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放射性肺炎(RP)是胸部放射治疗最主要的剂量限制性不良反应.三维适形放疗(3D-CRT)能够使靶区剂量分布与靶区形状保持一致,靶区周围危及器官暴露体积减少,有可能使患者生存获益[1].固定野调强放疗(IMRT)较3D-CRT进一步提高靶区的剂量学参数,满足靶区剂量分布的需要,更好地避免对危及器官的照射,有助于提升靶区剂量[2-3],即IMRT降低高剂量区参数(如双肺V20和V30)的同时可能会增加低剂量区参数(如双肺V5).早期研究发现V20和V30与RP发生风险相关[4],近年来发现V5与RP也具有显著相关性[5].本研究以3D-CRT为比较,回顾分析了IMRT对RP发生率的影响. 相似文献
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目的:探讨胸部肿瘤三维适形放疗(3D-CRT)所致放射性肺炎(RP)的影像学表现及发生的相关因素。方法:对28例三维适形放疗所致RP患者胸部影像学征象进行评定,并通过临床观察对RP的相关因素进行分析。结果:97例胸部肿瘤放疗患者中发生RP 28例,发生率28.87%。在各临床指标中,吸烟患者、肿瘤位于双肺上叶的患者发生概率较高。在剂量学指标中,单因素分析显示受到20、30、40Gy剂量照射的肺体积占全肺总体积的百分比(V20、V30、V40)、全肺平均剂量(MLD)与RP相关。结论:CT诊断RP较X线敏感,有特征表现,而且对肺炎的不同时期可作出正确判断。肺炎的发生因素,除放疗技术外,个人体质、吸烟、手术等都有影响。 相似文献
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目的 比较容积旋转调强放疗(VMAT)和常规调强放疗(IMRT)两种技术在乳腺癌保乳术后同步推量放疗中剂量学差异。方法 随机选择10例左侧乳腺癌保乳术后患者,使用MONACO 5.1计划系统,分别设计VMAT和IMRT计划,处方剂量均为PTV50Gy/25 f、PGTVtb60 Gy/25 f,评估两种计划靶区剂量适形指数(CI)、均匀性指数(HI),以及正常器官受照剂量(Gy)、机器跳数(MU)及治疗时间。结果 VMAT计划中靶区剂量的适形度明显优于IMRT(P<0.05),而患侧肺V5、V10、V20及健侧肺V5稍高于IMRT组(P<0.05)。结论 对于乳腺癌保乳术后同步推量放疗,VMAT和IMRT计划都可以满足临床剂量学的要求,VMAT在适形度方面对于IMRT计划有优势,并缩短了治疗时间。 相似文献
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目的 分析接受根治性放疗的Ⅲ期非小细胞肺癌患者放射性肺炎(radiation pneumonitis, RP)发生相关的临床、剂量学因素。方法 回顾性分析北京大学肿瘤医院放疗科2013年1月至2014年12月收治的126例接受胸部根治性放疗的Ⅲ期非小细胞肺癌患者,统计性别、年龄、病理类型、肿瘤位置、糖尿病史、高血压病史、吸烟史、治疗开始季节、治疗前体力状况(采用美国东部肿瘤协作组ECOG评分)、放疗前化疗方案、同步化疗方案、放射性肺炎分级等临床因素,以及GTV体积、肺体积(lung volume, LV)、全肺V5、V10、V20、V30、平均肺剂量(MLD)等剂量学参数。对各因素与2级以上放射性肺炎(RP≥2)进行相关性分析。结果 126例患者中发生≥2级放射性肺炎者31例,占24.6%。单因素分析显示,年龄、治疗前ECOG评分、同步化疗方案、GTV/LV比值与≥2级RP具有相关性(R=0.157~0.222,P<0.05);多因素分析显示,年龄、同步化疗方案、GTV/LV比值与≥2级RP发生显著相关(Wald=4.754、6.422和14.79,P<0.05)。结论 Ⅲ期非小细胞肺癌患者接受胸部根治性放疗时,年龄增加和GTV/LV比值≥3.2%是≥2级RP发生的危险因素;同步使用单药小剂量紫杉醇也可能导致放射性肺炎发生危险增加。 相似文献
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目的 探讨胸段食管癌患者临床特征、照射技术及肺剂量体积参数等因素对放疗后放射性肺炎(RP)的影响,为食管癌放疗方案的制定提供参考。方法 回顾性分析山东省肿瘤防治研究院山东省肿瘤医院山东第一医科大学山东省医学科学院2014年6月至2019年6月247例胸段食管癌患者放疗后RP的发生情况,对患者临床特征、照射技术及肺剂量学参数进行单因素和多因素分析,采用受试者工作特征(ROC)曲线下的面积(AUC)分别验证≥1级、≥2级、≥3级RP的诊断效能。结果 全组患者中≥1级RP 118例(47.8%),≥2级RP 54例(21.9%),≥3级RP 17例(6.9%)。单因素分析结果显示,双肺V5~V40、平均肺剂量(MLD)均与≥1级RP(Z=-5.802~-4.306,P<0.05)和≥2级、≥3级RP(F=0.057~11.616、0.087~3.392,P<0.05)发生有关,GTV体积、PTV体积、GTV/肺体积(%)、PTV/肺体积(%)均与≥1级RP(Z=-3.377~-2.041,P<0.05)和≥2级RP(F=3.600~9.801,P<0.05)发生有关;吸烟指数>400与≥3级RP明显相关(χ2=13.295,P<0.05),慢性阻塞性肺病(COPD)与≥1级RP者明显相关(χ2=9.146,P<0.05),而不同的照射技术、化疗因素、放疗剂量以及食管癌分期、位置均与RP无显著相关。多因素分析结果显示,双肺V5和V40为≥1级RP的独立危险因素,AUC最佳临界值分别为55.74%和4.13%;MLD为≥2级RP的独立危险因素,最佳临界值为11.91 Gy;双肺V5为≥3级RP的独立危险因素,最佳临界值为57.60%。吸烟指数>400为≥3级RP的独立危险因素(Wald=5.964,P<0.05),COPD为≥1级RP的独立危险因素(Wald=6.110,P<0.05)。结论 胸段食管癌放疗后RP的发生率较低,双肺V5、V40、MLD等剂量学参数及吸烟程度和COPD等临床特征与相应等级的RP的发生密切相关,实施食管癌放疗时应重点关注。 相似文献
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目的针对宫颈癌复发病例,比较逆向调强(IMRT)、三维适形(3D-CRT)及超级伽玛刀弧形适形(SGS-CRT)三种照射方式的剂量学特点。方法对15例宫颈癌复发患者进行IMRT、3D-CRT及SGS-CRT计划设计,以包绕计划靶区(PTV)体积95%的等剂量线为处方剂量线,分别给予50Gy的处方剂量,分次方案均为2Gy×25次,根据剂量-体积直方图(DVH)评价三种照射方式中靶区和危及器官的剂量学特点。结果 3D-CRT的95%处方剂量包括靶区体积(99.9%±0.2%)高于IMRT(99.5%±0.5%)及SGS-CRT(99.3%±0.8%,P<0.05);SGS-CRT的靶区剂量梯度(85%±20%)明显高于IMRT(10%±7%)及3D-CRT(8%±5%,P<0.05);IMRT的适形指数(0.9±0.3)优于SGS-CRT(0.8±0.2,P<0.05),且SGS-CRT优于3D-CRT(0.7±0.5,P<0.05)。DVH显示,在10~30Gy之间,SGS-CRT膀胱平均受照体积(27.8%)明显低于IMRT(40.1%)和3D-CRT(57.4%,P<0.05);在5~45Gy之间,直肠平均受照射体积SGS-CRT(25.4%)明显低于IMRT(48.9%)和3D-CRT(73.2%,P<0.05);在小肠剂量分布上,三种照射方式无显著差异。结论在宫颈癌复发放疗中,SGS-CRT具有一定剂量学优势,值得在临床应用中进一步探讨。 相似文献
