外挂多叶准直器开展宫颈癌调强放射治疗的可行性

doi:10.20047/j.issn1673-7210.2022.34.33

摘要
图/表
参考文献(25)
相关文章 (15)

全文: PDF (593 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研究外挂多叶准直器（MLC）与内置MLC在宫颈癌调强放射治疗（IMRT）计划物理参数的差异，为IMRT技术合理应用于临床提供必要参考。方法选取2020年6月至2021年6月河北省沧州市人民医院接受放疗的宫颈癌术后患者29例，分别采用外挂MLC和内置MLC在 Pinnacle3 9.11计划系统上设计两种IMRT计划，并将其分为外挂组和内置组。比较两组计划的靶区与危及器官剂量（D2、D50、D95、D98、Dmin、Dmax、Dmean）、体积参数（V20%、V30%、V40%、V45%、V95%、V100%、V105%、V110%）、治疗计划验证通过率、机器跳数（MU）及治疗时间的差异。结果外挂组计划中靶区计划靶体积（PTV）的适形性指数高于内置组，均匀性指数低于内置组（P＜0.05）。外挂组计划中靶区PTV的D95、D98、Dmin、V95%、V100%高于内置组，Dmax、D2、D50、Dmean、V105%、V110%低于内置组（P＜0.05）。外挂组直肠D2、Dmean、V30%、V40%、V45%，膀胱Dmean、V30%、V40%，小肠D2，左侧股骨头Dmean、D98，右侧股骨头D98低于内置组（P＜0.05）；小肠V20%高于内置组（P＜0.05）。外挂组MU、通过率低于内置组，治疗时间长于内置组（P＜0.05）。结论外挂准直器计划的剂量参数优于内置准直器计划，但验证通过率低、治疗时间长；两种计划均能满足临床需求，开展宫颈癌调强放疗是可行的。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张萍刘琦张坤许新明蔡亚磊张斌杨健▲

关键词 ：宫颈癌, 调强放射治疗, 多叶准直器, 剂量学

Abstract：Objective To study the differences of physical parameters between external multi-leaf collimator (MLC) and internal MLC in intensity-modulated radiotherapy (IMRT) for cervical cancer, and to provide necessary reference for the rational application of IMRT technology in clinical practice. Methods A total of 29 postoperative patients with cervical cancer who received radiotherapy in Cangzhou People’s Hospital of Hebei Province from June 2020 to June 2021 were selected. Two IMRT plans were designed on the Pinnacle3 9.11 planning system using external MLC and internal MLC, and were divided into external group and internal group. The target area and organ at risk dose (D2, D50, D95, D98, Dmin, Dmax, and Dmean), volume parameters (V20%, V30%, V40%, V45%, V95%, V100%, V105%, and V110%), treatment plan validation pass rate, machine units (MU), and treatment time of two groups were compared. Results The conformal index of planned target volume (PTV) in external group was higher than that in internal group, and the homogeneity index was lower than that in internal group (P＜0.05). The D95, D98, Dmin, V95%, and V100% of target PTV in external group were higher than those in internal group, while Dmax, D2, D50, Dmean, V105%, and V110% were lower than those in internal group (P＜0.05). D2, Dmean, V30%, V40%, V45% of rectum, Dmean, V30%, V40% of bladder, D2 of small intestine, Dmean, D98 of left femoral head and D98 of right femoral head in external group were lower than those in internal group (P＜0.05); V20% of small intestine was higher than that in external group (P＜0.05). The MU and pass rate of external group were lower than those in internal group, the treatment time was longer than that in internal group (P＜0.05). Conclusion The dose parameters of the external collimator plan are better than those of the internal collimator plan, but the verification pass rate is low and the treatment time is long. Both plans can meet the clinical needs. It is feasible to conduct postoperative radiotherapy for cervical cancer.

Key words： Cervical cancer Intensity-modulated radiotherapy Multi-leaf collimator Dosimetry

基金资助:河北省医学科学研究课题计划项目（20211665）。

通讯作者: ▲通讯作者

引用本文:

张萍刘琦张坤许新明蔡亚磊张斌杨健▲. 外挂多叶准直器开展宫颈癌调强放射治疗的可行性[J]. 中国医药导报, 2022, 19(34): 144-148.
ZHANG Ping LIU Qi ZHANG Kun XU Xinming CAI Yalei ZHANG Bin YANG Jian▲. Feasibility of external multi-leaf collimator for intensity-modulated radiation therapy of cervical cancer. 中国医药导报, 2022, 19(34): 144-148.

链接本文:

https://www.yiyaodaobao.com.cn/CN/10.20047/j.issn1673-7210.2022.34.33 或 https://www.yiyaodaobao.com.cn/CN/Y2022/V19/I34/144

