华西医学

华西医学

有无均整器调强与容积旋转调强在甲状腺功能亢进突眼放射治疗中的剂量学研究

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目的探讨非均整模式调强放射治疗(flattening filter free intensity modulated radiotherapy,3FIMRT)、非均整模式容积旋转调强放射治疗(flattening filter free volumetric modulated arc therapy,3FVMAT)、均整模式调强放射治疗(flattening filter intensity modulated radiotherapy,IMRT)和均整模式容积旋转调强放射治疗(flattening filter volumetric modulated arc therapy,VMAT)4 种计划应用于甲状腺功能亢进(甲亢)突眼放射治疗(放疗)的剂量学差异。方法选取 2016 年 9 月—2017 年 9 月已行放疗的 29 例甲亢突眼患者的 CT 图像作为研究对象。对 29 例患者以相同处方剂量和目标条件分别重新设计 IMRT、VMAT、3FIMRT、3FVMAT 4 套放疗计划。评估 4 种计划靶区剂量分布、正常组织受照射剂量、机器跳数和治疗时间。结果4 种治疗计划均能满足临床治疗的要求,在靶区最大剂量、平均剂量、均匀指数方面差异无统计学意义(P>0.05)。在靶区最小剂量、50% 处方剂量包裹体积、适形指数、梯度指数方面 4 套计划差异均有统计学意义(F=10.920、35.860、11.320、17.790,P<0.05)。IMRT 和 3FIMRT 在适形指数方面优于 VMAT 和 3FVMAT,但 IMRT 和 3FIMRT 二者之间无明显差异。在眼晶状体平均剂量和脑组织平均剂量方面 4 套计划差异具有统计学意义(F=5.054、83.780,P<0.05)。和其他 3 种计划相比较,3FVMAT 可以更好地保护眼晶状体和脑组织。3FVMAT 和 VMAT 之间机器跳数和治疗时间无明显差异。3FVMAT 相比 IMRT、3FIMRT 的机器跳数分别减少 65.07%、70.22%,治疗时间分别减少 48.1%、35.24%。结论3FVMAT 与 IMRT、3FIMRT、VMAT 相比能为甲亢突眼放疗带来更多的剂量学优势。

ObjectiveTo compare the dosimetric differences among flattening filter free intensity modulated radiotherapy (3FIMRT), flattening filter free volumetric modulated arc therapy (3FVMAT), filter free intensity modulated radiotherapy (IMRT), and filter free volumetric modulated arc therapy (VMAT) for hyperthyroidism exophthalmus patients.MethodsComputed tomography (CT) scans of 29 patients, who were diagnosed with hyperthyroidism exophthalmus and treated with radiation therapy between September 2016 and September 2017, were selected for study. Four treatment plans with the same dose prescription and objective constrains were designed for each patient based on their images, consisting of IMRT, VMAT, 3FIMRT, and 3FVMAT. The target dosimetric distribution, normal tissue radiation dose, monitor units, and treatment time of each plan were evaluated.ResultsFour types of plans were all able to satisfy the clinical treatment requirements, and there were no significant differences in maximum dose, mean dose (Dmean), homogeneity index of the targets (P>0.05). For the parameters minimum dose,V50%, conformity index (CI), gradient index of the targets, statistically significant differences were observed among the four kinds of technologies (F=10.920, 35.860, 11.320, 17.790; P<0.05). The CI of IMRT and 3FIMRT were superior to those of VMAT and 3FVMAT, but there was no significant difference between IMRT and 3FIMRT. In terms of LensDmean and Brain Dmean, statistically significant differences were observed among the four kinds of technologies (F=5.054, 83.780; P<0.05). For LensDmean and Brain Dmean, 3FVMAT achieved better sparing effects when compared with the other three plans. The total monitor units and treatment time did not significantly differ between 3FVMAT and VMAT. The mean monitor units of 3FVMAT were 65.07% and 70.22% less than that of IMRT and 3FIMRT respectively. The mean treatment time of 3FVMAT were 48.1% and 35.24% less than that of IMRT and 3FIMRT respectively.Conclusion3FVMAT can bring more dosimetric advantages for hyperthyroidism exophthalmus radiation therapy when compared with IMRT, 3FIMRT, and VMAT.

关键词: 甲状腺功能亢进突眼; 均整; 非均整; 调强放射治疗; 旋转调强放射治疗

Key words: Hyperthyroidism exophthalmus; Flatting filter; Flatting filter free; Intensity modulated radiotherapy; Volumetric modulated arc therapy

引用本文: 赖佳路, 刘首鹏, 张琴, 柏森, 钟仁明. 有无均整器调强与容积旋转调强在甲状腺功能亢进突眼放射治疗中的剂量学研究. 华西医学, 2019, 34(2): 172-178. doi: 10.7507/1002-0179.201810017 复制

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