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目的比较胸中段食管癌适形调强放疗(IMRT)和三维适形放疗(3D-CRT)两种不同技术中计划靶区(PTV)及正常组织的受量。方法对52例ⅡB-Ⅳ期胸中段食管癌患者用同一放疗计划系统分别设计IMRT和3D-CRT根治性放疗计划,应用剂量体积直方图(DVH)比较两种方法中计划靶区和正常组织受量并且计算计划靶区适形指数(CI)和剂量不均匀指数(HI)。结果 IMRT方法的PTV适形度优于3D-CRT;脊髓剂量的最大值低于3D-CRT,但无统计学差异;心脏接受V25和V40的体积百分比低于3D-CRT;IMRT显著降低了肺部V10和V20的有效体积,但其肺部的V5大于3D-CRT。结论在可接受的放射性损伤的基础上,IMRT技术较3D-CRT能够提高行根治性放疗的ⅡB-Ⅳ期胸中段食管癌患者靶区剂量,靶区适形度高,但可使肺组织受到更大容积的低剂量照射。 相似文献
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Dose-volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung cancer 总被引:3,自引:0,他引:3
Kim TH Cho KH Pyo HR Lee JS Zo JI Lee DH Lee JM Kim HY Hwangbo B Park SY Kim JY Shin KH Kim DY 《Radiology》2005,235(1):208-215
PURPOSE: To retrospectively evaluate dose-volumetric parameters for association with risk of severe (grade >/=3) radiation pneumonitis (RP) in patients after three-dimensional (3D) conformal radiation therapy for lung cancer. MATERIALS AND METHODS: The study was approved by the institutional review board, which did not require informed consent. Data from 76 patients (66 men, 10 women; median age, 60 years; range, 35-79 years) with histologically proved lung cancer treated curatively with 3D conformal radiation therapy between August 2001 and October 2002 were retrospectively analyzed. Twenty patients underwent surgery before radiation therapy; 57 patients received chemotherapy. Median total radiation dose of 60 Gy (range, 54-66 Gy) was delivered in 30 (range, 27-33) fractions over 6 weeks. RP was scored by using Radiation Therapy Oncology Group criteria. Clinical parameters were analyzed. Dose-volumetric parameters analyzed were percentage of lung volume that received a dose of 20 Gy or more (V20), 30 Gy or more (V30), 40 Gy or more (V40), or 50 Gy or more (V50); mean lung dose (MLD); normal tissue complication probability (NTCP); and total dose. Fisher exact test was performed to compare clinical parameters between patients who developed severe RP and those who did not. Univariate and multivariate logistic regression analyses were performed to evaluate data for association between dose-volumetric parameters and severe RP. Pearson chi(2) test was used to assess data for correlations among dose-volumetric parameters. P < or = .05 was considered to indicate statistically significant difference. RESULTS: Of 76 patients, 30 (39%) did not develop RP; 23 (30%) developed RP of grade 1; 11 (14%), grade 2; 11 (14%), grade 3; and 1 (1%), grade 4. None had grade 5 RP. Age (< 60 vs > or =60), sex, Karnofsky performance status (< 70 vs > or =70), forced expiratory volume in 1 second, presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy did not significantly differ between patients who developed severe RP and those who did not. In univariate analyses, MLD, V20, V30, V40, V50, and NTCP were associated with severe RP (P < .05). In multivariate analysis, MLD was the only variable associated with severe RP. CONCLUSION: MLD is a useful indicator of risk for development of severe RP after 3D conformal radiation therapy in patients with lung cancer. 相似文献
