[1]李萍,张书旭,阳露,等.基于MRI活性骨髓勾画的非共面调强放疗在宫颈癌骨髓保护方面的剂量学优势[J].中国医学物理学杂志,2019,36(12):1390-1395.[doi:DOI:10.3969/j.issn.1005-202X.2019.12.005]
　LI Ping,ZHANG Shuxu,YANG Lu,et al.Dosimetric advantages of MRI image-guided non-coplanar intensity-modulated radiotherapy in active bone marrow sparing for patients with cervical cancer[J].Chinese Journal of Medical Physics,2019,36(12):1390-1395.[doi:DOI:10.3969/j.issn.1005-202X.2019.12.005]
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基于MRI活性骨髓勾画的非共面调强放疗在宫颈癌骨髓保护方面的剂量学优势()
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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12期
页码:
1390-1395
栏目:
医学放射物理
出版日期:
2019-12-25

文章信息/Info

Title:
Dosimetric advantages of MRI image-guided non-coplanar intensity-modulated radiotherapy in active bone marrow sparing for patients with cervical cancer
文章编号:
1005-202X（2019）12-1390-06
作者:
李萍1; 张书旭2; 阳露2; 曾庆星1; 林晓辉1; 张国前2
1.广州医科大学研究生院， 广东 广州510182； 2.广州医科大学附属肿瘤医院放疗中心， 广东 广州510095
Author(s):
LI Ping1;  ZHANG Shuxu2;  YANG Lu2;  ZENG Qingxing1;  LIN Xiaohui1;  ZHANG Guoqian2
1. Graduate School, Guangzhou Medical University, Guangzhou 510182, China; 2. Radiotherapy Center, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
关键词:
宫颈癌; 根治性放疗; 骨髓保护; 非共面调强放疗; 共面调强放疗
Keywords:
Keywords: cervical cancer;  radical radiotherapy;  bone marrow sparing;  non-coplanar intensity-modulated radiotherapy;  coplanar intensity-modulated radiotherapy
分类号:
R811.1；R737.33
DOI:
DOI:10.3969/j.issn.1005-202X.2019.12.005
文献标志码:
A
摘要:
目的：探讨MRI指导下非共面野调强放疗（NC-IMRT）在宫颈癌骨髓保护方面的剂量学特点和优势。方法：选取20例宫颈癌术前放疗患者，根据MRI图像勾画骨盆有效造血活性骨髓，分别制定9野的共面野调强（IMRT）计划和NC-IMRT计划（其中NC-IMRT计划包括7个共面野和2个非共面野）。两组计划均采用相同的靶区上下界、危及器官限值和权重因子及计算网格，归一条件均为95%的计划靶区（PTV）接受到处方剂量。对比分析两类计划中靶区和危及器官的剂量学参数差异：受照剂量、体积、适形度指数和均匀性指数。结果：在定位CT上勾画的全骨盆体积为（600.32±6.88） cm3，MRI勾画的活性骨髓体积为（219.38±9.73） cm3，后者较前者减少了63.4%，差异有统计学意义（P<0.05）。NC-IMRT组PTV的适形度指数优于IMRT组。NC-IMRT组有效减少骨盆活性骨髓的低剂量辐射区V10、V20和高剂量辐射区V40、V50，左侧股骨头的Dmean、V10、V20、V30、V40和右侧股骨头Dmean、Dmax、V10、V20，差异均有统计学意义（P<0.05）。两组直肠、小肠的受照剂量无明显差异（P>0.05）。结论：在保证临床靶区剂量的情况下，与IMRT相比，基于MRI活性骨髓勾画的NC-IMRT能更好地保护骨盆活性骨髓。
Abstract:
Abstract: Objective To investigate the dosimetric characteristics and advantages of non-coplanar intensity-modulated radiotherapy (NC-IMRT) guided by magnetic resonance imaging (MRI) in the bone marrow sparing for cervical cancer patients. Methods A total of twenty patients with cervical cancer scheduled for radiotherapy were enrolled. Two different plans, namely 9-field coplanar IMRT plan and NC-IMRT plan including 7 coplanar fields and 2 non-coplanar fields, were designed based on the active pelvic bone marrow segmented in MRI images. Both plans adopted the same target upper and lower bounds, limit doses to organs-at-risk, weighting factors and calculation grids, and the same normalization condition that 95% of planning target volume received the prescription dose was applied for evaluation. The differences in dosimetric parameters of target areas and organs-at-risk such as exposure dose, volume, conformity index and homogeneity index were compared between two groups. Results The active bone marrow volume segmented in MRI images was (219.38±9.73) cm3, 63.4% less than the volume of the pelvis segmented in positioning CT images which was (600.32±6.88) cm3, with statistical significance (P<0.05). The conformity index of planning target volume in NC-IMRT group was superior to that in IMRT group. The low-dose radiation region (V10 and V20) and high-dose radiation region (V40 and V50) of the active bone marrow of the pelvis as well as the Dmean, V10, V20, V30, V40 of the left femoral head and the Dmean, Dmax, V10, V20 of the right femoral head in NC-IMRT group were significantly reduced, with statistical differences (P<0.05). There was no significant difference in the doses to rectum and small intestine between two groups (P>0.05). Conclusion With guaranteed clinical target doses for cervical cancer patients, NC-IMRT based on active bone marrow segmentation in MRI images is advantageous over coplanar IMRT in the sparing of the active bone marrow of the pelvis.

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备注/Memo

备注/Memo:
【收稿日期】2019-06-05 【基金项目】广东省教育厅特色创新项目（2016KTSCX116）；广州市科技创新发展专项（201804010297） 【作者简介】李萍，硕士研究生，E-mail: 1529949325@qq.com 【通信作者】张书旭，博士，二级教授/主任技师，博士生导师，主要从事肿瘤精确放疗技术研究，E-mail: gthzsx@163.com
更新日期/Last Update: 2019-12-24