适形调强与容积旋转调强技术对局部晚期非小细胞肺癌临床效果比较

[目的]比较局部晚期非小细胞肺癌(NSCLC)常规静态调强(step-and-shoot intensity-modulated radiation therapy,sIMRT)和容积旋转调强(volumetric modulated arc therapy,VMArT)的临床效果.[方法]回顾性分析68例分别行IMRT和VMAT的NSCLC患者资料,IMRT组38例,VMAT组30例.比较两组患者的近期、远期疗效及急性不良反应.[结果]IMRT组和VMAT组的有效率分别为76.3％和80.0％.除放射性食管损伤外(P=0.045),其他急性不良反应两组均无显著性差异(P＞0.05).IMRT组和VMAT组中位OS分别为23.0个月(95％CI:20.4～25.5)和24.3个月(95％ CI:21.6～26.9);PFS分别为15.5个月(95％CI:13.5～17.6)和16.2个月(95％ CI:13.5～18.9);局部复发时间分别为17.1个月(95％CI:14.6～19.6)和18.4个月(95％CI:15.8～21.1);远处转移时间分别为20.3个月(95％CI:17.5～23.1)和20.8个月(95％ CI:17.5～24.1),差异均无统计学意义(P＞0.05).[结论]VMAT能够获得与IMRT相同的临床疗效,且可降低放射性食管损伤的发生率.     

宫颈癌术后容积旋转调强治疗与三维适形调强放疗的临床研究

目的 评估宫颈癌术后盆腔放疗中开展容积旋转调强治疗(VMAT)与三维适形调强放疗(IMRT)的近期疗效及不良反应.方法 选取30例宫颈癌术后盆腔肿瘤床及淋巴引流区预防性放射治疗的患者,其中15例接受了VMAT治疗,15例患者接受了IMRT治疗.放疗采用每周5次,每日1次,每次1.8Gy.盆腔预防性放疗处方剂量为45Gy.根据RTOG评定指标评价放射治疗反应.结果 至末次随访时间,VMAT组4例复发,IMRT组5例复发.骨髓抑制反应VMAT组11例,IMRT组12例.全部患者中,均未出现3级及以上胃肠道早期反应及泌尿道早期反应.结论 对宫颈癌术后应用容积旋转调强技术及固定野调强技术进行照射治疗,两者在不良反应及复发率上无明显差别.     

食管癌静态调强放疗与容积调强放疗计划的剂量学比较

目的研究食管癌患者应用静态调强放疗(s IMRT)和容积调强弧形治疗(VMAT)的计划剂量学差异。方法 65例食管癌单纯放疗患者分别设计s IMRT、VMAT 2组计划,比较2组的剂量学参数。结果与s IMRT比较,VMAT计划的GTV的D99、D95、Dmean的剂量较低(P<0.05);PTV的99%、95%的覆盖度、最大剂量较高(P<0.05);PTV的105%覆盖度较低(P<0.05);适形指数、不均匀指数相似(P>0.05)。危及器官比较中,VMAT的双肺V20、V30、平均剂量明显低于s IMRT(P<0.05)。脊髓、心脏照射量2组相似(P>0.05)。s IMRT、VMAT的射线数分别为572.33±97.9、754.95±177.6,s IMRT相比于VMAT降低了24%(P<0.05)。结论与s IMRT相比较,VMAT可以改善靶区剂量,减少照射时间,在食管癌的治疗中可能会有较好的疗效。     