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Neha P. Amin Moyed Miften Dale Thornton Nicole Ryan Brian Kavanagh Laurie E Gaspar 《Medical Dosimetry》2013,38(3):320-326
Patients with bulky non–small cell lung cancer (NSCLC) may be at a high risk for radiation pneumonitis (RP) if treated with up-front concurrent chemoradiation. There is limited information about the effect of induction chemotherapy on the volume of normal lung subsequently irradiated. This study aims to estimate the reduction in risk of RP in patients with NSCLC after receiving induction chemotherapy. Between 2004 and 2009, 25 patients with Stage IV NSCLC were treated with chemotherapy alone (no surgery or radiation therapy [RT]) and had computed tomography (CT) scans before and after 2 cycles of chemotherapy. Simulated RT plans were created for the prechemotherapy and postchemotherapy scans so as to deliver 60 Gy to the thoracic disease in patients who had either a >20% volumetric increase or decrease in gross tumor volume (GTV) from chemotherapy. The prechemotherapy and postchemotherapy scans were analyzed to compare the percentage of lung volume receiving≥20 Gy (V20), mean lung dose (MLD), and normal tissue complication probability (NTCP). Eight patients (32%) had a GTV reduction >20%, 2 (8%) had GTV increase >20%, and 15 (60%) had stable GTV. In the 8 responders, there was an absolute median GTV decrease of 88.1 cc (7.3 to 351.6 cc) or a 48% (20% to 62%) relative reduction in tumor burden. One had >20% tumor progression during chemotherapy, yet had an improvement in dosimetric parameters postchemotherapy. Among these 9 patients, the median decrease in V20, MLD, and NTCP was 2.6% (p<0.01), 2.1 Gy (p<0.01), and 5.6% (p<0.01), respectively. Less than one-third of patients with NSCLC obtain >20% volumetric tumor reduction from chemotherapy alone. Even with that amount of volumetric reduction, the 5% reduced risk of RP was only modest and did not convert previously ineligible patients to safely receive definitive thoracic RT. 相似文献
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Lysian Cartier Pierre Auberdiac Mustapha Khodri Nadia Malkoun Cyrus Chargari Julie Thorin Adrien Mélis Jean-Noël Talabard Guy de Laroche Pierre Fournel Olivier Tiffet Thierry Schmitt Nicolas Magné 《Medical Dosimetry》2012,37(2):152-156
The purpose of this study was to analyze and revisit toxicity related to chest chemoradiotherapy and to correlate these side effects with dosimetric parameters obtained using analytical anisotropic algorithm (AAA) in locally unresectable advanced lung cancer. We retrospectively analyzed data from 47 lung cancer patients between 2005 and 2008. All received conformal 3D radiotherapy using high-energy linear accelerator plus concomitant chemotherapy. All treatment planning data were transferred into Eclipse 8.05 (Varian Medical Systems, Palo Alto, CA) and dosimetric calculations were performed using AAA. Thirty-three patients (70.2%) developed acute pneumopathy after radiotherapy (grades 1 and 2). One patient (2.1%) presented with grade 3 pneumopathy. Thirty-one (66%) presented with grades 1–2 lung fibrosis, and 1 patient presented with grade 3 lung fibrosis. Thirty-four patients (72.3%) developed grade 1–2 acute oesophagic toxicity. Four patients (8.5%) presented with grades 3 and 4 dysphagia, necessitating prolonged parenteral nutrition. Median prescribed dose was 64 Gy (range 50–74) with conventional fractionation (2 Gy per fraction). Dose–volume constraints were respected with a median V20 of 23.5% (maximum 34%) and a median V30 of 17% (maximum 25%). The median dose delivered to healthy contralateral lung was 13.1 Gy (maximum 18.1 Gy). At univariate analysis, larger planning target volume and V20 were significantly associated with the probability of grade ≥2 radiation-induced pneumopathy (p = 0.022 and p = 0.017, respectively). No relation between oesophagic toxicity and clinical/dosimetric parameters could be established. Using AAA, the present results confirm the predictive value of the V20 for lung toxicity as already demonstrated with the conventional pencil beam convolution approach. 相似文献
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Yi-Jen Chen An Liu Chunhui Han Peter T Tsai Timothy E Schultheiss Richard D Pezner Nilesh Vora Dean Lim Stephen Shibata Kemp H Kernstine Jeffrey Y C Wong 《Medical Dosimetry》2007,32(3):166-171
We compare different radiotherapy techniques-helical tomotherapy (tomotherapy), step-and-shoot IMRT (IMRT), and 3-dimensional conformal radiotherapy (3DCRT)-for patients with mid-distal esophageal carcinoma on the basis of dosimetric analysis. Six patients with locally advanced mid-distal esophageal carcinoma were treated with neoadjuvant chemoradiation followed by surgery. Radiotherapy included 50 Gy to gross planning target volume (PTV) and 45 Gy to elective PTV in 25 fractions. Tomotherapy, IMRT, and 3DCRT plans were generated. Dose-volume histograms (DVHs), homogeneity index (HI), volumes of lung receiving more than 10, 15, or 20 Gy (V(10), V(15), V(20)), and volumes of heart receiving more than 30 or 45 Gy (V(30), V(45)) were determined. Statistical analysis was performed by paired t-tests. By isodose distributions and DVHs, tomotherapy plans showed sharper dose gradients, more conformal coverage, and better HI for both gross and elective PTVs compared with IMRT or 3DCRT plans. Mean V(20) of lung was significantly reduced in tomotherapy plans. However, tomotherapy and IMRT plans resulted in larger V(10) of lung compared to 3DCRT plans. The heart was significantly spared in tomotherapy and IMRT plans compared to 3DCRT plans in terms of V(30) and V(45). We conclude that tomotherapy plans are superior in terms of target conformity, dose homogeneity, and V(20) of lung. 相似文献
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Takeda A Ohashi T Kunieda E Sanuki N Enomoto T Takeda T Oku Y Shigematsu N 《The British journal of radiology》2012,85(1013):636-642
Objective
The aim of this study was to investigate significant clinical, tumour-related and dosimetric factors among patients with grade 0–1, grade 2 and grade 3 radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for lung tumours.Methods
