切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (21) : 2349 -2356. doi: 10.3877/cma.j.issn.1674-0785.2017.21.001

所属专题: 文献

临床论著

颈段和胸上段食管癌调强放射治疗计划的参数优化及模板建立
陈利1, 柳弥2,(), 李贤富1, 田维科2, 赵小庆3   
  1. 1. 637100 四川南充,川北医学院附属医院肿瘤科
    2. 637100 四川南充,川北医学院附属医院健康管理中心
    3. 637100 四川南充,川北医学院
  • 收稿日期:2017-03-23 出版日期:2017-11-01
  • 通信作者: 柳弥

Parameter optimization of intensity-modulated radiotherapy plan in cervical and upper thoracic esophageal cancer

Li Chen1, Mi Liu2,(), Xianfu Li1, Weike Tian2, Xiaoqing Zhao3   

  1. 1. Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637100, China
    2. Health Management Center, Affiliated Hospital of North Sichuan Medical College, Nanchong 637100, China
    3. North Sichuan Medical College, Nanchong 637100, China
  • Received:2017-03-23 Published:2017-11-01
  • Corresponding author: Mi Liu
  • About author:
    Corresponding author: Liu Mi, Email:
引用本文:

陈利, 柳弥, 李贤富, 田维科, 赵小庆. 颈段和胸上段食管癌调强放射治疗计划的参数优化及模板建立[J/OL]. 中华临床医师杂志(电子版), 2017, 11(21): 2349-2356.

Li Chen, Mi Liu, Xianfu Li, Weike Tian, Xiaoqing Zhao. Parameter optimization of intensity-modulated radiotherapy plan in cervical and upper thoracic esophageal cancer[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(21): 2349-2356.

目的

探讨基于Monaco计划系统时颈段、胸上段食管癌予调强放射治疗(IMRT)的最佳优化模板。

方法

根据制定的标准选择2012年10月至2014年10月到川北医学院附属医院放疗科行放射治疗的11例患者,所有入组患者在规定条件下行CT模拟定位,修改、确认靶区后由物理师制作射野数目不同的IMRT计划,将不同计划肿瘤靶区、危及器官及正常组织相关评估参数进行统计并比较分析,从而得到更优的放疗计划。

结果

(1)PTV1体积参数中V95%(%)3野计划明显低于其他放疗计划(P<0.05)。(2)PTV2中各评估参数在各组调强计划中差异无统计学意义(P>0.05)。(3)危及器官中甲状腺、气管及脊髓在不同计划中未见明显区别。(4)肺V10、V20及V30 3野计划受照体积较其他放射野大(P<0.05)。(5)各放疗计划相比,9野计划的治疗时间最长,治疗效率最低(P<0.05)。(6)Patient中V20、V30、V40及V50照射时3野计划高于其他各组放疗计划(P<0.05),而其余参数无明显差异(P>0.05)。

结论

应用医科达Monaco 3.2调强计划系统,放疗计划子野参数限制条件为最小射野面积为4.000 cm2,最小变化面积3.000 cm2,叶片端面最小宽度为0.60 cm,最小跳数为6 MU,在颈段和胸上段食管癌IMRT中,5野及7野计划比较合适。

Objective

To optimize the parameters of Monaco planning system based intensity-modulated radiotherapy (IMRT) plan for cervical and upper thoracic esophageal cancer.

Methods

Eleven esophageal cancer patients treated at the Radiotherapy Department of Affiliated Hospital of North Sichuan Medical College were selected and included in this study. Under specified conditions, all the patients underwent CT simulation. The physicists set the optimization parameters, changed the number of radiation fields to establish different IMRT plans, and analyzed the data on tumor target volume, organs at risk, and normal tissue of different plans to obtain the optimal radiotherapy plan.

Results

The three-field radiotherapy plan had significantly lower V95% (a PTV1 volume parameter) than the other radiotherapy plans (P<0.05). The volume parameters and dose parameters of PTV2 in each IMRT plan had no significant difference (P>0.05). The thyroid gland, trachea, and spinal cord in different irradiation field plans had no significant difference in risk. The irradiated volume of the lungs was the largest in the V10, V20, and V30 three-field plan, and smaller in the five-, seven-, and nine-field plans (P<0.05). Among the IMRT plans, the nine-field plan had the longest therapy time and the poorest therapeutic effect (P>0.05). The undefined normal tissue was larger in the V20, V30, V40, and V50 three-field plan than in the other plans (P<0.05), and there was no significant difference between the plan at V5, V10, and V60, (P>0.05).

Conclusion

Using the Elekta Monaco 3.2 IMRT radiotherapy planning system and selecting the size of 4.000 cm2 as the minimum field, the area of 3.000 cm2 as the minimum change, 0.60 cm as the minimum width of leaf, and 6 MU as the minimum hop number, the five-field and seven-field plans are more suitable than the others in cervical and upper thoracic esophageal cancer.

