[1]成坚强,李凤菊,赵凤菊,等.超声引导前列腺癌放疗中的剂量学研究[J].中国医学物理学杂志,2026,43(2):155-161.[doi:DOI:10.3969/j.issn.1005-202X.2026.02.003]
　CHENG Jianqiang,LI Fengju,ZHAO Fengju,et al.Dosimetric analysis of ultrasound-guided radiotherapy for prostate cancer[J].Chinese Journal of Medical Physics,2026,43(2):155-161.[doi:DOI:10.3969/j.issn.1005-202X.2026.02.003]
点击复制

超声引导前列腺癌放疗中的剂量学研究()

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
43卷
期数:
2026年第2期
页码:
155-161
栏目:
医学放射物理
出版日期:
2026-02-27

文章信息/Info

Title:
Dosimetric analysis of ultrasound-guided radiotherapy for prostate cancer
文章编号:
1005-202X（2026）02-0155-07
作者:
成坚强; 李凤菊; 赵凤菊; 牛瑞军; 魏玺仪; 陶娜; 贾怀琳; 卢亚琼; 张春林; 董方
甘肃省肿瘤医院放疗科， 甘肃 兰州 730050
Author(s):
CHENG Jianqiang;  LI Fengju;  ZHAO Fengju;  NIU Ruijun;  WEI Xiyi;  TAO Na;  JIA Huailin;  LU Yaqiong;  ZHANG Chunlin;  DONG Fang
Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
关键词:
前列腺癌; 放射治疗; 超声引导; 剂量学
Keywords:
prostate cancer radiotherapy ultrasound-guided dosimetry
分类号:
R318；R815
DOI:
DOI:10.3969/j.issn.1005-202X.2026.02.003
文献标志码:
A
摘要:
目的：基于超声引导前列腺癌放疗，研究分次间和分次内治疗过程中靶区和危及器官的放疗剂量差异。方法：选取2020~2024年期间甘肃省肿瘤医院放疗科收治的36例前列腺癌患者进行回顾性分析，依据超声引导方式不同分为以下两类，三维分次间超声引导和四维实时分次内超声引导，分析靶区和危及器官不同摆位误差的受量情况。结果：三维超声引导451个分次间摆位误差中，误差值最大为5.8 mm，最小为4.8 mm，三维方向摆位误差X轴方向（-0.31±2.50） mm、Y轴方向（0.48±2.39） mm和Z轴方向（-0.12±2.02） mm之间差异无统计学意义（P>0.05）。四维实时超声引导45个分次内的前列腺摆位误差最小值为0.1 mm，三维方向摆位误差最大值分别为2.8 mm（右）、2.6 mm（左）、3.2 mm（脚）、2.4 mm（头）、1.9 mm（后）和1.6 mm（前），三维方向摆位误差平均值分别为1.2 mm（右）、1.1 mm（左）、1.6 mm（脚）、1.2 mm（头）、1.2 mm（后）和1.5 mm（前）。统计发现，摆位误差X轴方向（0.21±2.30） mm、Y轴方向（-0.36±2.15） mm和Z轴方向（-0.18±2.07） mm之间差异无统计学意义（P>0.05）。三维方向摆位偏移不同的距离，偏移3 mm以上对靶区剂量覆盖影响显著，偏移2 mm以上对计划的γ通过率3 mm/3%影响显著，通过率均低于95%。头脚方向偏移对膀胱、盆骨剂量影响较显著，前后方向对直肠剂量影响较显著，阴茎受量在三维方向上并无显著性差异（P>0.05）。结论：通过分析前列腺癌超声引导放疗靶区和危及器官受照剂量情况，3 mm以内的前列腺移动不管是在靶区处方剂量覆盖还是危及器官受量方面，统计差异较小。偏移超过3 mm后，靶区处方剂量覆盖显著降低，危及器官受量有显著差异，此项研究为临床医生靶区外扩提供一定的参考意义。
Abstract:
Abstract: Objective To analyze the differences in irradiation doses delivered to target areas and organs-at-risk (OAR) during interfraction and intrafraction treatments of ultrasound-guided radiotherapy for prostate cancer. Methods A retrospective analysis was conducted on 36 prostate cancer patients admitted to Department of Radiation Oncology, Gansu Provincial Cancer Hospital from 2020 to 2024. According to ultrasound guidance modalities, they were divided into interfraction guidance with three-dimensional ultrasound and intrafraction guidance with four-dimensional real-time ultrasound. The doses received by target areas and OAR were analyzed in relation to different setup errors. Results The maximum and minimum setup errors in 451 interfractions guided by three-dimensional ultrasound were 5.8 mm and 4.8 mm, respectively, and the setup errors along the X-, Y-, and Z-axes were (-0.31±2.50), (0.48±2.39), and (-0.12±2.02) mm, respectively, without significant inter-axis differences (P>0.05). The minimum prostate setup error in the 45 intrafractions guided by four-dimensional real-time ultrasound was 0.1 mm. In terms of three-dimensional setup errors, the maximum values were 2.8 mm (Right), 2.6 mm (Left), 3.2 mm (Inferior), 2.4 mm (Superior), 1.9 mm (Posterior), and 1.6 mm (Anterior), respectively while the average values were 1.2 mm (Right), 1.1 mm (Left), 1.6 mm (Inferior), 1.2 mm (Superior), 1.2 mm (Posterior), and 1.5 mm (Anterior), respectively. The setup errors along the X-, Y-, and Z-axes were (0.21±2.30), (-0.36±2.15), and (-0.18±2.07) mm, respectively, without significant inter-axis differences (P>0.05). For varying three-dimensional displacements, displacements exceeding 3 mm significantly affected the dose coverage of the target areas, whereas displacements over 2 mm exerted a remarkable effect on the gamma passing rate 3 mm/3% of the treatment plan, with passing rates below 95%. The head-foot directional deviations had a significant effect on the irradiation doses delivered to the bladder and pelvic bones, whereas the anterior-posterior directional deviations had a pronounced effect on the rectal dose. No significant difference was observed in the three-dimensional penis dose. Conclusion The analysis of the radiation doses delivered to the target areas and OAR in ultrasound-guided radiotherapy for prostate cancer shows that prostate displacement within 3 mm rarely affects the prescription dose coverage in the target area and the exposure to the OAR, while the displacement exceeding 3 mm results in significant reduction in prescription dose coverage in the target areas, and statistically significant differences in radiation doses received by the OAR. This study provides certain reference significance for clinicians to determine the target area margins.

