食管癌调强放疗中心脏及肺损伤的相关因素分析

Dosimetry research of injury of hearts and lungs in patients with esophageal cancer treated with IMRT

目的观察食管癌调强放疗(IMRT)中心脏及肺组织受量上的情况,对其相关因素进行分析,探讨食管癌放射治疗理想的计划模式。方法采用TopslaneVenus调强放疗系统,对29例首程治疗食管癌病人设计动态调强放射治疗计划,均做全组处方剂量60～68Gy,在规定计划靶区(PTV)达到95%处方剂量前提下,用剂量体积直方图(DVH)比较肺及心脏组织受照射时剂量体积与损伤关系,以及临床因素与心脏及肺损伤关系。结果与放射性肺损伤有关的因素最大剂量(Dmax)、最小剂量(Dmin)、平均剂量(Dmean)、肺V10、V20、V30中,V20、V30、Dmean的参数有显著性差异。与放射性心脏损伤有关的因素最大剂量(Dmax)、最小剂量(Dmin)、平均剂量(Dmean)、心脏V45、V60、V75、V90中,V45、V60、V75、V90、Dmean、Dmin的参数有显著性差异。结论剂量学因素可以较好地预测放射性心、肺损伤的发生。其中肺Dmean,V30,V20的剂量是放射性肺损伤的关键因素;心脏的V45、V60、V75、V90、Dmean、Dmin是放射性心脏损伤的关键因素。

Objective To observe the influence of the doses of risk organs such as hearts and lungs to their functions in patients with esophageal cancer with IMRT.Methods To design IMRT plans which tumour dose are 60～68 Gy for 29 patients with esophageal cancer and analyze the relationships of injury of lungs and hearts and the irradiated volume of them with DVH on the conditions of 95% turmor dose covers PTV.Results V20,V30,Dmean of lung have significant difference for radioactivity injury of lungs in these pertinent factors such as Dmax,Dmin,Dmean,V10,V20,V30.V45,V60,V75,V90,Dmean,Dmin of heart have significant difference for radioactivity injury of hearts in these pertinent factors such as Dmax,Dmin,Dmean,V45,V60,V75,V90.Conclusions Dosimetry factor can predict well the occurrence of injure of hearts and lungs.V20,V30,Dmean of lung are important factors for injury of lung.V45,V60,V75,V90,Dmean,Dmin of heart are important factors for injury of heart.