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目的:分析比较晚期胰腺癌三维适形放疗(3D-CRT)、简化调强放射治疗(s IMRT)和螺旋断层放疗(HT)的剂量学特点。方法:选择10例晚期胰腺癌腹膜后淋巴结转移患者,分别设计其3D-CRT、s IMRT和HT计划,比较其靶区及危及器官的所受剂量情况。结果:3D-CRT、s IMRT和HT计划平均适形指数分别为0.63、0.79和0.90;与3D-CRT相比较,s IMRT(P=0)、HT(P=0)均具有统计学差异;与s IMRT相比较,HT(P=0)亦存在统计学差异。对3D-CRT而言,s IMRT和HT在肝脏V5、V10等低剂量区均偏高,且三者之间均具有统计学差异(P=0.001,P=0.004);而V20、V30、V40、V50等高剂量区均偏低,且V30(P=0.002)、V50(P=0)均显示统计学差异。与s IMRT相比,HT中肝脏V5、V10、V20较高,而V30、V40、V50均较低,而其他危及器官中相对于3D-CRT,s IMRT和HT中左/右肾、小肠V5值较高,左/右肾、小肠及胃V20、V30、V40及V50值均较低;与s IMRT相比,HT中左/右肾、小肠V5、V20、V30、V40较低,而胃的V5、V10值则略高,然而其V20、V30、V40及V50均显较低。结论:与3D-CRT相比,晚期胰腺癌s IMRT和HT改善了剂量分布适形度,降低了肝脏、胃、小肠和左、右肾的高剂量区体积;与s IMRT比较,HT靶区剂量更均匀,肝脏等危及器官的高剂量区体积更低。本研究为临床治疗计划设计提供了重要的参考依据。
OBJECTIVE: To analyze and compare the dosimetric features of three-dimensional conformal radiotherapy (3D-CRT), simplified IMRT and spiral CT in patients with advanced pancreatic cancer. Methods: Ten cases of patients with retroperitoneal lymph node metastasis of pancreatic cancer were selected and their 3D-CRT, s IMRT and HT plans were respectively designed. The target dose and the dose to endangering organs were compared. Results: The mean conformal indices of 3D-CRT, s IMRT and HT were 0.63, 0.79 and 0.90, respectively. Compared with 3D-CRT, s IMRT (P = 0) and HT There was also a statistical difference in HT (P = 0) compared to s IMRT. For 3D-CRT, s IMRT and HT were high in the low dose areas such as V5 and V10 in the liver, with statistically significant differences among the three groups (P = 0.001, P = 0.004); while V20, V30 and V40 , V50 and other high dose areas were low, and V30 (P = 0.002), V50 (P = 0) showed statistical differences. Compared with s IMRT, the V5, V10 and V20 in HT were higher and the V30, V40 and V50 were lower in HT, while in the other endangered organs relative to 3D-CRT, s IMRT and left / right kidney in HT, The values of V20, V30, V40 and V50 were lower in left / right kidney, small intestine and stomach; compared with s IMRT, left, right kidney and small intestine of HT were lower in V5, V20, V30 and V40, Of the V5, V10 value is slightly higher, however, its V20, V30, V40 and V50 were significantly lower. CONCLUSIONS: Compared with 3D-CRT, sIMRT and HT in advanced pancreatic cancer improve the dose distribution conformality and decrease the volume of high dose area in liver, stomach, small intestine and left and right kidney. Compared with s IMRT, Dosage is more uniform, liver and other organs that endanger the high dose volume lower. This study provides an important reference for clinical treatment plan design.