表1 11例食管鳞癌基本资料
表2 不同照射野PTV1各参数比较(±s
表3 不同照射野PTV2各参数比较(±s
图1 甲状腺剂量体积直方图
表4 不同照射野各危及器官比较(±s
图2 脊髓剂量体积直方图
图3 不同照射野肺比较
图4 肺剂量体积直方图
图5 不同照射野肺的平均剂量比较
图6 不同照射野子野数比较
图7 不同照射野总机器跳数比较
表5 不同照射野未定义正常组织比较(%,±s
图8 不同照射野未定义正常组织比较
[1]
张思维,张敏,李光琳, 等. 2003~2007年中国食管癌发病与死亡分析[J]. 中国肿瘤, 2012, 21(4): 241-247.
[2]
Chen WQ,He YT,Zheng RS, et al. Esophageal cancer incidence and mortlaity in China, 2009 [J]. J Thorac Dis, 2013, 5(1): 19-26.
[3]
陈万青,张思维,曾红梅, 等. 中国2010年恶性肿瘤发病与死亡[J]. 中国肿瘤, 2014, 23(1): 1-10.
[4]
Shimada H,Shiratori T,Okazumi S, et al. Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45 years of experience [J]. J Amer College Surg, 2008, 206(1): 48-56.
[5]
Tong DK,Law S,Wong KH, et al. Current management of cervical esophageal cancer [J]. World J Surg, 2011, 35(3): 600-607.
[6]
Chou SH,Huang MF,Lee KW, et al. Raderyical resection or chemoradiotherapy for cervical esophageal cancer? [J]. World J Surg, 2010, 34(8): 1832-1839.
[7]
王军,韩春,李晓宁, 等. 食管癌调强放射治疗初期疗效分析[J]. 癌症, 2009, 28(11): 1138-1142.
[8]
王玥玥. 三维调强放疗与传统常规放疗治疗食管癌的近期效果比较[J]. 中国当代医药, 2015, 22(6): 65-67.
[9]
孔雁,高红梅. 食管癌放射治疗10年生存分析及不同治疗方式的疗效比较[J]. 肿瘤防治研究, 2015, 42(1): 56-61.
[10]
Peng G,Wang T,Yang KY, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma [J]. Radiother Oncol, 2012, 104(3): 286-293.
[11]
Beziak A,Rumble RB,Rodrigues G, et al. Intensity-modulated radiotherapy in the treatment of lung cancer [J]. Clin Oncol, 2012, 24(7): 508-520.
[12]
蒋俊,权循凤,洪浩, 等. 颈及胸上段食管癌同步加量调强放疗的剂量学研究[J]. 安徽医科大学学报, 2014, 49(3): 392-394.
[13]
宋婉莹. 头颈部肿瘤放射治疗对甲状腺功能影响的临床观察[D]. 长春: 吉林大学, 2011.
[14]
孙华茂,王剑锋,卢彦达, 等. 头颈部肿瘤患者放射治疗早期甲状腺功能减退发生率及其影响因素[J]. 中国老年学杂志, 2014, 34(16): 4487-4489.
[15]
杨晓蓉. 鼻咽癌放射治疗对甲状腺的影响[J]. 中国现代医学杂志, 2012, 22(21): 80-82.
[16]
Lin Z,Wu VW,Lin J, et al. A longitudinal study on the radiation-induced thyroidgland changes after external beam radiotherapy of nasopharyngeal carcinoma [J]. Thyroid, 2011, 21(1): 19-23.
[17]
惠蓓娜,张晓智,王蕊华, 等. 颈段、胸上段食管癌3DCRT/IMRT剂量学比较[J]. 临床肿瘤学杂志, 2012, 17(1): 36-41.
[18]
张武哲,陈志坚,李德锐, 等. 胸上段食管癌调强放疗与适形放疗计划的剂量学比较[J]. 癌症, 2009, 28(11): 1127-1131.
[19]
张瑞,习勉,李巧巧, 等. 胸上段食管癌容积旋转调强和静态调强与三维适形放疗计划的剂量学比较[J]. 中山大学学报(医学科学版), 2012, 33(2): 260-264.
[20]
庄志邈,吕长兴,刘俊. 颈段及胸上段食管癌调强放射治疗计划的比较[J]. 中国医学物理学杂志, 2010, 27(6): 2233-2237, 2290.
[21]
Werner-Wasik M,Paulus R,Curran WJ, et al. Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group(RTOG) database [J]. Clin Lung Cancer, 2011, 12(4): 245.
[22]
Phernammbucq EC,Spoelstra FO,Verbakel WF, et al. Outcomes of concurrent chemoradiotherapy in patients with stage III non-small-cell lung cancer and significant comorbidity [J]. Ann Oncol, 2011, 22(1): 132-138.
[23]
李双双,孔炜伟,刘宝瑞. 放射性肺炎相关预测指标的研究进展[J]. 现代肿瘤医学, 2015, 23(8): 1152-1156.
[24]
Kumar G,Rawat S,Puri A, et al. Analysis of dose-volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT [J]. Jpa J Radiol, 2012, 30(1): 18.
[25]
Allen AM,Czerminska M,Janne PA, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelionma [J]. Int J Radiat Oncol Biol Phys, 2006, 65(3): 640-645.
