-
宫颈癌是严重威胁女性健康的恶性肿瘤之一,全球宫颈癌年龄标准化发病率为13.3/10万[1]。在我国,宫颈癌发病率居女性恶性肿瘤的前列,具有高发病率和病死率,有调查结果显示, 2003—2018年,20~79岁女性宫颈癌标准化发病率和标准化病死率均呈明显的逐年增长趋势[2]。近80%的宫颈癌患者就诊时已处于局部晚期[3] ,通常对于局部晚期宫颈癌患者不推荐手术治疗,应以同步放化疗为主。目前宫颈癌放疗包括固定野调强适形放射治疗(intensity-modulated radiation therapy,IMRT)、容积弧形调强放射治疗(volumetric intensity modulated arc therapy,VMAT)等,其中,IMRT是主流的宫颈癌放疗方式,与常规放疗相比,其具有较高的适形度及靶区内剂量均匀性[4]。VMAT是一种新型的调强方式,不仅具有固定野IMRT的优势,且在多数肿瘤中具有更好的均匀性和适形度,能更好地保护危及器官并缩短治疗时间[5]。本研究拟通过比较分析VMAT与固定野IMRT在局部晚期宫颈癌延伸野放疗计划中的剂量学差异,为局部晚期宫颈癌的放疗提供依据。
-
VMAT和IMRT 2种放疗技术靶区的剂量分布均能够满足处方剂量要求。由表1可知,在PTV中,VMAT组的CI高于IMRT组,且差异有统计学意义(t=−2.190,P=0.035),VMAT组和IMRT组的Dmax、Dmin、Dmean、HI的差异均无统计学意义(均P>0.05)。在PGTVnd中,VMAT组的HI低于IMRT组,且差异有统计学意义(t=−2.315,P=0.026),VMAT组和IMRT组的Dmax、Dmin、Dmean、CI的差异均无统计学意义(均P>0.05)。
参数 IMRT组(n=10) VMAT组(n=10) t值 P值 PTV Dmax(Gy) 61.24±1.05 61.35±1.12 −0.321 0.750 Dmin(Gy) 47.09±1.12 47.20±1.27 −0.296 0.769 Dmean(Gy) 52.29±1.01 52.35±1.12 −0.178 0.860 HI 0.27±0.01 0.27±0.02 0.469 0.642 CI 0.79±0.23 0.81±0.03 −2.190 0.035 PGTVnd Dmax(Gy) 64.35±1.12 64.24±1.05 −0.321 0.750 Dmin(Gy) 60.34±1.12 59.87±1.20 1.266 0.213 Dmean(Gy) 62.35±1.12 62.18±1.08 −0.473 0.639 HI 0.07±0.01 0.06±0.01 −2.315 0.026 CI 0.37±0.05 0.41±0.08 −1.561 0.127 注:IMRT为调强适形放射治疗;VMAT为容积弧形调强放射治疗;PTV为计划靶区;Dmax为最高剂量;Dmin为最低剂量;Dmean为平均剂量;HI为均匀性指数;CI为适形指数;PGTVnd为转移淋巴结计划靶区 表 1 20例局部晚期宫颈癌患者2种放疗计划的计划靶区剂量参数比较(
)$ \bar x\pm s $ Table 1. Comparison of planning target volume dose parameters for two radiotherapy plans in 20 locally advanced cervical cancer patients (
)$ \bar x\pm s $ -
在膀胱受照射剂量中,VMAT组的V20 Gy低于IMRT组,且差异有统计学意义(t=2.220,P=0.032)。2组其他参数的比较差异均无统计学意义(均P>0.05)(表2)。
参数 IMRT组(n=10) VMAT组(n=10) t值 P值 膀胱 V10 Gy(%) 99.35±1.12 99.19±1.13 −0.449 0.656 V20 Gy(%) 93.98±1.47 92.64±2.29 2.220 0.032 V30 Gy(%) 79.15±1.08 78.22±3.00 1.305 0.200 V40 Gy(%) 64.35±1.12 64.19±1.13 −0.449 0.656 V50 Gy(%) 34.35±1.12 34.09±1.39 −0.650 0.519 Dmean(Gy) 40.47±1.17 39.74±2.52 −1.176 0.247 直肠 V10 Gy(%) 99.26±1.07 99.09±1.39 −0.433 0.667 V20 Gy(%) 93.68±1.88 92.20±2.21 2.282 0.028 V30 Gy(%) 79.00±1.16 78.17±3.00 1.150 0.257 V40 Gy(%) 64.31±1.08 64.09±1.39 −0.558 0.580 V50 Gy(%) 35.29±1.01 35.21±1.10 0.239 0.812 Dmean(Gy) 39.21±1.10 39.08±1.39 −0.314 0.755 肝 V10 Gy(%) 7.93±0.10 7.73±0.39 2.372 0.023 V20 Gy(%) 5.51±0.16 5.14±0.68 2.367 0.023 V30 Gy(%) 0.78±0.03 0.76±0.06 1.265 0.214 Dmean(Gy) 4.43±0.11 4.38±0.12 1.266 0.213 小肠 V10 Gy(%) 95.30±1.17 94.87±1.55 0.991 0.328 V20 Gy(%) 80.24±1.05 77.67±4.64 2.416 0.021 V30 Gy(%) 42.34±6.00 39.21±1.10 2.228 0.028 V40 Gy(%) 22.34±6.01 18.35±3.05 2.628 0.012 Dmean(Gy) 34.23±6.71 30.36±3.46 2.290 0.028 脊髓 V10 Gy(%) 