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目的:对比研究中心型非小细胞肺癌(NSCLC)三维适形放疗(3D-CRT)和正向调强(fIMRT)及逆向调强(iIM-RT)放疗计划特点,为中心型NSCLC放疗计划制定提供指导。方法:选择拟行根治性放疗的21例中心型NSCLC患者进行3D-CRT、fIMRT和iIMRT治疗计划设计,对3种治疗计划的相关剂量学参数进行比较。结果:3D-CRT、fIMRT和iIMRT治疗计划的适形指数(CI)差异有统计学意义,P=0.000;均匀性指数(HI)差异也有统计学意义,P=0.032。全肺V20和全肺平均受照剂量(MLD)差异均无统计学意义,P值分别为0.896和0.926;全肺V10和全肺V35组间差异均有统计学意义,P值分别为0.001和0.022;全肺V15和全肺V30组间差异为临界值,P值分别为0.058和0.051。心脏Dmean组间差异无统计学意义,P=0.989;心脏V40组间差异也无统计学意义,P=0.934。食管V45组间差异无统计学意义,P=0.708。脊髓Dmax组间差异无统计学意义,P=0.216。结论:对中心型NSCLC而言,采用iIMRT可以获得更好的靶区适形度,但iIMRT计划的剂量均匀性优势并不显著。iIMRT对中心型NSCLC正常肺组织的影响需要辨证看待,其并没有显著降低全肺V20和MLD而且增加了全肺V10、V15及键侧肺V5、V10、V15,但其显著降低了全肺V30。iIMRT没能使中心型NSCLC患者心脏、食管及脊髓受照剂量显著下降。
Objective: To compare the characteristics of three-dimensional conformal radiotherapy (3D-CRT) and fIMRT and iIM-RT radiotherapy in central non-small cell lung cancer (NSCLC) to provide radiotherapy planning for central NSCLC guide. METHODS: Twenty-one patients with central NSCLC scheduled for radical radiotherapy were enrolled in the design of 3D-CRT, fIMRT and iIMRT treatment plans, and the relevant dosimetric parameters of the three treatment plans were compared. Results: The conformal index (CI) of 3D-CRT, fIMRT and iIMRT treatment plans had statistical significance (P = 0.000). The difference of homogeneity index (HI) was also statistically significant, P = 0.032. There was no significant difference between the whole lung V20 and the whole lung (MLD), the P values were 0.896 and 0.926, respectively. The differences between the whole lung V10 and the whole lung V35 group were statistically significant (P = 0.001) 0.022; the difference between the whole lung V15 and the whole lung V30 group was the critical value, P values were 0.058 and 0.051 respectively. There was no significant difference in cardiac Dmean group (P = 0.989). There was no significant difference in V40 between hearts (P = 0.934). There was no significant difference between esophageal V45 group, P = 0.708. There was no significant difference in spinal cord Dmax group, P = 0.216. CONCLUSIONS: With iIMRT, better target domain conformality is obtained for central NSCLC, but the dose uniformity advantage of iIMRT is not significant. The impact of iIMRT on normal lung tissue in patients with central NSCLC requires a dialectical view that does not significantly reduce whole-lung V20 and MLD and increases whole-lung V10, V15 and key-side lung V5, V10, V15, but significantly reduces V30 . iIMRT did not significantly reduce the dose of heart, esophagus and spinal cord in patients with central NSCLC.