三维适型放疗与调强放疗在胸中段食管癌根治性放疗中的剂量学比较(1)
摘 要：目的 比较胸中段食管癌三维适型放疗与调强放疗对靶区和危及器官的剂量学影响，探讨两种放射治疗方法在胸中段食管癌根治性放疗中重要器官受保护的优劣，寻找食管癌放射治疗的理想计划模式。方法 15例经病理证实胸中段食管鳞癌患者，经体位固定、CT模拟定位扫描成像传输到治疗计划系统、勾画肿瘤体积、临床靶区体积和危及器官。15例病例均做三维适型和调强计划，60 Gy/30次，评估/优化后应用剂量体积直方图比较两种计划对靶区及危及器官的剂量学影响。结果 在相同靶区、相同剂量模式下，对胸中段食管癌患者的放射治疗中，调强放疗对靶区剂量的分布及对危及器官的保护均优于三维适形放疗。结论 胸中段食管鳞癌，长度4～18 cm放射治疗，三维适型/调强放疗对危及器官剂量学的影响有明显差异。同部位的肿瘤受到相同剂量照射情况下，调强放疗对危及器官的影响较三维适型放疗小，靶区剂量分布均匀度好。
关键词：食管癌；放射治疗；三维适型；调强放疗；剂量学
中图分类号：R735.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.13.021
, http://www.100md.com
文章编号：1006-1959(2018)13-0073-04
Abstract：Objective To compare the effects of three-dimensional radiotherapy and intensity-modulated radiotherapy on the target area and endangered organs in the middle thoracic esophageal carcinoma，and to explore the advantages and disadvantages of two radiotherapy methods in the protection of important organs in radical thoracic esophageal cancer radical radiotherapy looking for an ideal planning model for radiation therapy for esophageal carcinoma.Methods 15 cases of middle thoracic esophageal squamous cell carcinoma confirmed by pathology were transmitted to the treatment plan system，the volume of the tumor，the volume of the clinical target area and the endanger organ by the position fixation and CT simulation.15 cases were subjected to three-dimensional conformal and intensity-modulated plans，60 Gy/30 times.After evaluation/optimization，dose-volume histograms were used to compare the dosimetric effects of the two plans on the target area and the organs at risk.Results In the same target area and the same dose mode， in the radiotherapy of patients with middle thoracic esophageal cancer，intensity-modulated radiotherapy was better than three-dimensional conformal radiotherapy for the distribution of target dose and protection of endangered organs.Conclusion In the middle thoracic esophageal squamous cell carcinoma，4 to 18 cm in length，the effect of three-dimensional conformal/intensity-modulated radiotherapy on the dosimetry of endangered organs was significantly different.When the tumors in the same site were irradiated by the same dose，the effect of intensity-modulated radiotherapy on the organs at risk was smaller than that of three-dimensional adaptive radiotherapy，and the uniformity of dose distribution in the target area was good.
, 百拇医药
Key words：Esophageal carcinoma；Radiotherapy；Three-dimensional conformal；Intensity-modulated radiotherapy；Dosimetric
食管癌(esophageal carcinoma)是人類常见的恶性肿瘤，放射治疗是食管癌的重要治疗方法之一。在食管癌常规根治性放疗中，由于临近靶区周围的正常组织无法耐受高剂量，靶区剂量也常常难以达到治疗要求剂量。食管癌常规根治性放疗5年生存率在10%左右，分析其相关影响因素主要是局部复发[1]。随着计算机技术的进步，在食管癌根治性放疗中，常规放疗技术已逐渐被三维适型及调强放疗替代。在中段食管癌病例中，由于病灶距离脊髓比较近，靶区剂量与危及器官剂量互相制约。三维适型放疗(three-dimensional conformal radiotherapy，3DCRT)在凹形靶区时剂量分布不足，脊髓等危及器官剂量控制更难。有研究证实，在鼻咽癌、食管癌、前列腺癌放疗中，调强放疗(intensity modulated radiotherapy，IMRT)可以在降低危及器官剂量的同时保证靶区剂量[2]。本次研究通过对比三维适型放疗与调强放疗在胸中段食管癌根治性放疗中对靶区、脊髓、肺、心脏组织中的剂量分布情况，现报道如下。, 百拇医药(许益芬)
关键词：食管癌；放射治疗；三维适型；调强放疗；剂量学
中图分类号：R735.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.13.021
, http://www.100md.com
文章编号：1006-1959(2018)13-0073-04
Abstract：Objective To compare the effects of three-dimensional radiotherapy and intensity-modulated radiotherapy on the target area and endangered organs in the middle thoracic esophageal carcinoma，and to explore the advantages and disadvantages of two radiotherapy methods in the protection of important organs in radical thoracic esophageal cancer radical radiotherapy looking for an ideal planning model for radiation therapy for esophageal carcinoma.Methods 15 cases of middle thoracic esophageal squamous cell carcinoma confirmed by pathology were transmitted to the treatment plan system，the volume of the tumor，the volume of the clinical target area and the endanger organ by the position fixation and CT simulation.15 cases were subjected to three-dimensional conformal and intensity-modulated plans，60 Gy/30 times.After evaluation/optimization，dose-volume histograms were used to compare the dosimetric effects of the two plans on the target area and the organs at risk.Results In the same target area and the same dose mode， in the radiotherapy of patients with middle thoracic esophageal cancer，intensity-modulated radiotherapy was better than three-dimensional conformal radiotherapy for the distribution of target dose and protection of endangered organs.Conclusion In the middle thoracic esophageal squamous cell carcinoma，4 to 18 cm in length，the effect of three-dimensional conformal/intensity-modulated radiotherapy on the dosimetry of endangered organs was significantly different.When the tumors in the same site were irradiated by the same dose，the effect of intensity-modulated radiotherapy on the organs at risk was smaller than that of three-dimensional adaptive radiotherapy，and the uniformity of dose distribution in the target area was good.
, 百拇医药
Key words：Esophageal carcinoma；Radiotherapy；Three-dimensional conformal；Intensity-modulated radiotherapy；Dosimetric
食管癌(esophageal carcinoma)是人類常见的恶性肿瘤，放射治疗是食管癌的重要治疗方法之一。在食管癌常规根治性放疗中，由于临近靶区周围的正常组织无法耐受高剂量，靶区剂量也常常难以达到治疗要求剂量。食管癌常规根治性放疗5年生存率在10%左右，分析其相关影响因素主要是局部复发[1]。随着计算机技术的进步，在食管癌根治性放疗中，常规放疗技术已逐渐被三维适型及调强放疗替代。在中段食管癌病例中，由于病灶距离脊髓比较近，靶区剂量与危及器官剂量互相制约。三维适型放疗(three-dimensional conformal radiotherapy，3DCRT)在凹形靶区时剂量分布不足，脊髓等危及器官剂量控制更难。有研究证实，在鼻咽癌、食管癌、前列腺癌放疗中，调强放疗(intensity modulated radiotherapy，IMRT)可以在降低危及器官剂量的同时保证靶区剂量[2]。本次研究通过对比三维适型放疗与调强放疗在胸中段食管癌根治性放疗中对靶区、脊髓、肺、心脏组织中的剂量分布情况，现报道如下。, 百拇医药(许益芬)