65.35±1.12 65.04±1.56 −0.723 0.474 V20 Gy(%) 42.88±6.19 38.81±2.33 2.752 0.009 V30 Gy(%) 32.35±1.12 32.24±1.04 −0.321 0.750 V40 Gy(%) 0.37±0.78 0.22±0.97 0.539 0.593 Dmean(Gy) 17.97±7.40 11.46±4.26 3.410 0.002 左肾 V20 Gy(%) 15.56±7.50 11.67±2.36 2.216 0.033 Dmean(Gy) 14.06±7.29 10.02±2.19 2.375 0.023 右肾 V20 Gy(%) 16.67±6.92 11.72±2.31 3.030 0.004 Dmean(Gy) 13.92±7.17 10.07±2.15 2.295 0.027 左股骨头 V10 Gy(%) 78.51±7.46 74.77±2.33 2.147 0.038 V20 Gy(%) 38.91±7.20 34.37±2.74 2.640 0.012 V30 Gy(%) 18.51±7.46 14.77±2.33 2.147 0.038 V40 Gy(%) 4.98±3.73 2.99±1.03 2.305 0.027 V50 Gy(%) 0.99±0.65 0.48±0.22 3.359 0.002 Dmean(Gy) 38.41±6.67 34.32±2.79 2.533 0.016 右股骨头 V10 Gy(%) 78.26±7.30 75.02±2.61 1.872 0.069 V20 Gy(%) 48.21±7.21 45.37±2.79 1.646 0.108 V30 Gy(%) 18.67±7.01 15.62±3.07 1.778 0.083 V40 Gy(%) 4.35±1.31 3.58±1.28 1.878 0.068 V50 Gy(%) 0.03±0.01 0.02±0.01 2.997 0.005 Dmean(Gy) 18.11±6.44 15.83±2.56 1.471 0.149 注:IMRT为调强适形放射治疗;VMAT为容积弧形调强放射治疗;Vx Gy表示接受≥x Gy照射的体积占总体积的百分比;Dmean为平均剂量 表 2 20例局部晚期宫颈癌患者2种放疗计划的危及器官剂量参数比较(
)$ \bar x\pm s $ Table 2. Comparison of dose parameters of organs at risk in 20 patients with locally advanced cervical cancer treated with two radiotherapy plans (
)$ \bar x\pm s $ -
在直肠受照射剂量中,VMAT组的V20 Gy低于IMRT组,且差异有统计学意义(t=2.282,P=0.028)。2组其他参数的比较差异均无统计学意义(均P>0.05)(表2)。
-
在肝受照射剂量中,VMAT组的V10 Gy、V20 Gy均低于IMRT组,且差异均有统计学意义(t=2.372、2.367,P=0.023、0.023)。2组其他参数的比较差异均无统计学意义(均P>0.05)(表2)。
-
在小肠受照射剂量中,VMAT组的V20 Gy、V30 Gy、V40 Gy和Dmean均低于IMRT 组,且差异均有统计学意义(t=2.228~2.628,均P<0.05)。2组V10 Gy的比较差异无统计学意义(P>0.05)(表2)。
-
在脊髓受照射剂量中,VMAT组的V20 Gy和Dmean均低于IMRT 组,且差异均有统计学意义(t=2.752、3.410,P=0.009、0.002)。2组其他参数的比较差异均无统计学意义(均P>0.05)(表2)。
-
在左肾受照射剂量中,VMAT组的V20 Gy和Dmean均低于IMRT组,且差异均有统计学意义(t=2.216、2.375,P=0.033、0.023);在右肾受照射剂量中,VMAT组的V20 Gy和Dmean均低于IMRT组,且差异均有统计学意义(t=3.030、2.295,P=0.004、0.027)(表2)。
-
在左股骨头受照射剂量中,VMAT组的V10 Gy、V20 Gy、V30 Gy、V40 Gy、V50 Gy及 Dmean 均低于 IMRT 组,且差异均有统计学意义(t=2.147~3.359,均P<0.05);在右股骨头受照射剂量中,VMAT组的 V50 Gy低于IMRT 组,且差异有统计学意义(t=2.997,P=0.005)。2组其他参数的比较差异均无统计学意义(均P>0.05)(表2)。
-
VMAT组的机器总跳数为(536.16±42.37),低于IMRT组的(614.44±59.44),且差异有统计学意义(t=−5.362,P<0.001);VMAT组的有效治疗时间为(152.23±0.31)min,短于IMRT组的(453.88±9.94) min,且差异有统计学意义(t=−151.708,P<0.001)。
VMAT与IMRT在局部晚期宫颈癌放疗中的剂量学差异
Dosimetric comparison of volumetric intensity modulated arc therapy and intensity-modulated radiation therapy in locally advanced cervical cancer
-
摘要:
