固定野动态调强放疗治疗局部晚期非小细胞肺癌效果及其对剂量学与适形度影响

Effect of fixed-field dynamic intensity-modulated radiotherapy in patients with locally advanced non-small cell lung cancer and its effect on dosimetry and conformity

目的探究固定野动态调强放疗(IMRT)应用于局部晚期非小细胞肺癌患者的效果及对适形度、剂量学、安全性的影响。方法选取2020-09-01-2021-11-30河南宏力医院肿瘤放疗科局部晚期非小细胞肺癌患者83例为研究对象,根据治疗方法不同分为三维适形放疗(3D-CRT)组(41例)和IMRT组(42例)。2组均实施同步放化疗。对比2组患者临床疗效;剂量学指标:计划靶区最小剂量、最大剂量、平均剂量;适形度:适形度指数(CI)、均质性指数(HI);放疗剂量-体积相关参数:患侧肺分别接受5、20、30Gy时照射体积占全肺体积的百分比(V_(5)、V_(20)、V_(30));安全性指标。采用SPSS 23.0对数据进行统计学分析。结果IMRT组总有效率为80.95%,高于3D-CRT组的56.10%,差异有统计学意义,χ^(2)=4.858,P=0.028;CI值为(0.79±0.05),高于3D-CRT组的(0.60±0.02),差异有统计学意义,t=22.827,P<0.001;HI值为(1.20±0.03)高于3D-CRT组的(1.00±0.01),差异有统计学意义,t=40.938,P<0.001。治疗后IMRT组V_(5)为(36.77±5.48)%,高于3D-CRT组的(32.10±6.20)%,差异有统计学意义,t=3.638,P=0.001;V_(20)为(18.98±4.02)%,高于3D-CRT组的(16.05±3.11)%,差异有统计学意义,t=3.708,P<0.001;V_(30)为(13.11±2.98)%,高于3D-CRT组的(10.16±2.53)%,差异有统计学意义,t=4.856,P<0.001。IMRT组计划靶区最小剂量为(4529.36±422.73)cGy,与3D-CRT组的(6548.23±331.75)cGy比较,差异无统计学意义,t=0.287,P=0.775;计划靶区最大剂量为(6546.30±329.86)cGy,与3D-CRT组的(4502.78±419.66)cGy比较,差异无统计学意义,t=0.027,P=0.980;计划靶区平均剂量为(6085.50±441.22)cGy,与3D-CRT组的(6052.44±425.71)cGy比较,差异无统计学意义,t=0.347,P=0.729。2组患者胃肠道反应、骨髓抑制、放射性食管炎、放射性肺炎不良反应发生率比较,差异无统计学意义,均P>0.05。结论IMRT与3D-CRT具有同等剂量学效果,且未对患者机体产生严重不良反应,安全性高;但IMRT对局部晚期非小细胞肺癌治疗具有靶区适形度优势。

Objective To investigate the effect of fixed-field dynamic intensity modulated radiotherapy(IMRT)in patients with locally advanced non-small cell lung cancer(NSCLC)and its influence on conformity,dosimetry and safety.Methods Totally 83patients with locally advanced NSCLC were selected from 2020-09-01-2021-11-30in the Department of Radiation Oncology,Henan Hongli Hospital,and divided them into three-dimensional conformal radiotherapy(3D-CRT)group(41cases)and IMRT group(42cases)according to different treatment methods.Both groups were treated with concurrent chemoradiotherapy.The clinical efficacy,dosimetry indicators(the minimum dose,maximum dose,and average dose in the planned target volume),conformity[conformity Index(CI),inhomogeneity Index(HI)]dose-volume related parameters(V_(5),V_(20),V_(30)of the affected lung),and safety indicators of the two groups of patients were compared;SPSS23.0statistical software was used to analyze the data in both groups.Results The total effective rate in the IMRT group was 80.95%,higher than that in the 3D-CRT group(56.10%),and the difference was statistically significant(χ^(2)=4.858,P=0.028);the CI value of the IMRT group was(0.79±0.05),which was higher than that of the 3D-CRT group(0.60±0.02),the difference was statistically significant(t=22.827,P<0.001);the HI value of the IMRT group was(1.20±0.03),higher than that of the 3D-CRT group(1.00±0.01),the difference was statistically significant(t=40.938,P<0.001);the posttreatment V_(5)of the IMRT group was(36.77±5.48)%,which was higher than that of the 3D-CRT group(32.10±6.20)%,and the difference was statistically significant(t=3.638,P=0.001);the V_(20)of IMRT group was(18.98±4.02)%,higher than 3D-CRT group(16.05±3.11)%,and the difference was statistically significant(t=3.708,P<0.001);V_(30)of IMRT group was(13.11±2.98)%,higher than The 3D-CRT group of(10.16±2.53)%,and the difference was statistically significant(t=4.856,P<0.001);the minimum dosage in planned target volume were(4529.36±422.73)cGy in the IMRT group and(6548.23±331.75)cGy in the 3D-CRT group(6548.23±331.75),and there was no significant difference in the minimum dose between the two groups(t=0.287,P=0.775);there was no significant difference in maximum dosage in the planned target volume between IMRT group(6546.30±329.86)cGy and 3D-CRT group(4502.78±419.66)(t=0.027,P=0.980);there was no significant difference in the mean dose of planned target volume in the IMRT group(6085.50±441.22)cGy compared with the 3D-CRT group(6052.44±425.71)cGy(t=0.347,P=0.729);the incidences of gastrointestinal reactions,bone marrow suppression,radiation esophagitis and radiation pneumonitis in the two groups were not statistically significant(all P>0.05).Conclusions IMRT radiotherapy has the same dosimetric effect as 3D-CRT radiotherapy.IMRT has no serious adverse reactions to the patient's body,and is safe in treatment.In addition,IMRT has the advantage of target conformity in the treatment of locally advanced NSCLC.