100例初治鼻咽癌容积调强旋转放疗的临床研究

[目的]探讨Rapid Arc治疗鼻咽癌（NPC）的剂量分布、近期临床疗效和毒副反应。[方法]100例初治鼻咽癌患者接受Rapid Arc治疗（排除远处转移患者）。2008中国分期,Ⅰ期1例,Ⅱ期14例,Ⅲ期57例,Ⅳa期28例。处方剂量为GTVnx 70Gy,CTV1 60Gy,CTV2 56Gy,颈部淋巴结GTVnd 60-68Gy,分32次。52例患者接受了同期顺铂单药化疗。[结果]PGTV、PTV1、PTV2靶区基本满足95%体积以上PTV大于100%的处方剂量的临床要求,对脊髓、脑干、腮腺、口咽、视神经等危及器官有较好的保护作用。同期放化疗组唾液腺和口咽急性损伤比单纯放疗组严重（P〈0.05）。中位随访时间19个月（9-31个月）,放疗结束原发病灶完全消退率为99%。1、2年无远处转移生存率为93.2%、82.4%,1、2年总生存率为97.6%、95.8%。[结论]Radid Arc治疗鼻咽癌能使高剂量区集中在靶区,同时可保护正常器官,治疗鼻咽癌局部控制率高。     

Planning Aspects of Volumetric Modulated Arc Therapy and Intensity Modulated Radio therapy in Carcinoma Left Breast - A Comparative Study

Background: The advantages of Rapid Arc plans versus Intensity modulated radiotherapy plans forCarcinoma left breast were analyzed. Materials and Methods: In this study 20 Post mastectomy carcinoma leftbreast patients were analyzed. Both Intensity modulated Radiotherapy and Rapid Arc plans were generated forthese patients. IMRT plans with 7 beams in an arc fashion and VMAT plans with two semi arcs were made toachieve 95% dose coverage to 100% volume. The plans were evaluated using Dose volume Histograms. Results:The mean Conformity and Homogeneity index in VMAT is found to be 1.05 and 0.065 respectively whereas inIMRT it was 1.07 and 0.069. The 20% volume of Heart received a mean dose of 960cGy in VMAT and 1300cGyin IMRT. The mean dose was 1236cGy in VMAT and 1870cGy in IMRT. The ipsilateral Lung received 3395cGyto 5% volume and 1840cGy to 20% volume on an average and the mean dose was 1205cGy in VMAT, while thesame were found to be 3525cGy, 2012cGy and 1435cGy respectively in IMRT. The Contralateral Lung receiveda mean dose of 505cGy in VMAT and 553cGy in IMRT. The mean Monitor units in VMAT were 512MU and1170MU in IMRT. The NTID in VMAT is 108.8 x 105 Gycm3 and 110.1 x 105 Gycm3 in IMRT. Conclusions: Thetarget coverage, homogeneity and Conformity index were better in VMAT plans. The Ipsilateral Lung and heartdose were very less in VMAT plans. The Contralateral Lung dose and the Normal Tissue Integral Dose werealso lesser in VMAT plans however the difference is not very appreciable. The MU in VMAT plans is almost50% that of the IMRT plans which results in the reduction of treatment time. On the whole VMAT proves tobe a better modality for treating Ca. Left Breast Patients.     

前列腺癌IMRT的质量保证现状及进展

适形调强放射治疗(IMRT)是\     

前列腺癌调强放疗和三维适形放疗临床剂量学研究

[目的]探讨前列腺癌调强放疗（IMRT）和三维适形放疗（3D-CRT）的剂量学差异。[方法]随机选取13例局限期前列腺癌患者,采取CT定位和PHLIPSPinnacle38.0治疗计划系统对每例患者进行IMRT和3D-CRT放疗计划设计和剂量计算,分析剂量体积直方图,比较两种计划的靶区剂量分布及直肠、膀胱、股骨头等正常组织受量的差异。[结果]IMRT计划中临床靶区的平均剂量（Mean）、D95、D100及CI值均高于3D-CRT计划（P〈0.01）。IMRT计划中,直肠D50、D25、V70、V45及膀胱D50、V60、V40均低于3D-CRT计划（P〈0.05）;股骨头D50显著性低于3D-CRT计划（P〈0.01）,而D5与3D-CRT计划比较无显著性差异（P〉0.05）。[结论]前列腺癌放疗中,IMRT剂量分布优于3D-CRT。     