目的 比较分析容积弧形调强放射治疗(VMAT)与固定野调强适形放射治疗(IMRT) 在局部晚期宫颈癌延伸野放疗计划中的剂量学差异。 方法 回顾性分析2019年1月至2021年12月南京医科大学附属淮安第一医院收治的20例宫颈癌患者的临床资料,患者年龄(56.3±9.1)岁,范围39~78岁,均行CT扫描,对所有患者进行计划靶区(PTV)、转移淋巴结计划靶区(PGTVnd)以及膀胱、直肠、双侧股骨头、 肝、双肾、小肠、脊髓等危及器官的勾画。按照随机数字表法将患者分为IMRT 组和VMAT组,每组10例,分别进行IMRT 和VMAT的放疗计划;其中IMRT 组患者年龄(54.1±7.1)岁,VMAT组患者年龄(58.1±10.8)岁。比较2组患者靶区的剂量参数、危及器官的剂量参数以及机器总跳数、有效治疗时间。计量资料的组间比较采用t检验。 结果 在PTV中,VMAT组的适形指数(0.81±0.03)高于IMRT组(0.79±0.23),且差异有统计学意义(t=−2.190,P=0.035)。在PGTVnd中,VMAT组的均匀性指数(0.06±0.01)低于IMRT组(0.07±0.01),且差异有统计学意义(t=−2.315,P=0.026)。在膀胱受照射剂量中,VMAT组的V20 Gy(Vx Gy表示接受≥x Gy照射的体积占总体积的百分比)为(92.64±2.29)%,低于IMRT组的(93.98±1.47)%,且差异有统计学意义(t=2.220,P=0.032)。在直肠受照射剂量中,VMAT组的V20 Gy为(92.20±2.21)%,低于IMRT组的(93.68±1.88)%,且差异有统计学意义(t=2.282,P=0.028)。在肝受照射剂量中,VMAT组的V10 Gy、V20 Gy分别为(7.73±0.39)%、(5.14±0.68)%,均低于IMRT组的V10 Gy[(7.93±0.10)%]、V20 Gy[(5.51±0.16)%],且差异均有统计学意义(t=2.372、2.367,P=0.023、0.023)。在小肠受照射剂量中,VMAT组的V20 Gy、V30 Gy、V40 Gy和平均剂量(Dmean)分别为(77.67±4.64)%、(39.21±1.10)%、(18.35±3.05)%和(30.36±3.46) Gy,均低于IMRT组的V20 Gy[(80.24±1.05)%]、V30 Gy[(42.34±6.00)%]、V40 Gy[(22.34±6.01)%]和Dmean[(34.23±6.71) Gy],且差异均有统计学意义(t=2.228~2.628,均P<0.05)。在脊髓受照射剂量中,VMAT组的V20 Gy和Dmean分别为(38.81±2.33)%和(11.46±4.26) Gy,均低于IMRT组的V20 Gy[(42.88±6.19)%]和Dmean[(17.97±7.40) Gy],且差异均有统计学意义(t=2.752、3.410,P=0.009、0.002)。在左肾受照射剂量中,VMAT组的V20 Gy和Dmean分别为(11.67±2.36)%和(10.02±2.19) Gy,均低于IMRT组的V20 Gy[(15.56±7.50)%]和Dmean[(14.06±7.29) Gy],且差异均有统计学意义(t=2.216、2.375,P=0.033、0.023)。在右肾受照射剂量中,VMAT组的V20 Gy和Dmean分别为(11.72±2.31)%和(10.07±2.15) Gy,均低于IMRT组的V20 Gy[(16.67±6.92)%]和Dmean[(13.92±7.17) Gy],且差异均有统计学意义(t=3.030、2.295,P=0.004、0.027)。在左股骨头受照射剂量中,VMAT组的 V10 Gy、V20 Gy、V30 Gy、V40 Gy、V50 Gy及Dmean均低于IMRT组[(74.77±2.33)%对(78.51±7.46)%、(34.37±2.74)%对(38.91±7.20)%、(14.77±2.33)%对(18.51±7.46)%、(2.99±1.03)%对(4.98±3.73)%、(0.48±0.22)%对(0.99±0.65)%、(34.32±2.79) Gy对(38.41±6.67) Gy],且差异均有统计学意义(t=2.147~3.359,均P<0.05)。在右股骨头受照射剂量中,VMAT组的 V50 Gy为(0.02±0.01)%,低于 IMRT组的V50 Gy[0.03±0.01%],且差异有统计学意义(t=2.997,P=0.005)。VMAT组的机器总跳数为(536.16±42.37),低于IMRT组的(614.44±59.44),且差异有统计学意义(t=−5.362,P<0.001);VMAT组的有效治疗时间为(152.23±0.31) min,短于IMRT组的(453.88±9.94) min,且差异有统计学意义(t=−151.708,P<0.001)。 结论 对于局部晚期宫颈癌,VMAT计划的适形度及均匀性较好,更能保护危及器官,且可减少机器跳数,缩短治疗时间。 -
关键词:
- 宫颈肿瘤 /
- 辐射剂量 /
- 放射疗法,调强适形 /
- 容积弧形调强放射治疗
Abstract:Objective To analyze and compare the dosimetric difference between volumetric intensity modulated arc therapy (VMAT) and conformal intensity-modulated radiation therapy (IMRT) in the extended field radiotherapy plan for locally advanced cervical cancer. Methods Retrospective analysis was carried out on the clinical data of 20 patients with cervical cancer admitted to the Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University from January 2019 to December 2021. Patients aged (56.3±9.1) years and ranging from 39 to 78 years old were included. Each patient underwent CT