[1]郑芳,陈洪涛,陈伟思,等.动态适形弧技术与容积调强技术在肺转移瘤立体定向放射治疗中的剂量学研究[J].中国医学物理学杂志,2022,39(8):929-935.[doi:DOI:10.3969/j.issn.1005-202X.2022.08.002]
　ZHENG Fang,CHEN Hongtao,CHEN Weisi,et al.Dosimetric evaluation of dynamical conformal arc and rapid arc in stereotactic body radiotherapy for lung metastases[J].Chinese Journal of Medical Physics,2022,39(8):929-935.[doi:DOI:10.3969/j.issn.1005-202X.2022.08.002]
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动态适形弧技术与容积调强技术在肺转移瘤立体定向放射治疗中的剂量学研究()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
39卷
期数:
2022年第8期
页码:
929-935
栏目:
医学放射物理
出版日期:
2022-08-04

文章信息/Info

Title:
Dosimetric evaluation of dynamical conformal arc and rapid arc in stereotactic body radiotherapy for lung metastases
文章编号:
1005-202X（2022）08-0929-07
作者:
郑芳; 陈洪涛; 陈伟思; 史亚滨; 高艳; 梁晓敏; 钟鹤立
深圳市人民医院/暨南大学第二临床医学院/南方科技大学第一附属医院肿瘤放疗科， 广东 深圳 518020
Author(s):
ZHENG Fang;  CHEN Hongtao;  CHEN Weisi;  SHI Yabin;  GAO Yan;  LIANG Xiaomin;  ZHONG Heli
Department of Radiation Oncology, Shenzhen Peoples Hospital/the Second Clinical Medical College, Jinan University/the First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, China
关键词:
动态适形弧; 容积调强; 立体定向放射治疗; 肺转移瘤
Keywords:
Keywords: dynamical conformal arc rapid arc stereotactic body radiotherapy lung metastasis
分类号:
R734；R811
DOI:
DOI:10.3969/j.issn.1005-202X.2022.08.002
文献标志码:
A
摘要:
【摘要】目的：比较动态适形弧（DCA）与容积调强（RA）两种放疗技术在肺部转移瘤立体定向放射治疗（SBRT）中的剂量学差异，评估各自的优势及在临床中的应用价值。方法：回顾性选择肺转移瘤患者20例，分别采用RA和DCA技术设计SBRT计划，基于RTOG0813报告标准，对比两种技术的PTV剂量学参数及危及器官受量。另外比较了计划设计时间、MU值及出束时间以评估两类计划的执行效率。结果：所有RA和DCA计划均能满足RTOG0813报告规定的靶区覆盖率要求，RA计划比DCA计划在靶区适形度CI（0.998±0.039 vs 1.357±0.138）、剂量跌落梯度指数R50%（4.90±0.93 vs 6.04±1.09）及D2 cm（47.3%±6.7% vs 54.5%±10.8%）指标上表现更好（P<0.05）。在肺部V12.5 Gy［（148.60±114.24）cm3 vs （176.25±152.16） cm3］、V13.5 Gy［（135.52±107.25 ） cm3 vs （162.10±141.21） cm3］、V20 Gy（2.83%±3.38% vs 3.52%±4.29%）以及胸壁Dmax［（3 734.42±1 229.70） cGy vs （4 230.31±1 510.60） cGy］、V30 Gy［（0.51±0.81） cm3 vs （0.93±1.25） cm3］指标上RA计划比DCA计划受量更低（P<0.05）。两类计划在心脏、脊髓、食管、血管及皮肤受量上无统计学差异（P>0.05）。在执行效率方面，DCA计划设计耗时平均比RA计划节省81.1%，机器跳数平均降低41.1%，机器出束时间平均降低56.5%（P<0.05）。结论：RA计划相对于DCA计划具有更好的适形度且能更好地控制靶区外剂量跌落梯度，在保护与靶区位置相近的危及器官上更有优势。而DCA相对RA计划可以显著提高计划设计速度和治疗效率，同时可以克服运动靶区与叶片间的交互效应。在两者剂量分布差异较小时，应注重提高治疗效率，DCA技术不失为一种可替代RA的有效治疗方案。 【关键词】动态适形弧；容积调强；立体定向放射治疗；肺转移瘤
Abstract:
Abstract: Objective To compare dosimetric differences between dynamic conformal arc (DCA) and rapid arc (RA) in stereotactic body radiotherapy (SBRT) for lung metastases, and to evaluate their advantages and clinical application value. Methods Twenty cases of lung metastases were selected retrospectively, and two kinds of SBRT plans were generated using RA and DCA techniques, separately. Based on the RTOG0813 protocol criteria, the plan metrics such as PTV dosimetric parameters and organs-at-risk doses were compared between two groups of SBRT plans. In addition, the execution efficiency was evaluated by planning time, MU and delivery time. Results All RA and DCA plans met the PTV coverage requirements in the RTOG0813 protocol. RA plans performed better than DCA plans in conformity index, intermediate dose spillage R50% and D2 cm(0.998±0.039 vs 1.357±0.138, 4.90±0.93 vs 6.04±1.09, 47.3%±6.7% vs 54.5%±10.8% P<0.05). Compared with DCA plans, RA plans provided a lower V12.5 Gy, V13.5 Gy, V20 Gy to lungs, and less Dmax, V30 Gy to the chest wall ［(148.60±114.24) cm3 vs (176.25±152.16) cm3, (135.52±107.25) cm3 vs (162.10±141.21) cm3, 2.83%±3.38% vs 3.52%±4.29%, (3 734.42±1 229.7) cGy vs (4 230.31±1 510.60) cGy, (0.51±0.81) cm3 vs (0.93±1.25) cm3 P<0.05］. There was no statistical difference between the two kindsof plans in the dosimetric parameters of the heart, spinal cord, esophagus, vessels and skin (P>0.05). The comparison of execution efficiency showed that DCA plans saved 81.1% planning time, reduced 41.1% MU and 56.5% delivery time than RA plans. Conclusion Compared with DCA plan, RA plan has better conformability and can better control the dose drop gradient outside the target area, and it is more beneficial in protecting organs-at-risk close to the target area.Compared with RA plan, DCA plan can significantly improve the planning and treatment efficiencies while overcoming the interaction effect between the moving target area and the blade. When the difference in dose distribution between them is trivial, attention should be paid to the improvement of treatment efficiency, and DCA technique can be regarded as an effective treatment alternative to RA.

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备注/Memo

备注/Memo:
【收稿日期】2022-03-15 【基金项目】广东省医学科研基金（B2021395） 【作者简介】郑芳，硕士研究生，工程师，研究方向：放射物理与剂量学，E-mail: 1095025681@qq.com 【通信作者】钟鹤立，高级工程师，研究方向：肿瘤放射物理，E-mail: zhongheli@tom.com
更新日期/Last Update: 2022-09-05