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目的比较选择性淋巴结照射(ENI)和累及野照射(IFI)调强放射治疗局部晚期非小细胞肺癌(LA-NSCLC)的优劣和剂量学特点。方法应用Varian Eclipse DX计划系统,对经病理证实的27例LA-NSCLC患者设计ENI和IFI两种放疗计划。通过剂量体积直方图(DVH)、靶区适形指数(CI)、肿瘤控制概率(TCP)、正常组织受照射剂量和正常组织并发症概率(NTCP)评价治疗计划优劣。结果 IFI组GTV的最大剂量、最小剂量、平均剂量、CI和TCP均高于ENI组,分别为77.1Gy和73.9Gy、67.3Gy和63.6Gy、70.9Gy和67.1Gy、0.82和0.73、96.7%和93.1%(P<0.05);IFI组肺平均剂量、V20和NTCP均低于ENI组,分别为13.2Gy和16.0Gy、22.1%和24.7%、5.2%和5.8%(P<0.05);IFI组的食管V45低于ENI组,分别为16.3%和21.7%(P<0.05),而LETT45两组间差异无统计学意义(P>0.05);IFI组与ENI组心脏受照平均剂量和脊髓受照最大剂量比较差异无统计学意义(P>0.05)。结论 IFI较ENI提高了靶区的照射剂量和肿瘤控制概率,可降低正常组织受照剂量和正常组织并发症的概率。
Objective To compare the advantages and dosages of selective lymphadenectomy (ENI) and intra-field radiation (IFI) intensity-modulated radiation in the treatment of locally advanced non-small cell lung cancer (LA-NSCLC) Methods The Varian Eclipse DX planning system was used to design both radiotherapy plans of ENI and IFI in 27 pathologically confirmed LA-NSCLC patients. The pros and cons of the treatment plan were evaluated by dose-volume histogram (DVH), target conformal index (CI), tumor control probability (TCP), normal tissue exposure dose and normal tissue complication probability (NTCP) Results The maximum dose, minimum dose, average dose, CI, and TCP of GTV in IFI group were significantly higher than those in ENI group, 77.1Gy and 73.9Gy, 67.3Gy and 63.6Gy, 70.9Gy and 67.1Gy, 0.82 and 0.73, 96.7% and (P <0.05). The average lung dose, V20 and NTCP of IFI group were lower than those of ENI group (13.2Gy and 16.0Gy, 22.1% and 24.7%, 5.2% and 5.8% respectively) (P <0.05). However, there was no significant difference in LETT45 between the two groups (P> 0.05). The mean cardiac irradiation dose and spinal cord volume in IFI group and ENI group were significantly lower than those in ENI group According to the maximum dose difference was not statistically significant (P> 0.05). Conclusion Compared with ENI, IFI can improve the radiation dose and tumor control probability of target area, and reduce the probability of normal tissue exposure dose and normal tissue complication.