scanning, and the delineations of the planning target volume (PTV), planning gross target volume for lymph node lesion (PGTVnd), and organs at risk such as bladder, rectum, bilateral femoral heads, liver, kidneys, small intestine, and spinal cord were outlined. All patients were divided into the IMRT and VMAT group by using a random number table method with 10 patients in each group. The IMRT and VMAT radiotherapy plans were conducted separately. The patients in the IMRT group were aged (54.1±7.1) years, while those in the VMAT group were aged (58.1±10.8) years. The relevant dosimetric parameters of the target volume and the organs at risk, total machine hops, and total treatment time were compared between the two groups. The t-test was used for inter-group comparison of measurement data. Results In PTV, the conformity index of VMAT was significantly higher than that of IMRT ((0.81±0.03) vs. (0.79±0.23), t=−2.190, P=0.035). In PGTVnd, the homogeneity index of VMAT was significantly lower than that of IMRT ((0.06±0.01) vs. (0.07±0.01), t=−2.315, P=0.026). In the bladder irradiation dose, the V20 Gy (Vx Gy indicates the percentage of volume irradiated with ≥ x Gy to total volume) in the VMAT plan was significantly lower than that in the IMRT group ((92.64±2.29)% vs. (93.98±1.47)%, t=2.220, P=0.032). In the rectal irradiation dose, the V20 Gy in the VMAT group was significantly lower than that in the IMRT group ((92.20±2.21)% vs. (93.68±1.88)%, t=2.282, P=0.028). In the liver irradiation dose, the V10 Gy and V20 Gy in the VMAT group were (7.73±0.39)% and (5.14±0.68)%, respectively, which were lower than the V10 Gy ((7.93±0.10)% ) and V20 Gy ((5.51±0.16)%) in the IMRT group, and the differences were statistically significant (t=2.372, 2.367, P=0.023, 0.023). In the small intestine irradiation dose, V20 Gy, V30 Gy, V40 Gy, and Dmean in the VMAT group were (77.67±4.64)%, (39.21±1.10)%, (18.35±3.05)%, and (30.36±3.46) Gy, respectively, which were significantly lower than the V20 Gy ((80.24±1.05)%), V30 Gy ((42.34±6.00)%), V40 Gy ((22.34±6.01)%), and Dmean ((34.23±6.71) Gy) in the IMRT group (t=2.228–2.628, all P<0.05). In the spinal cord irradiation dose, the V20 Gy and Dmean in the VMAT group were (38.81±2.33)% and (11.46±4.26) Gy, respectively, which were significantly lower than the V20 Gy ((42.88±6.19)%) and Dmean ((17.97±7.40) Gy) in the IMRT group (t=2.752, 3.410, P=0.009, 0.002). In the left kidney irradiation dose, the V20 Gy and Dmean in the VMAT group were (11.67±2.36)% and (10.02±2.19) Gy, respectively, which were significantly lower than the