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头颈部肿瘤ART-IMRT四种方案剂量学评估
引用本文:谭淑慧,李玉锋,黄浦,娄惊蛟,李洪升,尹勇,李登旺.头颈部肿瘤ART-IMRT四种方案剂量学评估[J].中华放射肿瘤学杂志,2017,26(5):560-564.
作者姓名:谭淑慧  李玉锋  黄浦  娄惊蛟  李洪升  尹勇  李登旺
作者单位:250014 济南,山东师范大学物理与电子科学学院生命与健康研究院 山东省医学物理图像处理技术省级重点实验室(谭淑慧、黄浦、娄惊蛟、李登旺);276826日照,山东省日照市人民医院肿瘤(李玉锋);250117济南,山东省医学科学院山东省肿瘤医院放疗科(李洪升、尹勇)
基金项目:国家自然科学基金(61471226),山东省自然科学杰出青年基金(JQ201516) National Natural Science Foundation of China(61471226),Natural Science Foundation for Distinguished Young Scholars of Shandong Province(JQ201516)
摘    要:目的 研究头颈部肿瘤ART-IMRT分次放疗中采用不同频次再计划方案时,靶区与OAR解剖结构变化规律,以及对其剂量影响。方法 选取山东省肿瘤医院28例头颈部肿瘤患者入组研究,其中鼻咽癌19例、喉癌4例、上颌窦肿瘤5例,患者均接受常规分割治疗。每周第1天进行1次CBCT扫描作为参考图像,共采集6次。将CBCT与计划CT配准得到“伪CT”图像。实施4种再计划方案,无再计划作为参考,分别得到实际剂量与计划预测剂量,并评估两种剂量差异。多组间比较采用非参数Friedman检验,两组间比较采用配对t检验。结果 PTV、CTV、左右腮腺6周中每周体积差异均有统计学意义(P=0.041、0.046、0.024、0.017)。4种再计划方案中两腮腺的实际剂量与计划预测剂量比较P值均<0.05,且4种方案中两腮腺的两种剂量之间差异与参考方案相比分别下降5.02%、11.17%、12.08%、13.19%。结论 再计划可确保靶区足够剂量,使OAR受量控制在安全范围内;再计划频次越高,实际剂量越接近计划预测剂量,2次再计划方案效率最高。

关 键 词:头颈部肿瘤/自适应放射疗法    头颈部肿瘤/调强放射疗法    剂量学  
收稿时间:2016-08-24

Dosimetric evaluation of four adaptive IMRT strategies for head-neck cancer
Tan Shuhui,Li Yufeng,Huang Pu,Lou Jingjiao,Li Hongsheng,Yin Yong,Li Dengwang.Dosimetric evaluation of four adaptive IMRT strategies for head-neck cancer[J].Chinese Journal of Radiation Oncology,2017,26(5):560-564.
Authors:Tan Shuhui  Li Yufeng  Huang Pu  Lou Jingjiao  Li Hongsheng  Yin Yong  Li Dengwang
Institution:Shandong Provincial Key Laboratory of Medical Physics Image Processing Technology,Institute of Biomedical Sciences,School of Physics and Electronics,Shandong Normal University,Ji’nan 250014,China (Tan SH,Huang P,Luo JJ,Li DW);Rizhao People′s Hospital of Shandong Province,Rizhao 276826,China (Li YF);Department of Radiation Oncology,Shandong Cancer Hospital,Ji’nan 250117,China (Li HS,Yin Y)
Abstract:Objective To investigate the effects of numerous re-planning strategies on the anatomic and dosimetric outcomes of target volume and organs at risk (OARs) in patients with head and neck cancer receiving fractionated radiotherapy.Methods From 2015 to 2016,28 patients with head and neck cancer were enrolled in this study with Shandong Cancer Hospital,consisting of 19 patients with nasopharyngeal carcinoma, 4 patients with laryngocarcinoma, and 5 patients with carcinoma of the maxillary sinus.All of them received conventionally fractionated radiotherapy.Each patient had six weekly cone-beam CT (CBCT) scans, which were performed on the first day of every week, to obtain reference images.A virtual CT image was generated by registration of planning CT and each weekly CBCT image.The four re-planning strategies were used for the reconstruction of re-planned dose, while the initial planning was used as a reference.The weekly doses calculated using virtual CT were summed together to obtain the actual dose.The actual and initial planned doses were evaluated.The nonparametric Friedman test was used to evaluate the differences between multiple groups, and the differences between any two groups were analyzed by paired t test.Results The sizes of planning target volume, clinical target volume, and left/right parotid glands (PGs) changed significantly within the six weeks (P=0.041, 0.046, 0.024, and 0.017, respectively).For these four re-planning strategies, there were significant differences between the actual dose and the initial planned dose to the PGs (all P<0.05), with average values decreased by 5.02%, 11.17%, 12.08%, and 13.19%, respectively, compared with that in the reference strategy.Conclusions Re-planning during treatment course could ensure the sparing of OARs and allow for sufficient dose to the target volume.The higher the number of re-planning strategies, the more the actual dose is close to the initial planed dose;the efficiency of two re-planning strategies is the highest.
Keywords:Head-neck neoplasms/adaptive radiotherapy  Head-neck neoplasms/intensity modulated radiotherapy  Dosimetry
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