胰腺癌三种精确放疗计划剂量学比较与分析

Comparation and analysis of three precise radiotherapy for pancreas carcinoma pationts

目的:分析胰腺癌三维适形放疗(three dimention conform radiotherapy,3DCRT)治疗计划、5野调强放疗(5beamIMRT)治疗计划和7野调强放疗(7beamIMRT)治疗计划,确定患者选择合适的放射治疗方法。方法:对10例胰腺癌的患者分别制定3DCRT、5beamIMRT和7beamIMRT治疗计划,对其计划的靶区剂量分布和危及器官的差异进行评估。结果:V110%剂量区3DCRT剂量高于5beamIMRT和7beamIMRT,差异有统计学意义,P=0.001。7beamIMRT的CI值均大于3DCRT和5beamIMRT,其适形度最好,而3DCRT的CI值较5beamIMRT略高,适形度较5beamIMRT好,差异有统计学意义,P<0.001。7beamIMRT的HI值均低于3DCRT和5beamIMRT,差异有统计学意义,P<0.001。肝脏D1/3剂量区3DCRT高于5beamIMRT和7beamIMRT,差异有统计学意义,P=0.003。肝脏Dmean区3DCRT高于5beamIMRT和7beamIMRT,差异有统计学意义,P=0.025。脊髓Dmax区7beamIMRT高于5beamIMRT和3DCRT,差异有统计学意义,P<0.001。结论:7beamIMRT在靶区处方剂量、CI、HI、肝脏受量上优于3DCRT及5beamIMRT;3DCRT脊髓受量上优于5beamIMRT和7beamIMRT,双肾受量D1/3、D1/2上7beamIMRT要低于5beamIMRT和3DCRT;7beamIMRT所需跳数做多;7beamIMRT对于胰腺癌癌放疗具有放射物理优势。

OBJECTIVE：To choose appropriate radiation therapy for pancreatic cancer patients through the compara tive analysis of three dimensional conformal therapy 3DCRT,5beam intensity modulated radiation treatment planning and 7beam intensity modulated treatment plan. METHODS： Ten cases of pancreatic cancer patients were formulated three di mensional conformal, 5beam intensity modulated and 7beam intensity modulated treatment plan respectively. Dose distribu tion and risks of the organs were evaluated. RESULTS：The results showed that dose of 3DCRT of Vl10%dose area was higher than that of 5beam IMRT and 7beam IMRT（P0. 001）. 7beamIMRT showed better dose uniformity and conform ity in CI and HI than that of 3DCRT and 5beamIMRT（P〈0. 001）. 7beamIMRT showed lower dose in 1/3 of liver re ceived dose compared with 3DCRT and 5beamIMRT （P=0. 003）. 7beamIMRT showed lower dose at mean liver received dose compared with 3DCRT and 5beamIMRT （P0. 025）. 3DCRT showed lower dose in maximum dose of spinal cord compared with 7beam IMRT and 5beamIMRT（P〈0. 001）. It showed that 7beamIMRT was superior to 3DCRT and 5beamIMRT in target prescription dose distribution, CI, HI and kidney received dose, 3DCRT was superior to 5beamIMRT and 7beamIMRT in maximum spinal cord received dose. CONCLUSIONS： 7beamIMRT has showed lower dose than that of 5beamIMRT and 3DCRT in 1/3 of kidney received dose and 1/2 Of right kidney received dose. The results data of 7beamIMRT showed more radioactive advantage for pancreative patients in physiologytherapy.