V20 Gy ((15.56±7.50)% ) and Dmean ((14.06±7.29) Gy) in the IMRT group (t=2.216, 2.375, P=0.033, 0.023). In the right kidney irradiation dose, the V20 Gy and Dmean in the VMAT plan were (11.72±2.31)% and (10.07±2.15) Gy, respectively, which were significantly lower than the V20 Gy ((16.67±6.92)%) and Dmean ((13.92±7.17) Gy) in the IMRT group (t=3.030, 2.295, P=0.004, 0.027). In the left caput femoris irradiation dose, significant differences were observed in the V10 Gy ( (74.77±2.33)% vs. (78.51±7.46)%), V20 Gy ((34.37±2.74)% vs. (38.91±7.20)%), V30 Gy ((14.77±2.33)% vs. (18.51±7.46)%), V40 Gy ((2.99±1.03)% vs. (4.98±3.73)%), V50 Gy ((0.48±0.22)% vs. (0.99%±0.65)%), and Dmean ((34.32±2.79) Gy vs. (38.41±6.67) Gy) in the VMAT plan compared with the IMRT group (t=2.147–3.359, all P<0.05). In the right caput femoris irradiation dose, the V50 Gy in the VMAT group was (0.02±0.01)%, which was significantly lower than the V50 Gy ((0.03±0.01)%) in the IMRT group (t=2.997, P=0.005). The total machine hop of VMAT group was significantly lower than that of the IMRT group ((536.16±42.37) vs. (614.44±59.44), t=−5.362, P<0.001). The effective treatment time of VMAT group was significantly lower than that of the IMRT group ((152.23±0.31) min vs. (453.88±9.94) min, t=−151.708, P<0.001). Conclusion VMAT has good plan conformation and uniformity, can effectively protect the organs at risk, and can reduce the number of machine hops, and can shorten the treatment time. -
表 1 20例局部晚期宫颈癌患者2种放疗计划的计划靶区剂量参数比较(
)$ \bar x\pm s $ Table 1. Comparison of planning target volume dose parameters for two radiotherapy plans in 20 locally advanced cervical cancer patients (
)$ \bar x\pm s $ 参数 IMRT组(n=10) VMAT组(n=10) t值 P值 PTV Dmax(Gy) 61.24±1.05 61.35±1.12 −0.321 0.750 Dmin(Gy) 47.09±1.12 47.20±1.27 −0.296 0.769 Dmean(Gy) 52.29±1.01 52.35±1.12 −0.178 0.860 HI 0.27±0.01 0.27±0.02 0.469 0.642 CI 0.79±0.23 0.81±0.03 −2.190 0.035 PGTVnd Dmax(Gy) 64.35±1.12 64.24±1.05 −0.321 0.750 Dmin(Gy) 60.34±1.12 59.87±1.20 1.266 0.213 Dmean(Gy) 62.35±1.12 62.18±1.08 −0.473 0.639 HI 0.07±0.01 0.06±0.01 −2.315 0.026 CI 0.37±0.05 0.41±0.08 −1.561 0.127 注:IMRT为调强适形放射治疗;VMAT为容积弧形调强放射治疗;PTV为计划靶区;Dmax为最高剂量;Dmin为最低剂量;Dmean为平均剂量;HI为均匀性指数;CI为适形指数;PGTVnd为转移淋巴结计划靶区 表 2 20例局部晚期宫颈癌患者2种放疗计划的危及器官剂量参数比较(
)$ \bar x\pm s $ Table 2. Comparison of dose parameters of organs at risk in 20 patients with locally advanced cervical cancer treated with two radiotherapy plans (