Patients (n=128) with a total of 133 lung tumours treated with SBRT of 50 Gy in 5 fractions were analysed. RP was graded according to the Common Terminology Criteria for Adverse Events v.3.0. Significant factors were identified by univariate and multivariate analyses. Threshold dose–volume histograms (DVHs) were constructed to identify the incidence of RP.Results
The median follow-up period was 12 months (range, 6–45 months). In univariate analyses, gender, operability, forced expiratory volume in 1 s (FEV1), internal target volume, lung volumes treated with doses >5–30 Gy (V5–30) and mean lung dose were significant factors differentiating between grade 0–1 and grade 2 RP, and V15–30 were significant factors differentiating between grade 2 and grade 3. However, no factors were significant between grade 0–1 and grade 3 RP. Multivariate analysis showed that female gender, high FEV1 and high V15 were significant factors differentiating between grade 0–1 and grade 2 RP. Threshold DVH curves were created based on ≤5% and ≤15% risk of grade 2 RP among patients with grade 0–2 RP.Conclusions
Grade 0–2 RP was dose–volume dependent, and female gender and high FEV1 were significant predictive clinical factors for grade 2 RP among patients with grade 0–2 RP. However, incidences of V15–30 in grade 3 RP were significantly lower than those in grade 2 RP, and no significant clinical or tumour-related factors were found. Further studies are needed to identify the mechanism underlying the development of grade 3 RP after SBRT for lung tumours.Previously, we investigated the clinical and dosimetric factors that correlate with severe radiation pneumonitis (RP) in patients with lung tumours treated with stereotactic body radiotherapy (SBRT) [1]. We found that, among a variety of factors, only a short latent period was a significant correlate of severe RP.Other reports [2-6] have also analysed the clinical and dosimetric factors correlated with RP after SBRT. Various dosimetric factors were reported to significantly correlate with RP after SBRT, which included the mean dose in the ipsilateral lung, V7 and V10 by Kyas et al [2], normal tissue complication probability (NTCP) by Ricardi et al [3], lung volumes treated with doses higher than 2.5–50 Gy (V2.5–50) by Guckenberger et al [4], mean lung dose by Barriger et al [5] and contralateral V5 by Ong et al [6].We found a discrepancy in the significant clinical and dosimetric factors between the results of these five studies on low-grade RP [2-6] and our study on severe RP [1]. We speculated that the mechanism underlying the development of grade ≥3 RP might be different from that of grade 2 RP. Additionally, the treatment of grade ≥3 RP was much more critical than that of grade 2 RP. Most patients with grade ≥3 RP needed to be admitted to hospital and steroids or oxygen therapy were administered. By contrast, patients with grade 2 RP were simply followed up carefully without administration of medication as outpatients.In the present study, to ascertain this discrepancy, we analysed the clinical and dosimetric factors that correlated with RP after SBRT among patients with grade 0–1, grade 2 and grade 3 RP in the same sample of patients as that included in our previous study [1]. 相似文献17.
