[1]陈艳,黄宇亮,吴昊,等. 食管癌调强计划中钨门锁定和钨门跟随技术剂量学比较[J].中国医学物理学杂志,2019,36(3):249-253.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.001]
　CHEN Yan,HUANG Yuliang,WU Hao,et al. Dosimetric comparison of fixed jaw and jaw tracking applied in intensity-modulated radiotherapy for esophageal cancer[J].Chinese Journal of Medical Physics,2019,36(3):249-253.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.001]
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 食管癌调强计划中钨门锁定和钨门跟随技术剂量学比较()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第3期
页码:
249-253
栏目:
医学放射物理
出版日期:
2019-03-25

文章信息/Info

Title:
 Dosimetric comparison of fixed jaw and jaw tracking applied in intensity-modulated radiotherapy for esophageal cancer
文章编号:
1005-202X（2019）03-0249-05
作者:
 陈艳1; 黄宇亮2; 吴昊2; 贾冬1; 贾霖1; 韩建军1; 李晨光2; 张艺宝2
 1.绵阳市第三人民医院/四川省精神卫生中心， 四川 绵阳 621000； 2. 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科/恶性肿瘤发病机制及转化研究教育部重点实验室， 北京 100142
Author(s):
 CHEN Yan1;  HUANG Yuliang2;  WU Hao2;  JIA Dong1;  JIA Lin1;  HAN Jianjun1;  LI Chenguang2;  ZHANG Yibao2
 1. Sichuan Mental Health Center, the Third Hospital of Mianyang, Mianyang 621000, China; 2. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
关键词:
 ; 食管癌; 钨门锁定; 钨门跟随; 调强放射治疗
Keywords:
 ; Keywords: esophageal cancer;  fixed jaw;  jaw tracking;  intensity-modulated radiotherapy
分类号:
R730.55；R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2019.03.001
文献标志码:
A
摘要:
 目的：比较研究食管癌调强计划中使用钨门锁定和钨门跟随技术对于计划设计质量尤其是肺受量的影响。方法：回顾性选取48例IV期食管癌患者，PTV体积为（542±192） cm3。基于Eclipse 10.0系统为每例患者设计7野调强计划，并通过归一使95% PTV剂量达到50.4 Gy。在保持布野、优化条件等其他参数不变的情况下，通过改变钨门设置分别生成钨门跟随（Tracking）组和钨门锁定（Fixed）组，并对Fixed组计划进行热点处理以确保其满足临床要求（Modified）。分析3种不同设计方法48例患者计划的剂量-体积参数绘制平均DVH图进行比较。结果：Fixed组比Tracking组心脏V30 Gy、V40 Gy、Dmean分别平均降低了0.68%、1.89%、1.77%；肺V5 Gy、V20 Gy、Dmean分别平均降低了6.84%、1.50%、4.06%；但脊髓的Dmax和全局热点分别增加了0.58%和2.14%，在去除热点后得到了解决，Modified组脊髓Dmax和全局热点均显著低于Tracking组（P<0.001），降幅分别为1.92%和2.38%，且心脏V30 Gy、V40 Gy、Dmean和肺V5 Gy、V20 Gy、Dmean等降幅分别为7.69%、2.00%、2.42%和6.56%、1.33%、3.73%，差异均具有统计学意义（P<0.05）。结论：钨门锁定技术在特殊情况下比钨门跟随技术更能够有效保护心脏、肺等重要器官，在设计食管癌固定野调强放疗计划时，应在临床实践中予以充分考虑。
Abstract:
 Abstract: Objective To compare the dosimetric effects of jaw tracking and fixed jaw techniques on intensity-modulated radiotherapy (IMRT) for esophageal cancer, especially on the lung dose. Methods The clinical data of 48 patients with stage IV esophageal cancers were analyzed retrospectively. The mean planning target volume of all 48 patients was (542±192) cm3. Based on Eclipse 10.0 treatment planning system, 7-field IMRT plan was designed for each patient. Moreover, 95% of planning target volume was irradiated by at least 50.4 Gy. Keeping beam geometry and optimization conditions unchanged, the plans were optimized using jaw tracking (Tracking group) or fixed jaw techniques (Fixed group). Subsequently, the hotspots of Fixed group were post-processed to ensure that the plans meet clinical requirements (Modified group). Finally, the dose-volume histogram was used to compare the dosimetric effects of jaw tracking and fixed jaw techniques on IMRT for esophageal esophageal cancer in 48 patients. Results Compared with those in Tracking group, the V30 Gy, V40 Gy, Dmean of heart and the V5 Gy, V20 Gy, Dmean of lungs in Fixed group were reduced by an average of 0.68%, 1.89%, 1.77%, and 6.84%, 1.50%, 4.06%, respectively. However, the Dmax of spinal cord and global Dmax in Fixed group were increased by 0.58% and 2.14%, respectively. After hotspot post-processing, the issues were well resolved. The Dmax of spinal cord and global Dmax in Modified group were 1.92% and 2.38% lower than those in Tracking group (P<0.001). Moreover , the V30 Gy, V40 Gy, Dmean of heart and the V5 Gy, V20 Gy, Dmean of lungs in Modified group were reduced by 7.69%, 2.00%, 2.42%, and 6.56%, 1.33%, 3.73%, respectively, with statistical differences (all P<0.05). Conclusion For special cases, the fixed jaw technique is superior to jaw tracking technique in protecting organs-at-risk, such as heart and lungs, which should be taken into full consideration during the IMRT for esophageal cancers.