)$ \bar x\pm s $ 参数 IMRT组(n=10) VMAT组(n=10) t值 P值 膀胱 V10 Gy(%) 99.35±1.12 99.19±1.13 −0.449 0.656 V20 Gy(%) 93.98±1.47 92.64±2.29 2.220 0.032 V30 Gy(%) 79.15±1.08 78.22±3.00 1.305 0.200 V40 Gy(%) 64.35±1.12 64.19±1.13 −0.449 0.656 V50 Gy(%) 34.35±1.12 34.09±1.39 −0.650 0.519 Dmean(Gy) 40.47±1.17 39.74±2.52 −1.176 0.247 直肠 V10 Gy(%) 99.26±1.07 99.09±1.39 −0.433 0.667 V20 Gy(%) 93.68±1.88 92.20±2.21 2.282 0.028 V30 Gy(%) 79.00±1.16 78.17±3.00 1.150 0.257 V40 Gy(%) 64.31±1.08 64.09±1.39 −0.558 0.580 V50 Gy(%) 35.29±1.01 35.21±1.10 0.239 0.812 Dmean(Gy) 39.21±1.10 39.08±1.39 −0.314 0.755 肝 V10 Gy(%) 7.93±0.10 7.73±0.39 2.372 0.023 V20 Gy(%) 5.51±0.16 5.14±0.68 2.367 0.023 V30 Gy(%) 0.78±0.03 0.76±0.06 1.265 0.214 Dmean(Gy) 4.43±0.11 4.38±0.12 1.266 0.213 小肠 V10 Gy(%) 95.30±1.17 94.87±1.55 0.991 0.328 V20 Gy(%) 80.24±1.05 77.67±4.64 2.416 0.021 V30 Gy(%) 42.34±6.00 39.21±1.10 2.228 0.028 V40 Gy(%) 22.34±6.01 18.35±3.05 2.628 0.012 Dmean(Gy) 34.23±6.71 30.36±3.46 2.290 0.028 脊髓 V10 Gy(%) 65.35±1.12 65.04±1.56 −0.723 0.474 V20 Gy(%) 42.88±6.19 38.81±2.33 2.752 0.009 V30 Gy(%) 32.35±1.12 32.24±1.04 −0.321 0.750 V40 Gy(%) 0.37±0.78 0.22±0.97 0.539 0.593 Dmean(Gy) 17.97±7.40 11.46±4.26 3.410 0.002 左肾 V20 Gy(%) 15.56±7.50 11.67±2.36 2.216 0.033 Dmean(Gy) 14.06±7.29 10.02±2.19 2.375 0.023 右肾 V20 Gy(%) 16.67±6.92 11.72±2.31 3.030 0.004 Dmean(Gy) 13.92±7.17 10.07±2.15 2.295 0.027 左股骨头 V10 Gy(%) 78.51±7.46 74.77±2.33 2.147 0.038 V20 Gy(%) 38.91±7.20 34.37±2.74 2.640 0.012 V30 Gy(%) 18.51±7.46 14.77±2.33 2.147 0.038 V40 Gy(%) 4.98±3.73 2.99±1.03 2.305 0.027 V50 Gy(%) 0.99±0.65 0.48±0.22 3.359 0.002 Dmean(Gy) 38.41±6.67 34.32±2.79 2.533 0.016 右股骨头 V10 Gy(%) 78.26±7.30 75.02±2.61 1.872 0.069 V20 Gy(%) 48.21±7.21 45.37±2.79 1.646 0.108 V30 Gy(%) 18.67±7.01 15.62±3.07 1.778 0.083 V40 Gy(%) 4.35±1.31 3.58±1.28 1.878 0.068 V50 Gy(%) 0.03±0.01 0.02±0.01 2.997 0.005 Dmean(Gy) 18.11±6.44 15.83±2.56 1.471 0.149 注:IMRT为调强适形放射治疗;VMAT为容积弧形调强放射治疗;Vx Gy表示接受≥x Gy照射的体积占总体积的百分比;Dmean为平均剂量 -
[1] 沈洁, 郑莹. 中国实现全球消除宫颈癌阶段性目标的研判[J]. 上海预防医学, 2021, 33(12): 1196−1200. DOI: 10.19428/j.cnki.sjpm.2021.20890.
Shen J, Zheng Y. Study on China achieving the WHO global elimination of cervical cancer[J]. Shanghai J Prev Med, 2021, 33(12): 1196−1200. DOI: 10.19428/j.cnki.sjpm.2021.20890.[2] 张仲华, 刘晨瑛, 任会叶, 等. 2003—2018年间中国女性宫颈癌发病与死亡趋势研究[J]. 中华疾病控制杂志, 2022, 26(1): 14−20. DOI: 10.16462/j.cnki.zhjbkz.2022.01.003.
Zhang ZH, Liu CY, Ren HY, et al. Analysis and prediction of the incidence and mortality trends of cervical cancer in Chinese women from 2003 to 2018[J]. Chin J Dis Control, 2022, 26(1): 14−20. DOI: 10.16462/j.cnki.zhjbkz.2022.01.003.[3] 龙行涛, 郭明芳, 周琦. 局部晚期宫颈癌放射治疗[J]. 中国实用妇科与产科杂志, 2018, 34(11): 1193−1199. DOI: 10.19538/j.fk2018110103.