[26]
Yorke ED,Jackson A,Rosenzweig K, et al. Correlation of dosimetric factors and radiation pneumonitis for non-small-cell lung cancer (NSCLC) patients in a recently completed dose escalation study [J]. Int J Radiat Oncol Biol Phys, 2005, 63(3): 672-682.
[27]
王渊,李晓宁,吕冬婕, 等. 肺低剂量区体积预测急性放射性肺炎价值探讨[J]. 中华放射肿瘤学杂志, 2010, 19(4): 296-300.
[28]
魏旋,李建锋,周琼芳, 等. 非小细胞肺癌三维适形放疗放射性肺损伤剂量学因素分析[J]. 肿瘤防治研究, 2014, 41(7): 762-765.
[29]
Vogelius IR,Bentzen SM. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis [J]. Acta Oncologica, 2012, 51(8): 975-983.
[30]
段晨阳,刘梦颖,吴剑, 等. 肺癌放射性肺炎危险因素的Meta分析[J]. 循证医学, 2013, 13(2): 106-115.
[31]
Romaine C,Nichols Jr,Randal H, et al. Proton therapy for lung cancer [J]. Thoracic Cancer, 2012, 3(2): 109-116.
[32]
Chen YJ,Liu A,Han C, et al. Helical tomotherapy for radiotherapy in esophageal cancer: a preferred plan with better conformal target coverage and more homogeneous dose distribution [J]. Med Dosimetry, 2007, 32(3): 166-171.
[33]
Zhang X,Zhao KL,Guerrero TM, et al. Four-dimensional computed tomography based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer [J]. Int J Radiat Oncol Biol Phys, 2008, 72(1): 278-287.
[1] 刘麾, 赵鹏, 冯静, 胡晓彦, 杜涛, 王凌云. 三维调强放射治疗对急性髓系白血病异基因造血干细胞移植后髓外复发的疗效观察[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 110-115.
[2] 郭小琦, 张璞, 李小军, 余明, 王博. 口服醋酸泼尼松联合局部注射曲安奈德对食管早癌ESD术后食管狭窄及肺部感染的预防疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 288-291.
[3] 陶金华, 陈珊珊, 陈晓四. 阿帕替尼联合替吉奥治疗晚期食管癌的疗效与安全性影响因素评价[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 325-329.
[4] 段伟, 刘飞, 许光源, 程宇豪, 陈星. 食管癌调强放疗计划剂量学参数差异对放射性肺炎发生及严重程度的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 320-324.
[5] 高建平, 王辉, 王淑萍. 定期家庭随访对胸腔镜食管癌术后饮食恢复功能的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(02): 188-192.
[6] 侯超, 潘美辰, 吴文明, 黄兴广, 李翔, 程凌雪, 朱玉轩, 李文波. 早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 383-387.
[7] 单秋洁, 孙立柱, 徐宜全, 王之霞, 徐妍, 马浩, 刘田田. 中老年食管癌患者调强放射治疗期间放射性肺损伤风险模型构建及应用[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 388-393.
[8] 苏鹏, 吕会来, 温士旺, 黄超, 张缜, 田子强. 全腔镜下食管癌根治术围手术期呼吸系统并发症发生的危险因素分析[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(05): 294-298.
[9] 曹旬旬, 费素娟. 食管癌患者肿瘤组织CXCL5和CXCR2的表达与病情和预后的相关性分析[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(05): 299-304.
[10] 王超, 王浩, 孙柏, 袁野, 羌伟光, 石红兵. 卡非佐米联合碘-125粒子照射促进人食管癌细胞KYSE-150凋亡的机制研究[J/OL]. 中华介入放射学电子杂志, 2024, 12(02): 106-113.
[11] 高鹏强, 林军鹏, 王佩元, 林辉, 周航, 魏文巍, 柳硕岩, 王枫. 胸段食管鳞状细胞癌中锁骨上淋巴结转移对预后的影响:一项大型回顾性研究[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 211-218.
[12] 李春光, 杨洋, 李斌, 华荣, 李志刚. 完全腹腔镜下管状胃制作技术在食管癌McKeown手术中的应用[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 219-224.
[13] 卢琪珏, 李斌, 杨超, 华荣, 李春光, 李志刚. 改良Grillo气管重建术在颈段食管癌挽救性食管切除术中的应用[J/OL]. 中华胸部外科电子杂志, 2024, 11(02): 91-95.
[14] 刘石健骢, 甘向峰, 吕良湛, 曹庆东. 机器人辅助充气式纵隔镜联合腹腔镜食管癌切除术初步探索[J/OL]. 中华胸部外科电子杂志, 2024, 11(02): 104-108.
[15] 黄志宁, 王高祥, 崔世军, 柳常青, 孙效辉, 徐美青, 解明然. 术前纤维蛋白原与前白蛋白比值对可切除食管鳞癌患者预后的影响[J/OL]. 中华胸部外科电子杂志, 2024, 11(01): 23-30.
阅读次数
全文


摘要