radiotherapy
分类号:
R730.55；R815
DOI:
DOI:10.3969/j.issn.1005-202X.2020.01.005
文献标志码:
A
摘要:
目的：通过移动等中心模拟系统误差，探讨宫颈癌术后调强放射治疗（IMRT）中剂量分布受系统摆位误差的敏感程度。方法：分别制定30例宫颈癌术后IMRT计划，在治疗计划中移动等中心，假设每次治疗时系统误差都为同一方向，每位患者沿原始x、y、z轴各移动等中心±3.0、±5.0和±7.0 mm模拟左右、腹背、头脚方向系统摆位误差对剂量分布的影响，在不改变优化条件的情况，重新计算剂量分布，得到30个参考计划与540个再计划DVH参数。配对t检验不同方向差异。结果：误差为3、5和7 mm时，CTV D98和PTV V95下降平均偏差分别为0.16%和0.55%、0.44%和1.72%、0.89%和3.41%；小肠、直肠、膀胱、左股骨头和右股骨头V50超标频率分别为2.22%、0.00%、0.00%、0.00%和0.00%，11.11%、2.22%、0.00%、4.44%和4.44%，15.56%、6.67%、2.78%、13.33%和14.44%。采用配对t检验对不同方向误差进行对比时发现：（1）y轴方向摆位误差比x和z轴方向对CTV D98和PTV V95影响更敏感（P<0.05, P<0.05）；（2）背方向摆位误差比其他方向对小肠和膀胱V50 影响更敏感（P<0.05, P<0.05）；（3）腹方向摆位误差比其他方向对直肠V50影响更敏感（P<0.05）；（4）右方向摆位误差比其他方向对左股骨头V50影响更敏感（P<0.05）；（5）左方向摆位误差比其他方向对右股骨头V50影响更敏感（P<0.05）。结论：摆位误差较小时（<5 mm），靶区剂量和小肠、膀胱、直肠、左右股骨头V50受摆位误差敏感程度较小，宫颈癌术后IMRT计划较稳健。当摆位误差增大时，宫颈癌术后IMRT计划不再稳健，治疗前一定需要寻找原因，如有必要还需重新做体位固定装置。
Abstract:
Abstract: Objective To discuss the sensitivity of dose distribution of postoperative intensity-modulated radiotherapy (IMRT) plan for cervical cancer to setup errors which were simulated by shifting the isocenter. Methods Postoperative IMRT plan was designed for 30 cases of cervical cancer. Assuming that all the systematic errors were in the same direction, the isocenter was shifted by ±3.0, ±5.0 and ±7.0 mm along the original axes of x, y and z to simulate the setup errors in left-right, abdomen-back, and head-feet directions, respectively, and the effects of setup errors on dose distribution were analyzed. After the recalculation of dose distribution without changing optimization conditions, the dose-volume histogram parameters of 30 reference plans and 540 recalculated plans were obtained. The differences in different directions were analyzed by paired t-test. Results When the error was 3, 5 and 7 mm, the average deviations of declines of CTV D98 and PTV V95 were 0.16% and 0.55%, 0.44% and 1.72%, 0.89% and 3.41%, respectively, and the frequency of excess V50 of small intestine, rectum, bladder, left femoral head and right femoral head were 2.22%, 0.00%, 0.00%, 0.00%, 0.00%; 11.11%, 2.22%, 0.00%, 4.44%, 4.44%; 15.56%, 6.67%, 2.78%, 13.33% and 14.44%, respectively. The results of paired t-test showed that compared with the setup errors in x and z axes, the setup error in y direction had greater effects on CTV D98 and PTV V95 (P<0.05, P<0.05); and that the V50 of small intestine and bladder was more affected by the setup error in back direction than the setup errors in the other directions (P<0.05, P<0.05). Moreover, the effect of the setup error in abdomen direction on the V50 of rectum was the greatest (P<0.05); the V50 of left femoral head was more affected by the setup error in right direction than the setup errors in the other directions (P<0.05), and the V50 of right femoral head was more affected by the setup error in the left direction (P<0.05). Conclusion When the setup error was smaller than 5 mm, the setup error has insignificant effects on target doses and the V50 of small intestine, bladder, rectum, left femoral head and right femoral head, which indicates the postoperative IMRT for cervical cancer was robust. However, with larger setup errors, the plans were no longer robust. The reason for that must be found before treatment, and if necessary, the device for positioning needed to be remade.

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备注/Memo

备注/Memo:
【收稿日期】2019-06-15 【基金项目】广西壮族自治区卫生和计划生育委员会自筹课题（Z20181010） 【作者简介】朱志鹏，硕士研究生，助理工程师，研究方向：医学物理，E-mail: 2228048236@qq.com 【通信作者】黎桂华，工程师，研究方向：医学物理，E-mail: 41556401@qq.com
更新日期/Last Update: 2020-01-14