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-  2017 

多剂量水平鼻咽癌容积调强与动态调强放射治疗剂量比较及传输效能分析

DOI: doi:10.7507/1001-5515.201607004

Keywords: 鼻咽癌, 多剂量水平, 容积旋转调强, 质量保证

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Abstract:

本研究目的为系统地比较双弧容积旋转调强放射治疗(VMAT)与动态调强放射治疗(d-IMRT)两种技术方法在多剂量水平鼻咽癌(NPC)计划质量和传输效能上的异同,分析靶体积与计划质量差异的相关性。为 20 例 2014 年—2015 年在本机构进行过 4~5 剂量水平全颈同步加量(SIB)调强放疗的 NPC 患者重新设计双弧 VMAT 计划,其逆向优化条件与设计 IMRT 计划时相同。然后对两组计划的靶区和危及器官(OAR)的剂量参数、传输效能进行了比较,用三维剂量验证系统进行了质量保证验证,分析肿瘤靶体积与计划质量差异的相关性。结果显示,双弧 VMAT 靶区的适形度指数(CI)优于 d-IMRT(P < 0.05),未发现两者差异与靶体积明显相关( P > 0.05)。VMAT 在靶区 PTV 1、PGTVnd 和 PTV3 的剂量分布与 d-IMRT 相似或前者略好。VMAT 降低了 PTV2 剂量,均匀指数(HI)变差。对脊髓、脑干等,VMAT 有更好的保护作用,但会增加腮腺剂量。d-IMRT 计划跳数为 VMAT 计划的 3.32 倍,出束时间为 VMAT 计划的 2.19 倍。在 COMPASS? 质量保证(QA)验证中,VMAT 与 IMRT 计划的靶区 γ(3 mm,3%)通过率均大于 97%。本研究结果表明,VMAT 和 d-IMRT 两种技术对多水平处方剂量 NPC 患者的治疗效果相差不大,VMAT 能提高靶区的适形度,但使除颈部转移淋巴结外的颈部靶区剂量覆盖率和剂量分布变差。VMAT 的 QA 优于 d-IMRT,且 VMAT 在传输效率上也明显高于 d-IMRT

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