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目的:分析比较螺旋断层调强(HT)、静态调强(IMRT)和容积旋转调强(VMAT)治疗非小细胞肺癌(NSCLC)的剂量学特点,为临床选择提供依据。方法:选取18例NSCLC患者,分别设计HT、IMRT和VMAT计划,给予计划肿瘤靶区处方剂量60 Gy/25 F,计划靶区处方剂量50 Gy/25 F。根据剂量体积直方图评估靶区的D_(2%)、D_(98%)、D_(mean)、适形度指数、均匀性指数和危及器官受量,比较3组治疗计划之间靶区以及器官剂量、治疗时间和机器跳数(MU)的差异。结果:3组计划的剂量分布均能很好满足临床剂量要求,HT计划在靶区覆盖度、靶区适形度和靶区均匀性上均优于IMRT计划和VMAT计划,但剂量差异无统计学意义。在危及器官受量方面,VMAT计划对患侧肺的保护优于HT和IMRT(P<0.05);而HT计划对健侧肺的保护优于IMRT和VMAT;从双肺来看,VMAT稍优于HT,HT稍优于IMRT(P>0.05);HT和VMAT计划对脊髓的保护均优于IMRT计划(P<0.05)。在治疗时间上,HT大于IMRT(P>0.05),IMRT大于VMAT(P<0.01),HT的MU数远大于IMRT和VMAT。结论:HT和VMAT计划均优于IMRT计划,VMAT计划相对于HT计划可以降低双肺剂量,并且具有效率优势。
Objective: To compare and analyze the dosimetric characteristics of non-small cell lung cancer (NSCLC) treated with helical CT, IMRT and VMAT to provide evidence for clinical choice. Methods: Eighteen patients with NSCLC were enrolled in this study. HT, IMRT and VMAT were designed respectively. The planned dose of targeted tumor was 60 Gy / 25 F and the planned target dose was 50 Gy / 25 F. The D_ (2%), D_ (98%), D_ (mean), conformal index, homogeneity index and endocrine tolerance of the target area were evaluated according to the dose volume histogram. The target areas between the three treatment plans were compared and Organ dose, treatment time and machine hop count (MU). Results: The dose distributions of the three groups all satisfied the clinical dose requirements well. The HT program was better than the IMRT and VMAT programs in target coverage, target conformality and target uniformity, but there was no statistical difference in dose Significance of learning. The VMAT program is superior to HT and IMRT (P <0.05) in protecting the ipsilateral lung against endotoxin exposure, whereas the HT program is superior to IMRT and VMAT in protecting the contralateral lung; VMAT is slightly better in both lungs HT and HT were better than IMRT (P> 0.05). Both HT and VMAT programs were superior to IMRT in spinal cord protection (P <0.05). HT was greater than IMRT (P> 0.05), IMRT was greater than VMAT (P <0.01), and the number of MU in HT was much larger than IMRT and VMAT. CONCLUSIONS: Both the HT and VMAT plans outperform the IMRT plan, and the VMAT plan relative to the HT plan can reduce both lung doses and have an efficiency advantage.