王昊, 鲁文力. 基于剂量验证探讨鼻咽癌调强放疗分次治疗过程中靶区和危及器官的剂量变化[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202307019-00415
引用本文: 王昊, 鲁文力. 基于剂量验证探讨鼻咽癌调强放疗分次治疗过程中靶区和危及器官的剂量变化[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202307019-00415
Wang Hao, Lu Wenli. Exploring the dose changes in the target area and organs at risk during intensity modulated radiotherapy fractionation therapy for nasopharyngeal carcinoma based on dose verifications[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202307019-00415
Citation: Wang Hao, Lu Wenli. Exploring the dose changes in the target area and organs at risk during intensity modulated radiotherapy fractionation therapy for nasopharyngeal carcinoma based on dose verifications[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202307019-00415

基于剂量验证探讨鼻咽癌调强放疗分次治疗过程中靶区和危及器官的剂量变化

Exploring the dose changes in the target area and organs at risk during intensity modulated radiotherapy fractionation therapy for nasopharyngeal carcinoma based on dose verifications

  • 摘要:
    目的 采集分次剂量验证的数据以量化鼻咽癌患者在调强适形放射治疗(IMRT)分次治疗过程中靶区和危及器官的剂量变化。
    方法 回顾性分析2022年2至4月于重庆医科大学附属第一医院收治的27例鼻咽癌患者的临床资料,患者年龄(57.8±9.0)岁,范围为40~72岁,均行容积弧形调强放射治疗(VMAT),对所有患者原发病灶的大体肿瘤靶区(GTVnx)、原发病灶侵犯区域的临床靶区(CTV1)、在CTV1的基础上向各方向外扩3 mm对应生成的鼻咽癌原发病灶侵犯区域的计划靶区(PTV1)以及脑干、脊髓、左腮腺、右腮腺等危及器官进行勾画。使用Delta4对患者的初始计划进行33次剂量验证并采集每次剂量验证的数据,比较33次剂量验证后的实测剂量与百分剂量偏差(%DD)与初始计划的差异。计量资料的组间比较采用配对t检验或Wilcoxon检验。
    结果 与第1次相比,完成33次剂量验证后GTVnx平均剂量(Dmean)(2.159±4.357) Gy对(2.173±4.375) Gy、CTV195%靶体积的受照剂量(D95%)、Dmean、5%靶体积的受照剂量(D5%) (50.859±1.753) Gy对(51.305±1.756) Gy、(0.135±0.064) Gy对(0.136±0.065) Gy、(64.261±2.979) Gy对(64.395±2.984) Gy、PTV1(D95%、Dmean、D5%) (49.364±1.440) Gy对(49.827±1.459) Gy、(0.089±0.032) Gy对(0.090±0.033) Gy、(64.105±3.201) Gy对(64.149±3.273) Gy以及左腮腺、右腮腺(Dmean) (1.185±0.612) Gy对(1.188±0.686) Gy、(1.227±0.640) Gy对(1.252±0.619) Gy的实测剂量较初始计划均降低,差异均有统计学意义(Z=−4.397,P=0.000;t=−6.060,P=0.000;Z=−4.541,P=0.000;Z=−3.339,P=0.001;t=−6.870,P=0.000;Z=−4.541,P=0.000;Z=−3.363,P=0.001;Z=−2.667,P=0.008;Z=−3.460,P=0.001);脑干1cc靶体积的受照剂量(D1cc)(40.770±3.670) Gy对(40.228±3.555) Gy的实测剂量较初始计划升高,差异有统计学意义(t=5.903,P=0.000);GTVnx2%靶体积的受照剂量(D2%)(0.090±1.993)%对(0.209±1.696)%、CTV1(D95%、Dmean、D5%)(0.153±1.575)%对(0.905±1.626)%、(0.145±0.903)%对(0.475±0.956)%、(−0.203±1.737)%对(0.050±1.572)%、PTV1(D95%、Dmean、D5%)(−1.017±1.237)%对(−0.213±1.303)%、(−0.003±1.130)%对(0.385±0.960)%、(−0.452±1.583)%对(0.044±1.430)%以及左腮腺、右腮腺(Dmean)(9.778±5.093)%对(10.018±5.795)%、(4.101±4.975)%对(7.050±5.177)%的%DD较初始计划均降低,差异均有统计学意义(Z=−3.195,P=0.001;t=−7.594,P=0.000;t=−3.254,P=0.003;Z=−2.763,P=0.006;t=−8.709,P=0.000;Z=−3.099,P=0.002;Z=−2.667,P=0.008;Z=−2.258,P=0.024;Z=−3.243,P=0.001);脑干、脊髓(D1cc)(3.895±3.135)%对(2.346±2.574)%、(2.935±2.929)%对(2.032±2.897)%的%DD较初始计划升高,差异均有统计学意义(t=7.469,P=0.000;Z=−4.469,均P<0.001)。在完成12次剂量验证后,脑干D1cc(3.005±2.841)%对(2.346±2.574)%的%DD较初始计划升高且差异具有统计学意义(t=4.398,P=0.000)且%DD>3%。
    结论 在鼻咽癌IMRT分次治疗的过程中,靶区剂量和危及器官剂量均会发生明显的变化,其中脑干的剂量变化超出了临床可接受的范围,而其他参数的剂量变化未超出临床可接受的范围,这提示在鼻咽癌的放疗实施过程中应对脑干的剂量变化予以关注,以最大程度地提高治疗获益。

     

    Abstract:
    Objective Using Delta4 to collect data from 33 dose verifications to simulate patients receiving 33 fractionated radiotherapy treatments, quantifying the dose changes in the target area and organs at risk during the intensity modulated radiotherapy fractionation treatment process for nasopharyngeal carcinoma patients, in order to provide some reference for radiotherapy plan design and secondary plan design.
    Methods Select 27 nasopharyngeal carcinoma patients who received intensity modulated radiation therapy at the same linear accelerator, then use Delta4 to implement 33 dose verifications based on their initial plan and collect relevant data.Analyze whether the measured dose and %Dose error(%DE) after 33 dose verifications differ from them in the initial planned, and figure out the magnitude of the difference.Further analyze the parameters with significant differences to find out which time that significant differences beyond the clinically acceptable range occur after several dose verifications.
    Results After completing 33 dose verifications, the measured doses of GTVnx (Dmean), CTV1 (D95%, Dmean, D5%), PTV1 (D95%, Dmean, D5%) and left and right parotid gland (Dmean) decreased, and the differences were statistically significant; The measured dose of brainstem (D1cc) increased, and the difference was statistically significant; The %DE of GTVnx (D2%), CTV1 (D95%, Dmean, D5%), PTV1 (D95%, Dmean, D5%) and left and right parotid gland (Dmean) decreased, and the differences were statistically significant; The %DE of brainstem and spinal cord (D1cc) increased, and the differences were statistically significant. After completing 12 dose verifications, the %DE of brainstem (D1cc) increased and exceeds 3%, with the difference was statistically significant.
    Conclusion In the process of intensity modulated radiotherapy for nasopharyngeal carcinoma, there will be significant changes in prescription doses of both target and organs at risk. The change of prescription dose in brainstem exceeds the clinically acceptable range, while the changes of prescription doses in other parameters do not exceed the clinically acceptable range. This suggests that attention should be paid to the change of prescription dose in brainstem during the radiotherapy implementation of nasopharyngeal carcinoma to maximize the treatment benefits.

     

/

返回文章
返回