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[2]曾 彪,张九堂,席许平,等.单中心上下半野技术在胸中上段食管癌放射治疗中的剂量学分布[J].中国医学物理学杂志,2015,32(03):357.[doi:10.3969/j.issn.1005-202X.2015.03.012]
[3]陈恩乐,吴 魁,董 事,等.改变多叶准直器角度对调强放疗计划效率的影响[J].中国医学物理学杂志,2015,32(03):437.[doi:10.3969/j.issn.1005-202X.2015.03.030]
[4]宋 威,赵 迪,鹿 红,等.射野方向优化技术在胸中上段食管癌调强放疗中的应用[J].中国医学物理学杂志,2014,31(05):5109.[doi:10.3969/j.issn.1005-202X.2014.05.003]
[5]苏善宁,曾自力.中下段食管癌三维适形放疗不同照射方法对剂量分布的影响[J].中国医学物理学杂志,2014,31(06):5249.[doi:10.3969/j.issn.1005-202X.2014.06.006]
[6]陈杨生.食管癌放射治疗胸部组织校正与否对剂量学影响的研究[J].中国医学物理学杂志,2013,30(05):4360.[doi:10.3969/j.issn.1005-202X.2013.05.005]
[7]刘苓苓,费振乐,李兵兵,等.个性化选择食管癌放疗技术[J].中国医学物理学杂志,2016,33(3):243.[doi:1005-202X（2016）03-0243-05]
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[9]张新,谷晓芳,王培臣,等.轻离子束治疗设备注册检验关键技术问题[J].中国医学物理学杂志,2016,33(6):559.[doi:10.3969/j.issn.1005-202X.2016.06.004]
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[12]汤可维,赵彪,赵玉涛,等. 20例胸中段食管癌根治性放射治疗IMRT与TOMO剂量学比较[J].中国医学物理学杂志,2018,35(6):643.[doi:DOI:10.3969/j.issn.1005-202X.2018.06.005]
　TANG Kewei,ZHAO Biao,ZHAO Yutao,et al. Dosimetric comparison between radical intensity-modulated radiotherapy and tomotherapy in 20 patients with middle thoracic esophageal cancer[J].Chinese Journal of Medical Physics,2018,35(3):643.[doi:DOI:10.3969/j.issn.1005-202X.2018.06.005]
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　XIE Hongliang,HU Can,CAO Yangsen,et al. Comparison of dose distributions calculated by two optimization methods of Monaco system used in volumetric modulated arc therapy of esophageal cancer[J].Chinese Journal of Medical Physics,2018,35(3):745.[doi:DOI:10.3969/j.issn.1005-202X.2018.07.001]
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　GONG Hanshun,XU Shouping,LIU Bo,et al. Accuracy of dose calculation with CBCT images in patients with esophageal cancer[J].Chinese Journal of Medical Physics,2019,36(3):497.[doi:DOI:10.3969/j.issn.1005-202X.2019.05.001]
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　LÜ,Mingyue,LI Ping,et al. Effect of different incidence angles on dosimetric parameters of radiotherapy for esophageal cancer[J].Chinese Journal of Medical Physics,2019,36(3):908.[doi:DOI:10.3969/j.issn.1005-202X.2019.08.009]

备注/Memo

备注/Memo:
 【收稿日期】2018-11-21
【基金项目】北京市自然科学基金（7172048，1174016）；北京市卫生和计划生育委员会首都卫生发展科研专项（首发2018-4-1027）；国家自然科学基金（11505012）；四川省科技计划项目（2018HH0099）；北京市属医院科研培育计划项目（PX2019042，PX2016060）；北京市医院管理局“青苗”计划专项经费（QML20171104）
【作者简介】陈艳，助理工程师，研究方向：医学物理，E-mail: chenyan200707@126.com
【通信作者】张艺宝，博士，高级工程师，硕士生导师，研究方向：医学物理，E-mail: ybzhang66@163.com
更新日期/Last Update: 2019-03-25