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目的比较包括鼻咽癌(NPC)为主的头颈部1-3弧快速容积调强放疗(Rapid Arc)和7-9固定野动态调强放疗(IMRT)的剂量学差异。方法应用Varian的Eclipse10.0治疗计划系统对80例头颈部肿瘤患者分别设计1-3弧快速容积调强计划和7-9野动态调强计划。比较两种计划靶区剂量适形指数(CI)、均匀性指数(HI)、不同危及器官(OAR)的最大剂量或感兴趣剂量体积和机器跳数(MU)。结果IMRT计划与Rapid Arc计划的靶区最高剂量Dmax比较差异有统计学意义(P<0.05),但Rapid Arc计划的靶区热点明显比IMRT计划低,可控制在处方剂量的108%以内,差异具有统计学意义(P<0.05)。两种治疗计划的最低剂量Dmin比较差异无统计学意义(P>0.05)。靶区的平均剂量Dmean Rapid Arc多数高于IMRT,差异具有统计学意义(P<0.05)。晶体D1%剂量中IMRT受量普遍更低,差异具有统计学意义(P<0.05)。腮腺的Rapid Arc平均受量低于IMRT,差异具有统计学意义(P<0.05)。在7000 c Gy处方剂量时差异具有统计学意义(P<0.05)。结论头颈部尤其是鼻咽癌1-3弧快速容积调强放疗的剂量分布好于7-9野动态调强,而且减少机器跳数、提高治疗效率,可在临床推广应用。
OBJECTIVE: To compare the dose-response differences between nasopharyngeal carcinoma (NPC) -based patients with head-neck 1-3-arc rapid volume modulated radiation therapy (Rapid Arc) and 7-9 fixed field dynamic intensity modulated radiation therapy (IMRT). Methods Varian’s Eclipse10.0 treatment planning system was used to design 1-3 arc rapid volumetric intensity augmentation and 7-9 hydroelectric intensity augmentation in 80 patients with head and neck cancer. Dose Conformity Index (CI), Homogeneity Index (HI), Maximum Dose of Different Endangered Organ (OAR) or Volume of Dose of Interest and Machine Hops (MU) were compared between the two planned targets. Results There was significant difference (P <0.05) between the highest dose Dmax and target dose of Rapid Arc program in Rapid Arc program. However, the target area of Rapid Arc program was significantly lower than that of IMRT plan and could be controlled within 108% of the prescription dose. Statistically significant (P <0.05). There was no significant difference in the minimum dose Dmin between the two treatment plans (P> 0.05). The average target dose Dmean Rapid Arc was higher than IMRT, the difference was statistically significant (P <0.05). The dose of IMRT in D1% of the crystal was generally lower, the difference was statistically significant (P <0.05). The average amount of Rapid Arc in parotid gland was lower than IMRT, the difference was statistically significant (P <0.05). At 7000 c Gy, the difference was statistically significant (P <0.05). Conclusion The dose distribution of 1-3 volumetric rapid-volume intensity modulated radiotherapy for head and neck, especially nasopharyngeal carcinoma, is better than that of 7-9 field dynamic intensity adjustment, and can reduce the number of machine hops and improve the treatment efficiency, which can be popularized and applied clinically.