相似文献/References:

[1]武 杰,袁杭英,欧阳蓓蕾.内旋式放射治疗用面罩固定装置的设计[J].中国医学物理学杂志,2015,32(02):265.[doi:10.3969/j.issn.1005-202X.2015.02.027]
[2]司 森,吴鑫全,包尚联,等.基于GPU的蒙特卡洛放疗剂量模拟[J].中国医学物理学杂志,2015,32(01):1.[doi:10.3969/j.issn.1005-202X.2015.01.001]
[3]王 文,程梦云,杨 琪,等.基于MCNP源子程序的放射治疗剂量计算验证方法[J].中国医学物理学杂志,2015,32(01):13.[doi:10.3969/j.issn.1005-202X.2015.01.004]
[4]张一戈,邱小平,陈维军,等.基于图像引导技术对头颈部肿瘤临床摆位误差的剂量学影响[J].中国医学物理学杂志,2015,32(01):25.[doi:10.3969/j.issn.1005-202X.2015.01.007]
[5]孟慧鹏,孙小喆,王 昊,等.胸部偏后背肿瘤RapidArc采用仰卧位设计治疗计划的可行性分析[J].中国医学物理学杂志,2015,32(01):31.[doi:10.3969/j.issn.1005-202X.2015.01.008]
[6]庞皓文,孙小扬.基于快速自由形变的弹性配准算法在放疗CT中的应用[J].中国医学物理学杂志,2015,32(03):404.[doi:10.3969/j.issn.1005-202X.2015.03.023]
[7]贾卫娟,周一兵,谭维维,等.利用模拟机及挡铅托架进行放疗前的治疗模拟[J].中国医学物理学杂志,2014,31(01):4622.[doi:10.3969/j.issn.1005-202X.2014.01.007]
[8]白 雪,杜向慧,王升晔,等.半野技术结合非共面照射技术在乳腺癌胸锁联合照射中的应用[J].中国医学物理学杂志,2014,31(03):4849.[doi:10.3969/j.issn.1005-202X.2014.03.001]
[9]周 钢,田 野,陆雪官,等.乳腺癌保乳术后三种瘤床同期加量放疗技术的剂量学比较[J].中国医学物理学杂志,2014,31(03):4853.[doi:10.3969/j.issn.1005-202X.2014.03.002]
[10]李贤富,谢 力,郭飞,等.医科达Precise直线加速器快速应急处理方法探讨[J].中国医学物理学杂志,2014,31(04):4984.[doi:10.3969/j.issn.1005-202X.2014.04.003]

备注/Memo

备注/Memo:
【收稿日期】2025-03-21 【基金项目】甘肃省科技计划项目（24JRRA1151）；甘肃省卫生行业科研计划（GSWSKY2022-18） 【作者简介】成坚强，硕士，工程师，研究方向：放射物理，E-mail: chengjqzlyy@163.com 【通信作者】董方，主任医师，研究方向：放射治疗，E-mail: dfpaulinekeyan@163.com
更新日期/Last Update: 2026-01-27