基于螺旋断层全身皮肤照射治疗难治性皮肤T细胞淋巴瘤中蕈样霉菌病-《中国医学物理学杂志》

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Title:: Total skin irradiation using helical tomotherapy for refractory mycosis fungoides-type cutaneous T cell lymphoma

文章编号:: 1005-202X（2021）09-1061-07

作者:: 王海洋1; 王鑫1; 皮一飞1; 裴运通1; 杨亚1; 韩滨1; 贾飞1; 刘乐乐1; 王芳娜1; 孔凡洋1; 胡金炎1; 樊锐太1; 裴曦2; 徐榭2; 郭跃信1; 1. 郑州大学第一附属医院放射治疗部，河南郑州450052；2. 中国科学技术大学核科学技术学院，安徽合肥230026

Author(s):: WANG Haiyang1; WANG Xin1; PI Yifei1; PEI Yuntong1; YANG Ya1; HAN Bin1; JIA Fei1; LIU Lele1; WANG Fangna1; KONG Fanyang1; HU Jinyan1; FAN Ruitai1; PEI Xi2; XU Xie2; GUO Yuexin1; 1. Department of Radiation Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China 2. School of Nuclear Science and Technology, University of Science and Technology of China, Hefei 230026, China

关键词:: 螺旋断层; 全身皮肤照射; 皮肤T细胞淋巴瘤; 蕈样霉菌病

Keywords:: helical tomotherapy total skin irradiation cutaneous T-cell lymphoma mycosis fungoides

分类号:: R144.1；R811.1

DOI:: 10.3969/j.issn.1005-202X.2021.09.003

文献标志码:: A

摘要:: 目的：探讨使用螺旋断层进行全身皮肤照射治疗难治性皮肤T细胞淋巴瘤中蕈样霉菌病的方法。方法：具有7年病史的男性患者确诊为全身多发皮肤T细胞淋巴瘤中的蕈样霉菌病，行全身皮肤照射，采用5 mm氯丁橡胶潜水衣作为组织补偿物，利用其剂量建成效应提高全身皮肤剂量。患者分上下两段扫描，髌骨上方10 cm附近作为分界线，总处方剂量24 Gy，单次1.2 Gy执行20次，5次/周。计划设计采用射野宽度5 cm，螺距0.287，调制因子2.5，在体中心加入全挡模式以减少内部危及器官受量，尤其是全身骨髓剂量，以降低骨髓抑制的发生率。通过Cheese Phantom点剂量、ArcCHECK 三维面剂量及全身多点EBT3胶片验证，确保剂量投照的准确性。最后利用兆伏级图像多部位引导确保摆位和治疗的精度。结果：上段靶区和下段靶区均实现95%靶区体积达到处方剂量，下段靶区的适形度指数和均匀性指数略优于上段靶区。全身骨髓随着距离皮肤间距的缩小而受量逐步增加，其余危及器官剂量均在临床可接受范围之内。点剂量验证偏差小于1%，三维面剂量验证Gamma通过率大于90%，胶片多点剂量验证偏差小于5%，多种验证确保实际投照剂量的准确性，整个治疗过程时间约1 h（包括摆位和图像引导），患者治疗后期仅出现轻微的乏力、恶心、呕吐、低热及Ⅲ度骨髓抑制，整个治疗效果接近完全缓解。结论：该方法具有剂量分布均匀、治疗时间短、实施过程简易、治疗效果佳和毒副作用低的特点，适合在临床中广泛开展，但对剂量建成层的组织补偿物选择及治疗后的毒副作用尤其是骨髓抑制需进一步探讨。

Abstract:: Objective To explore the method using helical tomotherapy for total skin irradiation to treat refractory mycosisfungoides- type cutaneous T cell lymphoma. Methods A male patient with a 7-year medical history who was diagnosed with multiple mycosis fungoides-type cutaneous T cell lymphoma was treated with total skin irradiation, with a 5 mm neoprene diving suit as a tissue compensator to increase the total skin dose through dose build-up effect. The upper and lower target areas targets of the patient were scanned, separately, with 10 cm above the patella as the dividing line. The total prescription was 24 Gy, and the treatment scheme was a single 1.2 Gy treatment for 20 times, 5 times per week. The treatment plan was designed with a field width of 5 cm, a pitch of 0.287 and a modulation factor of 2.5. A complete mode was added to the center of the body to decrease the dose delivered to internal organs-at-risk, especially the total bone marrow dose, thereby reducing the incidence of bone marrow suppression. The accuracy of dose delivery was ensured through Cheese Phantom point dose, ArcCHECK three-dimensional plane dose and total body multi-point EBT3 film verifications. Finally, MVCT guidance was used to ensure the accuracies of set-up and treatment. Results For both upper and lower targets, 95% of target volume received the prescribed dose, but the conformity index and homogeneity index of the lower target were slightly better than those of the upper target. The total bone marrow dose was gradually increased with the reduced distance from the skin, while the doses of other organs-at-risk were within the clinically acceptable range. The accuracy of the actual dose delivery was guaranteed by multiple verifications, including point dose verification deviation less than 1%, Gamma passing rate of threedimensional plane dose verification greater than 90%, and film multi-point dose verification deviation less than 5%. The entire treatment took about 1 hour (including set-up and image guidance). At the later period of treatment, the patient only experienced slight fatigue, mild nausea and vomiting, low-grade fever and grade 3 bone marrow suppression. After the completion of treatment, the patient achieved complete remission. Conclusion The proposed method which has the characteristics of uniform dose distribution, short treatment time, simple implementation process, excellent treatment effect and low toxic and side effects is suitable for widespread clinical application. However, the choices of the tissue compensator for the dose build-up layer and the toxic and side effects after treatment, especially bone marrow suppression, need to be further researched.

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

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