[1] Liu Y，Yu J，Qian L，et al. Extended field intensity-modulated radiotherapy plus concurrent nedaplatin treatment in cervical cancer [J]. Oncol Lett，2016，11（5）：3421-3427.
[2] Marnitz S，Martus P，K?觟hler C，et al. Role of Surgical Versus Clinical Staging in Chemoradiated FIGO Stage IIB-IVA Cervical Cancer Patients-Acute Toxicity and Treatment Quality of the Uterus-11 Multicenter Phase Ⅲ Intergroup Trial of the German Radiation Oncology Group and the Gynecologic Cancer Group [J]. Int J Radiat Oncol Biol Phys，2016，94（2）：243-253.
[3] Xu KM，Rajagopalan MS，Kim H，et al. Extended field intensity modulated radiation therapy for gynecologic cancers：Is the risk of duodenal toxicity high? [J]. Pract Radiat Oncol，2015，5（4）：e291-7.
[4] Lan ML，Yu X，Xiao H，et al. Clinical outcomes and toxicity of postoperative intensity-modulated versus three-dimensional conformal radiation therapy in patients with cervical cancer [J]. Asia Pac J Clin Oncol，2016，12（4）：430-436.
[5] Yu C，Zhu W，Ji Y，et al. A comparative study of intensity- modulated radiotherapy and standard radiation field with concurrent chemotherapy for local advanced cervical cancer [J]. Eur J Gynaecol Oncol，2015，36（3）：278-282.
[6] Ray A，Sarkar B. Small bowel toxicity in pelvic radiotherapy for postoperative gynecological cancer：comparison between conformal radiotherapy and intensity modulated radiotherapy [J]. Asia Pac J Clin Oncol，2013，9（3）：280-284.
[7] 欧光明，戴相昆，冯林春.利用外挂式电动多叶光栅开展头部立体定向适形放疗技术[J].中国肿瘤，2007，16（9）：754-755.
[8] Wang D，Yin Y，Zhou Q，et al. Dosimetric predictors and Lyman normal tissue complication probability model of hematological toxicity in cervical cancer patients with treated with pelvic irradiation [J]. Med Phys，2022，49（1）：756-767.
[9] Vavassori A，Riva G，Spoto R，et al. High precision radiotherapy including intensity-modulated radiation therapy and pulsed-dose-rate brachytherapy for cervical cancer：a retrospective monoinstitutional study [J]. J Contemp Brachytherapy，2019，11（6）：516-526.
[10] 闫冰，吴爱东，张洪波，等.肝细胞癌共面和非共面容积旋转调强放疗与螺旋断层放疗的剂量学研究[J].中国医学物理学杂志，2019，36（8）：877-881.
[11] Al-Rawi S，Abouelenein H，Khalil MM，et al. Evaluation of Conformity and Homogeneity Indices Consistency Throughout the Course of Head and Neck Cancer Treatment With and Without Using Adaptive Volumetric Modulated Arc Radiation Therapy [J]. Adv Radiat Oncol，2022，7（5）：1-7.
[12] Kaliyaperumal V，Abraham S，Veni M，et al. Dosimetric Comparison of Robotic and Linear Accelerator Multi-Leaf Collimator-Based Stereotactic Radiosurgery for Arteriovenous Malformation [J]. J Med Phys，2021，46（1）：16-25.
[13] Kamal R，Singh G，Thaper D，et al. Efficiency of a novel non-monotonic segmented leaf sequence delivery of Varian MLC for non-split IMRT fields [J]. Rep Pract Oncol Radiother，2020，25（5）：801-807.
[14] Pan Y，Yang R，Zhang S，et al. National survey of patient specific IMRT quality assurance in China [J]. Radiat Oncol，2019，14（1）：69-78.
[15] Moon YM，Bae SI，Han MJ，et al. Correlation Between Average Segment Width and Gamma Passing Rate as a Function of MLC Position Error in Volumetric Modulated Arc Therapy [J]. Technol Cancer Res Treat，2021，20（1）：1-10.
[16] 叶淑敏，滕建建，石锦平，等.MLC叶片系统误差对鼻咽癌VMAT和IMRT计划剂量影响的比较[J].中国医学物理学杂志，2019，36（10）：1139-1144.
[17] 刘丰华，戴国胜，何自怀.医用外置多叶光栅的性能和特点[J].中国医疗器械信息，2018，24（11）：55-57.
[18] 查元梓，屠永清，王为，等.加速器多叶准直器半影特性研究[J].中国医学物理学杂志，2011，28（6）：2981-2984.
[19] 郭召.动态多叶光栅准直器的技术现状及发展趋势[J].中国医疗设备，2021，36（1）：154-158.
[20] 何自怀，刘丰华，戴国胜.外挂电动多叶光栅调强放射治疗计划的剂量验证[J].中国医学装备，2017，14（10）：26-29.
[21] 陈济杭，柏朋刚，陈文娟，等.多叶准直器叶片宽度对宫颈癌调强放疗计划的影响[J].医疗卫生装备，2019，40（10）：49-52.
[22] Abisheva Z，Floyd SR，Salama JK，et al. The effect of MLC leaf width in single-isocenter multi-target radiosurgery with volumetric modulated arc therapy [J]. J Radiosurg SBRT，2019，6（2）：131-138.
[23] van Kesteren Z，Janssen TM，Damen E，et al. The dosimetric impact of leaf interdigitation and leaf width on VMAT treatment planning in Pinnacle：comparing Pareto fronts [J]. Phys Med Biol，2012，57（10）：2943-2952.
[24] 叶柳清，洪文松，李桢，等.不同MLC叶片宽度对肺癌调强放疗剂量学的影响[J].临床肿瘤学杂志，2017，22（11）：1035-1037.
[25] 杨超凤，钟胜河，杨海明，等.MLC类型不同的加速器对鼻咽癌调强放疗计划影响的研究[J].医疗卫生装备，2016， 37（8）：78-80.