Long XT, Guo MF, Zhou Q. Radiotherapy for locally advanced cervical cancer[J]. Chin J Pract Gynecol Obstet, 2018, 34(11): 1193−1199. DOI: 10.19538/j.fk2018110103.[4] Heron DE, Gerszten K, Selvaraj RN, et al. Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose-volume histograms[J]. Gynecol Oncol, 2003, 91(1): 39−45. DOI: 10.1016/s0090-8258(03)00461-x. [5] Verbakel WFAR, Cuijpers JP, Hoffmans D, et al. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study[J]. Int J Radiat Oncol Biol Phys, 2009, 74(1): 252−259. DOI: 10.1016/j.ijrobp.2008.12.033. [6] Merz J, Bossart M, Bamberg F, et al. Revised FIGO staging for cervical cancer—a new role for MRI[J]. Rofo, 2020, 192(10): 937−944. DOI: 10.10555/a-1198-5729. [7] Hodapp N. The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)[J]. Strahlenther Onkol, 2012, 188(1): 97−99. DOI: 10.1007/s00066-011-0015-x 2010. [8] 牛锐, 赵维秋, 陈忠, 等. 宫颈癌术后容积旋转调强治疗与三维适形调强放射治疗的临床应用价值分析[J]. 实用医技杂志, 2019, 26(9): 1166−1168. DOI: 10.19522/j.cnki.1671-5098.2019.09.038.
Niu R, Zhao WQ, Chen Z, et al. Clinical application value analysis of volume rotation intensity modulated therapy and three-dimensional conformal intensity modulated radiation therapy after cervical cancer surgery[J]. J Pract Med Tech, 2019, 26(9): 1166−1168. DOI: 10.19522/j.cnki.1671-5098.2019.09.038.[9] 魏敏. 宫颈癌术后容积旋转调强治疗与三维适形调强放疗的效果[J]. 中国现代药物应用, 2020, 14(3): 80−81. DOI: 10.14164/j.cnki.cn11-5581/r.2020.03.037.
Wei M. The effect of volume rotation intensity modulated therapy and three-dimensional conformal intensity modulated radiotherapy after cervical cancer surgery[J]. Chin J Mod Drug Appl, 2020, 14(3): 80−81. DOI: 10.14164/j.cnki.cn11-5581/r.2020.03.037.[10] 高长鹏, 杨岩, 王远航, 等. 容积旋转调强与固定野调强在宫颈癌术后放疗的剂量学比较[J]. 实用妇科内分泌杂志, 2018, 5(19): 57−58. DOI: 10.16484/j.cnki.issn2095-8803.2018.19.033.
Gao CP, Yang Y, Wang YH, et al. Dosimetric comparison of volume rotation intensity modulation and fixed field intensity modulation in postoperative radiotherapy for cervical cancer[J]. J Pract Gynecol Endocrinol, 2018, 5(19): 57−58. DOI: 10.16484/j.cnki.issn2095-8803.2018.19.033.[11] 葛彬彬, 储开岳, 金建华, 等. 不同射野方法在宫颈癌术后放射治疗中的剂量学比较[J]. 生物医学工程与临床, 2021, 25(2): 179−183. DOI: 10.13339/j.cnki.sglc.20210226.006.
Ge BB, Chu KY, Jin JH, et al. Dosimetry comparison of different radiation field methods in cervical cancer radiotherapy[J]. Biomed Eng Clin Med, 2021, 25(2): 179−183. DOI: 10.13339/j.cnki.sglc.20210226.006.[12] 申芹, 陈念永, 李光俊. 容积旋转调强放射治疗技术在头颈部肿瘤的应用[J]. 华西医学, 2016, 31(9): 1614−1617. DOI: 10.7507/1002-0179.201600442.
Shen Q, Chen NY, Li GJ. Application of volume rotation intensity modulated radiation therapy technology in head and neck tumors[J]. West China Med J, 2016, 31(9): 1614−1617. DOI: 10.7507/1002-0179.201600442.[13] 石婷婷, 韩济华, 张艳, 等. 食管癌固定野调强和旋转容积调强计划的剂量学比较[J]. 中国辐射卫生, 2020, 29(1): 89−92. DOI: 10.13491/j.issn.1004-714X.2020.01.021.
Shi TT, Han JH, Zhang Y, et al. Dosimetry comparison of the 5-field IMRT and VMAT planning for esophageal carcinoma[J]. Chin J Radiol Health, 2020, 29(1): 89−92. DOI: 10.13491/j.issn.1004-714X.2020.01.021.[14] 刘路, 王皓, 杨瑞杰, 等. 直肠癌术前固定野容积旋转调强放疗剂量学比较[J]. 中华肿瘤防治杂志, 2017, 24(13): 921−925, 929. DOI: 10.16073/j.cnki.cjcpt.2017.13.008.
