[1]程婷婷,张彦秋,张子健,等.晚期鼻咽癌螺旋断层调强放疗与容积旋转调强放疗剂量学比较[J].中国医学物理学杂志,2018,35(9):1005-1011.[doi:1005-202X（2018）09-1005-07]
　CHENG Tingting,ZHANG Yanqiu,ZHANG Zijian,et al.Dosimetric comparison of helical tomotherapy and volumetric modulated arc therapy for latestagenasopharyngeal carcinoma[J].Chinese Journal of Medical Physics,2018,35(9):1005-1011.[doi:1005-202X（2018）09-1005-07]
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晚期鼻咽癌螺旋断层调强放疗与容积旋转调强放疗剂量学比较()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
35卷
期数:
2018年第9期
页码:
1005-1011
栏目:
医学放射物理
出版日期:
2018-09-27

文章信息/Info

Title:
Dosimetric comparison of helical tomotherapy and volumetric modulated arc therapy for latestage nasopharyngeal carcinoma
文章编号:
10.3969/j.issn.1005-202X.2018.09.003
作者:
程婷婷1; 张彦秋2; 张子健1; 黄昕琼1; 金泽夫1; 刘归1; 胡永梅1; 李钐1; 申良方1
1.中南大学湘雅医院肿瘤科，湖南长沙410008；2. 秦皇岛市第一医院肿瘤放疗科，河北秦皇岛066000
Author(s):
CHENG Tingting1;  ZHANG Yanqiu2;  ZHANG Zijian1;  HUANG Xinqiong1;  JIN Zefu1;  LIU Gui1;  HU Yongmei1;  LI Shan1;  SHEN Liangfang1
1. Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha 410008, China; 2. Department of Radiotherapy, First Hospital of Qinhuangdao, Qinhuangdao 066000, China
关键词:
鼻咽癌; 螺旋断层调强放疗; 容积旋转调强; 剂量学
Keywords:
Keywords: nasopharyngeal carcinoma;  helical tomotherapy;  volumetric modulated arc therapy;  dosimetry
分类号:
R811.1
DOI:
1005-202X（2018）09-1005-07
文献标志码:
A
摘要:
目的：探讨螺旋断层放射治疗（Helical Tomotherapy, HT）技术和容积旋转调强放射治疗（VMAT）技术在晚期鼻 咽癌放疗中的剂量学特点。方法：使用TomoHDTM计划系统对随机选取的10例已行VMAT的晚期鼻咽癌患者制定HT 计划。在满足相同处方剂量要求的情况下，评价和比较两种治疗计划中计划靶区（PGTvnx、PGTVnd、PTV1和PTV2）的 最小剂量、最大剂量（Dmax）、中位剂量、适形指数、均匀度指数、V107（%）和危及器官受量（脊髓、脑干、晶体、视神经、视交叉、 垂体Dmax，颞叶Dmax和V60，腮腺V30，颞颌关节V50），并比较两种治疗计划的正常组织B-P受量和总机器跳数。结果：对两 种计划的靶区、危及器官以及正常组织剂量学指标采用配对样本t检验。（1）对于靶区剂量学指标，HT计划与VAMT计划 相比，靶区PGTVnd的Dmax和中位剂量略有下降（t=-4.734、-3.341；P=0.001、0.009）；HT计划的适形指数好于VMAT计划 （t=-0.403, P=0.026）；靶区PGTVnd 的其它剂量学参数无统计学差异。靶区PGTVnx、PTV1 和PTV2 的所有剂量学参 数均无统计学差异。（2）对于危及器官剂量学指标，HT 计划与VMAT 计划相比，脑干Dmax有所降低，有统计学意义 （t=-2.309, P=0.046）；对侧视神经的Dmax有所升高，有统计学意义（t=0.050, P=0.002）；两侧颞叶的Dmax有所降低，有统计学 意义（t=-4.929、-3.480；P=0.001、0.007）；两侧腮腺的V30有所降低，有统计学意义（t=-5.971、-5.603；P=0.000、0.000）。其 它危及器官受量，两组计划比较均无统计学意义。（3）正常组织B-P受量比较显示，HT计划相比于VMAT计划，V5、V10、 V15、V20、V25略有增高，有统计学意义（t=9.141、8.409、7.100、5.883、3.560；P=0.000、0.000、0.000、0.000、0.049）。其它剂量学 指标无统计学意义。（4）HT计划和VMAT计划单次计划中各射野机器跳数累加之和分别为6 345±210、821±38，有统计学 意义（t=-20.234, P=0.000）；治疗传输时间分别为（9.1±0.4）、（6.9±0.3）min，有统计学意义（t=-10.236, P=0.000）。结论：根 据HT和VMAT方案的剂量学特点，一般情况下，复杂程度高的计划应考虑选择HT方案，而复杂程度一般的计划应考虑 VMAT方案。在临床实践中，根据不同的情况选择不同的方案。当患者耐受性较差时，可选择VMAT方案；而当患者对保 护正常器官（如腮腺）的要求比较高时，可选择HT方案。
Abstract:
Abstract: Objective To compare the dosimetric characteristics of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) for late-stage nasopharyngeal carcinoma. Methods TomoHDTM planning system was used to design HT plans for 10 randomly selected patients who had been treated with VMAT for late-stage nasopharyngeal carcinoma. Under the condition of meeting the same prescription dose requirements, the dosimetric indexes of planning target areas (PGTvnx, PGTVnd, PTV1 and PTV2) and organs-at-risk (OAR) of the two plans were evaluated and compared. The dosimetric indexes of planning target areas included minimum dose, maximum dose (Dmax), median dose, conformity index and homogeneity index, and V107 (%); and the dosimetric indexes of OAR included the Dmax of spinal cord, brain stem, lens, optic nerve, optic chiasma and pituitary, the Dmax andV60 of temporal lobe, the V30 of parotid gland, and the V50 of temporomandibular joint. The dose of normal tissues B-P and total monitor units were also compared between HT plans and VMAT plans. Results Paired sample t test was conducted on the dosimetric indexes of target areas, OAR and normal tissues. No statistical differences were found in the dosimetric parameters of PGTVnd between the two plans, except the Dmax and median dose of PGTVnd which were slightly decreased in HT plans (t=-4.734, -3.341; P=0.001, 0.009) and conformity index which was better in HT plan (t=-0.403, P=0.026). All dosimetric parameters of PGTVnx, PTV1 and PTV2 didn’t show any statistical differences. The comparison of OAR dose between VMAT plans and HT plans showed that there were statistical differences in some dosimetric indexes, including the Dmax of brain stem which was decreased in HT plan (t=-2.309, P=0.046), the Dmax of contralateral optic nerve which was increased in HT plan (t=0.050, P=0.002), the Dmax on both sides of the temporal lobe which was decreased in HT plan (t=-4.929, -3.480; P=0.001, 0.007), the V30 on both sides of the parotid glands which was decreased in HT plan (t=-5.971, -5.603; P=0.000, 0.000). As for the other dosimetric indexes of OAR, no statistical significance was found between the two plans. Moreover, the V5, V10, V15, V20, V25 of normal tissues B-P were slightly increased in HT plans as compared with VMAT plans, with statistical significance (t=9.141, 8.409, 7.100, 5.883, 3.560; P=0.000, 0.000, 0.000, 0.000, 0.049) and no statistical differences were found in the other dosimetric indexes of normal tissues B-P. The sum of the monitor unit of each field in HT plans and VMAT plans was 6 345±210, 821±38, respectively, with statistical differences (t=-20.234, P=0.000), and the delivery time of the two plans was (9.1±0.4), (6.9±0.3) min, respectively, with statistical differences (t=-10.236, P=0.000). Conclusion According to the dosimetric characteristics of the two schemes, in general, HT scheme should be considered for the plan with high complexity, while VMAT scheme for the plan with general complexity. In clinical practice, different plans should be selected based on different situations. If the patient has poorer tolerance, VMAT plan should be considered. For the patient who has higher requirements for the protection of normal organs, such as parotid gland, HT plan is more suitable.

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备注/Memo

备注/Memo:
【收稿日期】2018-04-29 【基金项目】湖南省卫生计生委科研计划课题（B2017100） 【作者简介】程婷婷，研究生，医师，研究方向：肿瘤放化疗，E-mail: chengtingting@csu.edu.cn 【通信作者】申良方，博士，主任医师，研究方向：肿瘤放射治疗，E-mail: lfshen2008@163.com
更新日期/Last Update: 2018-09-28