自动计划在非小细胞肺癌调强放疗中应用的可行性及优越性

目的:比较非小细胞肺癌（NSCLC）调强放疗（IMRT）自动计划和人工计划的剂量学差异，评估自动计划在NSCLC放疗的可行性及优越性。方法:选择本院确诊的NSCLC患者28例做回顾性分析，通过Pinnacle3 v9.10治疗计划系统进行人工IMRT计划和自动计划设计。利用SPSS v22.0统计学软件分析两种计划的靶区D2、D98、Dmean、适形度指数（conformity index，CI）、均匀性指数（homogeneity index，HI）和危及器官全肺、心脏、脊髓的剂量学结果以及机器跳数（monitor units，MU）、计划优化时间。结果:自动计划和手动计划靶区均能满足临床要求，自动计划CI优于人工计划，结果有统计学意义（P＜0.05）；D2、D98和HI均无显著差异（P＞0.05）。危及器官方面，自动计划全肺的V5、V10、V15、V20、V30、Dmean均小于人工计划，结果有显著差异（P＜0.05），而V40结果无显著差异（P=0.139）。心脏V30、V40结果为自动计划小于人工计划，结果有显著差异（P＜0.05），而Dmean结果无显著差异（P=0.326）。此外，自动计划较人工计划MU减少约29.8%，计划优化时间减少约39.91%。结论:NSCLC自动IMRT计划在达到与人工计划相同靶区剂量的同时，能进一步降低肺、心脏、脊髓等危及器官的剂量，也可缩短计划设计时间，降低机器跳数，提高计划质量，值得临床推广。

The feasibility and superiority of application of automatic plan in intensity modulated radiation therapy for non-small cell lung cancer

Objective:To compare the dosimetric difference of automatic and manual plans for non-small cell lung cancer(NSCLC) treated by intensity modulated radiotherapy(IMRT),and to evaluate the feasibility and superiority of automatic plan for NSCLC radiotherapy.Methods:28 cases of NSCLC patients diagnosed in our hospital were selected for retrospective analysis.First,a manual IMRT plan was developed for each patient based on the Pinnacle v9.10 treatment planning system.Then the automatic plans were designed through the Pinnacle auto-plan module.The target volume D2,D98,Dmean,conformity index(CI),homogeneity index(HI),the monitor unit and the dosimetric parameters of whole lungs,heart,and spinal cord of the automatic and manual plans were analyzed using SPSS v22.0 statistical software.And the plan optimization time were also compared.Results:Both automatic and manual plans of the target volume could meet clinical requirements.The CI of automatic plans were better than manual plans,and the results were significantly from manual plans(P＜0.05).There was no significant difference in D2,D98,and HI(P＞0.05).In terms of organs at risk,the whole lung V5,V10,V15,V20,V30,and Dmean of the automatic plans were all smaller than those of the manual plans,and the results were significantly different(P＜0.05),while the V40 results were not significantly different(P=0.139).The results of cardiac V30 and V40 for automatic plans were smaller than the manual plans,and the results were significantly different(P＜0.05),while the Dmean results were not significantly different(P=0.326).In addition,compared with the manual plan mv the automatic plan reduced about 29.8%,the optimization time of automatic planning was reduced by about 39.91% compared with manual planning.Conclusion:NSCLC automatic IMRT plans could achieve the same target dose as the manual plan,and at the same time reduce the dose of lung,heart,spinal cord.It can also shorten the planning design time and improve the quality of the plan.It is worthy of clinical application.