Liu L, Wang H, Yang RJ, et al. Dose comparison between fix-field IMRT and VMAT in pre-operation rectum cancer radiation therapy[J]. Chin J Cancer Prev Treat, 2017, 24(13): 921−925, 929. DOI: 10.16073/j.cnki.cjcpt.2017.13.008.[15] 张怀文, 钟晓鸣. 中晚期宫颈癌术后容积旋转调强放疗计划剂量学研究[J]. 实用癌症杂志, 2019, 34(9): 1451−1454. DOI: 10.3969/j.issn.1001-5930.2019.09.018.
Zhang HW, Zhong XM. Dosimetric study of volumetric modulation arc therapy for postoperative cervical cancer[J]. Pract J Cancer, 2019, 34(9): 1451−1454. DOI: 10.3969/j.issn.1001-5930.2019.09.018.[16] 苏晓科, 胡艳微, 谷晓华, 等. 宫颈癌术后容积旋转调强与三维适形调强放疗技术的剂量学差异[J]. 现代肿瘤医学, 2021, 29(4): 675−678. DOI: 10.3969/j.issn.1672-4992.2021.04.029.
Su XK, Hu YW, Gu XH, et al. Dosimetry difference between postoperative volumetric modulated arc therapy and intensity modulated radiotherapy for cervical cancer[J]. Mod Oncol, 2021, 29(4): 675−678. DOI: 10.3969/j.issn.1672-4992.2021.04.029.[17] 武雅琴, 韩晶晶, 朱必清, 等. 宫颈癌腹主动脉旁淋巴结转移静态调强放疗与容积旋转调强放疗的剂量学比较[J]. 南京医科大学学报:自然科学版, 2018, 38(9): 1275−1279, 1291. DOI: 10.7655/NYDXBNS20180920.
Wu YQ, Han JJ, Zhu BQ, et al. Dosimetric study of intensity modulated radiotherapy and volumetric-modulated arc radiotherapy for cervical cancer with para-aortic lymph node metastasis[J]. Acta Univ Med Nanjing (Nat Sci), 2018, 38(9): 1275−1279, 1291. DOI: 10.7655/NYDXBNS20180920.[18] 胡丽娟, 王琪, 张鹏闯, 等. 容积旋转调强放疗与固定野调强放疗在巨块型宫颈癌根治性放疗中的剂量学比较[J]. 现代肿瘤医学, 2020, 28(24): 4321−4325. DOI: 10.3969/j.issn.1672-4992.2020.24.024.
Hu LJ, Wang Q, Zhang PC, et al. Dosimetric comparison of volumetric rotary intensity-modulated radiotherapy and fixed field-intensity-modulated radiotherapy in radiotherapy for large and advanced cervical cancer[J]. Mod Oncol, 2020, 28(24): 4321−4325. DOI: 10.3969/j.issn.1672-4992.2020.24.024.[19] 范娇娇. 局部晚期宫颈癌延伸野容积调强(VMAT)与固定野调强(IMRT)的剂量学比较[D]. 长春: 吉林大学, 2018.
Fan JJ. Dosimetric comparison between volumetric modulated arc therapy and intensity modulated radiation therapy of extended-field radiation for locally advanced cervical cancer[D]. Changchun: Jilin University, 2018.[20] 邓海军, 赵艳群, 罗文娟, 等. 宫颈癌术后IMRT和VMAT放疗技术剂量学研究[J]. 中华肿瘤防治杂志, 2017, 24(10): 708−713. DOI: 10.16073/j.cnki.cjcpt.2017.10.011.
Deng HJ, Zhao YQ, Luo WJ, et al. Research of postoperative patients with cervical cancer dosimetry of IMRT and VMAT radiotherapy technology[J]. Chin J Cancer Prev Treat, 2017, 24(10): 708−713. DOI: 10.16073/j.cnki.cjcpt.2017.10.011.[21] 崔天祥, 金俊余, 徐艳梅, 等. 宫颈癌二弧旋转容积调强与固定7野动态调强的剂量学比较[J]. 第三军医大学学报, 2013, 35(23): 2569−2572. DOI: 10.16016/j.1000-5404.2013.23.020.
Cui TX, Jin JY, Xu YM, et al. Volumetric modulated arc therapy with double arcs vs seven-field fixed-gantry dynamic intensity modulated radiotherapy in cervical cancer: a dosimetric study[J]. J Third Milit Med Univ, 2013, 35(23): 2569−2572. DOI: 10.16016/j.1000-5404.2013.23.020.