论文部分内容阅读
目的探讨肺癌应用常规放疗(CTP)与肺癌三维适形放疗(3DCRP)的剂量分布,比较分析3D-CRT的优势。方法选取2010年8月至2012年3月间山东省济宁市第一人民医院收治的32例无法耐受手术治疗肺癌患者,均采用美国RAHD 3D-CRT计划系统设计CTP和3D-CRT计划治疗,观察CTP及3D-CRT治疗效果并进行比较。结果 3D-CRT 90%等剂量线包绕靶区大体肿瘤靶区(GTV)、临床靶区(CTV)和计划靶区(PTV)明显大于CTP,两种放疗方法差异有统计学意义(P<0.05)。相同处方剂量下,3D-CRT CTV最大剂量和最小剂量明显低于CTP,平均剂量和95%体积剂量明显高于CTP,两种放疗方法差异有统计学意义(P<0.05)。3D-CRT 90%等剂量线包绕肺和心脏体积明显小于CTP,两种放疗方法差异有统计学意义(P<0.05)。3D-CRT 90%等剂量线包绕食管体积略小于CTP,两种放疗方法差异无统计学意义(P>0.05)。3D-CRT全肺照剂量V20、V30和平均肺剂量(MLD)与CTP大致相同,两种放疗方法间差异无统计学意义(P>0.05)。3D-CRT脊髓照射最大剂量和心脏1/3体积照剂量明显低于CTP,两种放疗方法间差异有统计学意义(P<0.05)。3DCRT食管照射最大剂量略高于CTP,两种放疗方法间差异无统计学意义(P>0.05)。3D-CRT靶区适形指数和靶区均匀性指数明显高于CTP,两种放疗方法间差异有统计学意义(P<0.001)。结论3D-CRT可有效提高肺癌靶区剂量分布均匀性,降低正常组织器官受照剂量,与CTP比较具有明显的剂量学优势,值得临床推广应用。
Objective To investigate the dose distribution of conventional radiotherapy (CTP) and three-dimensional conformal radiotherapy (3DCRP) for lung cancer and to compare and analyze the advantages of 3D-CRT. Methods From August 2010 to March 2012, 32 cases of lung cancer patients who were intolerant to surgery in Jining First People’s Hospital of Shandong Province were enrolled in the study. All of them were treated with CTP and 3D-CRT planned by American RAHD 3D-CRT planning system. CTP and 3D-CRT were observed and compared. Results The 3D-CRT 90% isodose line wrapped around the target general tumor target (GTV), the clinical target (CTV) and the target volume (PTV) were significantly larger than CTP, the difference between the two radiotherapy methods was statistically significant (P < 0.05). Under the same prescription dose, the maximum dose and the minimum dose of 3D-CRT CTV were significantly lower than CTP, and the average dose and 95% volume dose were significantly higher than CTP, the difference between the two radiotherapy methods was statistically significant (P <0.05). The 3D-CRT 90% isodose line wrapped around the lung and heart volume was significantly smaller than CTP, the two radiotherapy methods were significantly different (P <0.05). The volume of 90% isodose line of 3D-CRT was slightly smaller than that of CTP, and there was no significant difference between the two radiotherapy methods (P> 0.05). The 3D-CRT whole-lung radiation dose V20, V30 and the average lung dose (MLD) were the same as those of CTP. There was no significant difference between the two radiotherapy methods (P> 0.05). The maximum dose of 3D-CRT spinal cord irradiation and the 1/3 volumetric dose of the heart were significantly lower than those of CTP. The difference between the two radiotherapy methods was statistically significant (P <0.05). The maximum dose of 3DCRT esophageal irradiation was slightly higher than CTP, there was no significant difference between the two radiotherapy methods (P> 0.05). The conformal index and the uniformity index of target area of 3D-CRT were significantly higher than those of CTP. The difference between the two radiotherapy methods was statistically significant (P <0.001). Conclusion 3D-CRT can effectively improve the uniformity of dose distribution in lung cancer target area and reduce the doses of normal tissues and organs. Compared with CTP, 3D-CRT has obvious dosimetric advantages and is worthy of clinical application.