目的 探讨接受三维适形放疗(3D-CRT)的非小细胞肺癌(NSCLC)患者发生≥2级急性放射性食管炎(ARE)的影响因素。方法 回顾102例接受3D-CRT的NSCLC患者的临床资料及三维计划资料,采用RTOG分级标准,评价患者自放疗开始3个月内≥2级的ARE。分析临床因素和三维计划的剂量体积参数。结果 发生2级ARE19例,3级15例,未出现更严重的ARE。非同步化疗组多因素回归分析显示,食管V55(OR=1.170,P<0.05)为≥2级ARE发生的惟一影响因素,食管V55的ROC曲线下面积为0.870(95%CI: 0.782~0.957,P<0.05),界值为16.0。同步化疗组多因素回归分析显示,食管V35(OR=1.125,P<0.05)和同步化疗方案(OR=39.740,P<0.05)是≥2级ARE发生的影响因素,食管V35的ROC曲线下面积为0.782(95%CI: 0.636~0.927,P<0.05),界值为23.75。长春瑞滨+顺铂(NP)同步化疗方案的≥2级ARE发生率明显低于其他方案(33.3% ∶66.7%)。结论 非同步化疗患者,食管V55是≥2级ARE的影响因素。同步化疗患者,食管V35和同步化疗方案是≥2级ARE的影响因素。同步NP方案≥2级ARE发生率较低。 相似文献
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Patrizia?Ciammella Giorgia?Timon Alessio?Bruni Davide?Franceschini Paolo?Borghetti Nicolò?Giaj-Levra Carlo?Greco Vieri?Scotti Marco?Trovo On the behalf of Associazione Italiana Radioterapia Oncologica 《La Radiologia medica》2018,123(7):554-560
Introduction
Radiation therapy plays an important role in the management of SCLC both in curative and palliative setting, however, conflicting data from clinical trials incite debate over the appropriate use of radiation therapy regarding prophylactic cranial irradiation (PCI) and/or thoracic consolidative in extensive-stage SCLC (ES-SCLC). This survey is conducted to evaluate the current pattern of care among Italian radiation oncologists.Methods
In June 2016, all Italian radiation oncologists were invited to a web-based survey. The survey contained 34 questions regarding the role of RT in SCLC. Questions pertaining the role of RT in the clinical management of both limited-stage (LS) and ES-SCLC were included.Results
We received 48 responses from Italian radiation oncologists. More than half of respondents had been practicing for more than 10 years after completing residency training and 55% are subspecialists in lung cancer. Preferred management of LS-SCLC favored primary concurrent chemoradiotherapy (89%), even if the 36.9% usually delivered RT during or after the cycle 3 of chemotherapy, due to organizational issues. The most common dose and fractionation schedule in this setting was 60 Gy in 30 once-daily fractions. Furthermore, almost all respondents recommended PCI in patients with LS-SCLC. For ES-SCLC scenario, chemotherapy was defined the standard treatment by all respondents. PCI was recommended in ES-SCLC patients with thoracic complete remission (63% of respondents), with thoracic partial response (45%) and with thoracic stable disease (17%) after first-line chemotherapy. Lastly, the thoracic consolidative RT was recommended by 51% of respondents in patients with ES-SCLC in good response after first-line chemotherapy and a great variability was shown in clinical target volume definition, doses and fractionation schedules.Conclusions
Our analysis showed a high adherence to current guidelines among the respondents in regard to chemoradiation approach in LS-SCLC patients and to PCI indications and doses. The great variability in radiation therapy doses and volumes in the thoracic consolidative radiotherapy in ES-SCLC is concerning. Future clinical trials are needed to standardize these treatment approaches to improve treatment outcomes among patients with ES-SCLC.19.
目的 比较胸中下段食管癌3种放疗技术心脏和肺的剂量分布。方法 搜集2015年1月至2016年2月在浙江省肿瘤医院接受治疗的15例胸中下段食管鳞癌患者资料。患者均接受胸部放射治疗,每位患者共制作3套放疗计划。调强放疗(IMRT)和容积旋转调强放疗(VMAT)在RayStation 4.0v系统制作,螺旋断层放疗(TOMO)在TomoHTM Version 2.0.5系统制作。处方剂量60 Gy/30次。比较计划体积(PTV)、心脏、心脏亚单位以及肺剂量参数。结果 PTV、心脏和肺的平均体积为(399±355)、(671±274)和(3 907±1 717) cm3。与IMRT和VMAT相比,TOMO可以降低PTV、心脏、左心房及肺的最大剂量(H=10.889、7.433、12.080、11.401,P<0.05)。3种放疗技术的适形指数和均匀性指数差异无统计学意义(P>0.05)。结论 相较于IMRT和VMAT,TOMO可以降低PTV、心脏、左心房和肺的最大剂量,但均匀性及适形性差异无统计学意义。放疗过程中心脏与肺存在相互影响,TOMO技术可能带来的临床优势尚待进一步研究证实。 相似文献
20.
Nomura M Kodaira T Furutani K Tachibana H Tomita N Goto Y 《The British journal of radiology》2012,85(1014):813-818