Clinical Implementation of Robust Multi-isocentric Volumetric Modulated Arc Radiotherapy for Craniospinal Irradiation

AimsTo determine if multi-isocentric volumetric modulated arc radiotherapy for craniospinal irradiation (CSI-VMAT) can be implemented safely and accurately using robust optimisation in a commercially available treatment planning system. Our initial clinical experience is reported for the first 20 patients treated with the technique.Materials and methodsPatients received between 23.4 and 39.6 Gy (mode 23.4 Gy) in 13–22 fractions with CSI-VMAT. The heart mean dose was 4.2–10.3 Gy (median 5.3 Gy) for patients prescribed up to 24 Gy and 6.5–16.3 Gy (median 10.1 Gy) for patients receiving 35 Gy or more. The lung mean dose was 5.5–7.6 Gy (median 6.8 Gy) for patients prescribed up to 24 Gy and 6.9–11.1 Gy (median 10.0 Gy) for patients receiving 35 Gy or more. The robustness of the planning target volume D_0.1cm3 and D_99% to systematic errors in the isocentre superoinferior position of up to 5 mm was evaluated. These remained acceptable but were correlated to the length of the available beam overlap through the neck.ResultsAs of January 2021, one patient was deceased after 508 days and one patient was lost to follow-up after completing treatment. The median follow-up was 399 days (range 175–756 days) and progression-free survival was 131 days (34–490 days). Acute toxicities at Common Terminology Criteria for Adverse Events v5.0 grade 3+ included lowered white blood cell count (16/20), decreased platelet count (8/20), nausea (5/20), vomiting (2/20), pharyngeal mucositis (1/20) and oral mucositis (1/20). Three patients developed grade 4 neutropenia or decreased white blood cell count.ConclusionsCSI-VMAT can be implemented safely and accurately using robust optimisation functions in a commercially available treatment planning system.     

双侧乳腺癌保乳术后单射野中心与双射野中心容积旋转调强放疗的剂量学比较

目的:研究双侧乳腺癌保乳术后采用单射野中心与双射野中心容积旋转调强放射治疗的剂量学差异.方法:随机选取2017年1月1日至2020年6月30日云南省肿瘤医院双侧乳腺癌保乳术后患者8例,女性,年龄33～65岁,中位年龄49岁.用Monaco计划系统为每例患者分别设计单射野中心和双射野中心放射治疗计划,双侧乳腺癌双靶区处方...     

Dosimetric Comparison of Volumetric Modulated Arc Therapy and Intensity Modulated Radiation Therapy for Soft Tissue Sarcoma of the Extremities

PurposeRadiation therapy is a standard part of limb conserving therapy for extremity soft tissue sarcoma (STS) at high risk of recurrence. Toxic effects increase with radiation dose and volume of normal tissue irradiated. This study sought to compare dosimetry of volumetric modulated arc therapy (VMAT) with intensity modulated radiation therapy (IMRT) and to investigate the optimal planning technique.Methods and MaterialsTwenty patients with extremity STS who underwent preoperative radiation therapy (50 Gy in 25 fractions) between 2016 and 2020 at a specialised sarcoma center were included. The original treatment techniques were sliding window IMRT or 3-dimensional conformal. VMAT plans were retrospectively generated according to the original tumor and organ-at-risk constraints. Quality assurance was performed as per departmental protocol. Wilcoxon signed-rank test was used to compare dosimetric parameters (for planning target volume [PTV], in-field bone, and soft tissue structures), monitor units (MUs), and treatment time.ResultsMedian patient age was 65 years and the majority were male (n = 14, 70%). The most common subtype was undifferentiated pleomorphic sarcoma (n = 14, 70%), and most tumors were located on the thigh (n = 12, 60%). Median PTV was 1110 cm³ and median volume of in-field bone 236 cm³. VMAT plans had significantly lower average MU (480 vs 862 MU, P < .001) and overall treatment time (300 vs 153 seconds, P < .001). PTV coverage favored VMAT, with marginally higher mean, minimum, and maximum doses and higher conformity index. However, differences were not statistically significant. Dose to infield bone and soft tissue structures were similar or slightly lower with VMAT.ConclusionsIn extremity STS, VMAT plans demonstrated a favorable trend toward tumor coverage and dose conformity compared with IMRT along with significantly lower MUs and half the overall treatment time.     

