离线自适应在食管癌放射治疗中的临床应用

The clinical application of off-line adaptive in esophageal carcinoma radiotherapy

收集未行手术的食管癌初治患者行自适应放射治疗,分别采集每位患者第1次放疗前、第8次放疗后和第16次放疗后的CT扫描图像勾画靶区,制定P1、P2、P3 3次治疗计划。通过比较3次计划间计划靶区(PTV)体积与剂量学差异、危及器官受照剂量学差异来观察并探讨自适应放疗在食管癌治疗上的临床价值。结果显示,3组计划中,靶区体积及靶区剂量差异无统计学意义,但平均剂量(D_(mean))有逐渐增大并接近计划剂量64 Gy的趋势。靶区的剂量均匀性指数(HI)、靶区适形度指数(CI)差异均无统计学意义,但Cl值有逐渐增大并接近1的趋势;心脏V_(40)差异无统计学意义。双肺V_5、V_(10)、V_(20)、V_(30)差异无统计学意义。脊髓D_(max)差异有统计学意义(P=0.013)。表明食管癌的离线自适应放疗对靶区剂量及体积影响不明显,但对危及器官脊髓保护较好。

This study had taken six esophageal cancer patients, without being treated by any surgery, but treated by the off-line adaptive radiotherapy as cases. According to the collected CT images of each patient before the first time radiotherapy, after the eighth time radiotherapy and after the sixteenth time radiotherapy, this study had drawn the target regions and made three groups therapy plans, respectively named P1, P2 and P3. Through comparing and observing the differences of volume and dosimetry of planning target volume （PTV） , and the differences of do- simetry of organ at risk（OAR） in the three groups plans,this thesis had studied the clinical significance of the ap- plication of the off - line adaptive radiotherapy on the esophageal cancer patients. In accordance with above results of the three groups plans, there was no statistical significance between differences of volume and dosimetry of PTV, but the D showed an increasing trend and approached to the dose of 64 Gy; there was no statistical significance in the HI and the CI as well, but the figure of the CI had an increasing tendency and approached to 1 ; there was no statistical significance in V40 of hearts; there was also no statistical significance in V5, V110, V20 and V30 of bilateral lung. However, there was some statistical significance in Dmax of spinal cords （P = 0. 013 ）. As the above research demonstrates, the off-line adaptive radiotherapy on the esophageal carcinoma patients has little effect on dosimetry and volume of PTV, but has good effect on the protection of the spinal cords.