[1]鞠孟阳,史玉静,李金凯,等. 直肠内气腔对前列腺癌放疗计划的影响[J].中国医学物理学杂志,2018,35(8):879-884.[doi:DOI:10.3969/j.issn.1005-202X.2018.08.003]
　JU Mengyang,SHI Yujing,LI Jinkai,et al. Effects of gas cavity in rectum on radiotherapy plan for prostate cancer[J].Chinese Journal of Medical Physics,2018,35(8):879-884.[doi:DOI:10.3969/j.issn.1005-202X.2018.08.003]
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 直肠内气腔对前列腺癌放疗计划的影响()
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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8期
页码:
879-884
栏目:
医学放射物理
出版日期:
2018-08-20

文章信息/Info

Title:
 Effects of gas cavity in rectum on radiotherapy plan for prostate cancer
文章编号:
1005-202X（2018）08-0879-06
作者:
 鞠孟阳1; 史玉静1; 李金凯2; 田甜2 郑海伦2; 孙新臣2
 1.南京医科大学特种医学系， 江苏 南京210009； 2.南京医科大学第一附属医院放疗科， 江苏 南京 210009
Author(s):
 JU Mengyang1;  SHI Yujing1;  LI Jinkai2;  TIAN Tian2;  ZHENG Hailun2;  SUN Xinchen2
 1. Department of Medicine in Specific Environments, Nanjing Medical University, Nanjing 210009, China; 2. Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210009, China
关键词:
 ; 前列腺癌; 气腔; 容积旋转调强; 剂量学差异; 适形性指数; 均一性指数
Keywords:
 ; Keywords: prostate cancer;  gas cavity;  volumetric modulated arc therapy;  dosimetric difference;  conformity index;  homogeneity index
分类号:
R815.6；R737.25
DOI:
DOI:10.3969/j.issn.1005-202X.2018.08.003
文献标志码:
A
摘要:
 目的：通过定义前列腺癌患者直肠内气腔结构，探讨其在前列腺癌放疗中对计划的影响。 方法：选取12例前列腺癌患者。取每位患者第一次治疗前的锥形束计算机断层扫描（CBCT）图像，勾画靶区、定义气腔结构。将CBCT图像上的气腔结构映射到CT图像上，依据气腔结构的CT值查找电子密度值并更改气腔结构的电子密度值，重新计算计划。比较两组计划计划靶区（PTV）的平均剂量（Dmean）和最大剂量（Dmax）、气腔结构对应的靶区（PTVg）的Dmean和Dmax，危及器官直肠、膀胱的Dmean、V30、V40、V50、V70的变化差异，以及股骨头V30的变化差异，对两组治疗计划的适形指数和均匀性指数的差异进行比较。 结果：所有病人共得到24个治疗计划。存在气腔时，PTV的Dmean和Dmax均较无气腔时减小，差异无统计学意义（P>0.05）；PTVg的Dmean和Dmax也减小，差异无统计学差异（P>0.05）。但存在气腔时，计划的适形性（适形指数减小）和均一性（均匀性指数增大）均降低。危及器官中，直肠的Dmean、V5、V30、V40分别增加0.4 Gy、0.5%、0.8%、1.7%，差异具有统计学意义（P<0.05），但是直肠V50的变化差异无统计学意义（P=0.310）。膀胱的Dmean、V5、V30、V40、V50均减小，差异无统计学差异（P>0.05）。两侧股骨头的V30分别增加0.1%和0.2%。计划的机器跳数和子野数没有因为气腔的存在而发生变化。 结论：气腔结构的存在对前列腺放疗计划的影响主要表现为直肠受量的增加，对靶区和其他危及器官的影响不大。因此，治疗前行CBCT扫描对于监测直肠内气腔存在具有一定意义。
Abstract:
 Abstract: Objective To define the structure of gas cavity and investigate the effect of gas cavity in rectum on radiotherapy plan for prostate cancer. Methods Twelve patients with prostate cancer were selected. The target volume was delineated and gas cavity was defined in cone beam computed tomography (CBCT) images obtained before the first treatment. The gas cavity in CBCT images was mapped into CT images. The electron density was determined based on the CT value of gas cavity, and then the electron density value of gas cavity was changed for recalculating the radiotherapy plan. The mean dose (Dmean) and maximum dose (Dmax) of planning target volume (PTV), the Dmean and Dmax of target area corresponding to gas cavity (PTVg), the variations of Dmean, V30, V40, V50, V70 of rectum and bladder, the variations of V30 of femoral head were compared. Furthermore, the differences in conformity index and homogeneity index were also compared. Results A total of 24 treatment plans were designed. In the present of gas cavity, both Dmean and Dmax of PTV were decreased compared to those without gas cavity, without statistical significance (P>0.05). The Dmean and Dmax of PTVg also decreased, without statistical differences (P>0.05). With the existence of gas cavity, the conformability (conformity index decreased) and homogeneity (homogeneity index increased) of the plans were decreased. For organs-at-risk, the Dmean, V5, V30, V40 of rectal was increased by 0.4 Gy, 0.5%, 0.8%, 1.7%, respectively, and the differences were statistically significant (P<0.05), but the variations of rectum V50 didn’t showed any statistical significant (P=0.310). The Dmean, V5, V30, V40, V50 of bladder were decreased, without statistical differences (P>0.05). The V30 of both sides of the femur was increased by 0.1% and 0.2%, respectively. The monitor units and segments didn’t changes even with the presence of gas cavity. Conclusion In prostate radiotherapy plans, gas cavity increases the target dose to rectum, but has little effects on the target area and other organs at risk. Therefore, it is significant to monitor the presence of gas cavity in the rectum before retreatment.

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备注/Memo

备注/Memo:
 【收稿日期】2018-02-06
【基金项目】国家自然科学基金（81472809, 81502653, 81672983, 81703028）
【作者简介】鞠孟阳，硕士，研究方向：放射治疗的质量控制和效果保证，E-mail: DrJmy2017@163.com
【通信作者】孙新臣，博士，主任医师，博士生导师，研究方向：肿瘤的放射治疗，E-mail: sunxinchen123@hotmail.com
更新日期/Last Update: 2018-07-26