累及野照射调强放疗在非小细胞肺癌中的剂量学研究

目的探讨累及野照射（IFI）调强放疗在非小细胞肺癌（NSCLC）中的剂量学特点。方法26例NSCLC患者分别用选择性淋巴结照射（ENI）野和IFI野来进行计划设计。用剂量体积直方图分别评价2组靶区、正常肺组织及食管的受量情况。结果IFI组靶区的受量与适形度均高于ENI组（P〈0．05）;食管受量低于ENI组（P〈0．05）;而正常肺组织受量与ENI组比较差异无统计学意义（P〉0．05）。结论IFI调强放疗治疗NSCLC在不增加正常肺组织和食管受量的基础上可以提高靶区的适形度和平均剂量,具有良好的剂量学优势。     

同期调强放疗联合内分泌治疗对局部晚期前列腺癌乏力症状的影响

目的 评价调强放疗联合内分泌治疗对局部晚期前列腺癌乏力症状的影响。方法 对符合纳入标准的局部晚期前列腺癌患者采用同期三维适形调强放疗联合内分泌治疗。采用FSI（Fatigue Symptom Inventory）量表进行长期问卷随访,调查时间分别为治疗前（A）、治疗结束后（B）、治疗结束3月（C）、12月（D）、24月（E）、36月（F）、48月（G）。随访内容包括疲劳程度、对生活质量影响程度及上周疲劳持续时间3个维度。Logistic多分类回归模型评价危险因素。结果 共97例局部晚期前列腺癌患者纳入研究。中位随访时间43.9月。乏力指数与PSA水平、Gleason评分、ECOG评分及文化程度相关（P<0.05）;年龄和临床分期与乏力指数无关（P>0.05）;多分类回归分析显示PSA水平和ECOG评分是癌症相关性乏力的独立危险因素。疲劳程度在各个随访时间点未体现出差异（P>0.05）,但最严重疲乏程度发生在时间点B和C;时间点C、D、E、F和G的疲乏对生活影响积分均高于基线评价,且差异有统计学意义（P<0.05）,尤其是对日常活动影响积分、注意力积分和情绪积分。疲乏持续时间呈现波动状态,时间点D、E、F呈明显上升,差异有统计学意义（P<0.05）。结论 ECOG评分高、Gleason≥8分、PSA＞20ng/ml、且文化程度高的局部晚期前列腺癌患者,在接受同期放疗联合内分泌治疗后,要关注乏力对生活质量产生的影响,特别是在对日常活动、注意力和情绪方面。     

全段食管癌非均整模式与均整模式下容积旋转调强放疗的剂量学研究

目的:比较全段食管癌非均整(flattening filter free,FFF)模式与均整(flattening filter,FF)模式下容积旋转调强放疗(volumetric modulated arc therapy,VMAT)的剂量学特性,分析全段食管癌FFF模式下VMAT计划的临床可行性。方法:纳入2020年10月至2021年4月全段食管癌患者20例,均采用VMAT技术分别设计FFF模式(FFF组)和FF模式(FF组)的计划,处方剂量60 Gy,比较2组计划靶区和危及器官的受照剂量、机器跳数(monitor unit,MU)、平均剂量率和照射时间。结果:FFF组和FF组靶区D₉₅、D_mean、D₁和适形性指数的差异无统计学意义(P> 0.05),其中FFF组的均匀性指数优于FF组,差异有统计学意义(P <0.05); FFF组的肺V₅、V₁₀、V₂₀和D_mean、心脏的V₂₀、脊髓的D