多目标优化在宫颈癌放疗中的临床应用分析

Clinical application of multi-criteria optimization in radiotherapy for cervical cancer

目的研究多目标优化在宫颈癌放射治疗中的临床应用。方法回顾性分析山东省肿瘤防治研究院已接受宫颈癌放射治疗的15例患者,于Halcyon平台9野均分重新优化固定野调强计划,以靶区覆盖率95%以上且危及器官受量最低为目标,反复优化直至达到目标(Plan I),利用多目标优化对仅优化一次的计划进行多目标遴选直至达到目标(Plan MI),并执行质量保证验证,采用Wilcoxon秩和检验比较计划的设计时间、靶区覆盖率、危及器官受照剂量和机器跳数。结果2种计划均能达到临床要求。Plan I与Plan MI的靶区剂量指标差异无统计学意义(P>0.05),Plan MI降低了小肠的最大受照剂量0.51 Gy(P<0.05),对于膀胱和直肠的剂量覆盖,2种计划基本相同(P>0.05)。Plan MI比Plan I的计划设计时间节省了34.04 min(P<0.05)。结论多目标优化工具能够提高优化调整能力,明显缩短计划设计时间,提高工作效率。

Objective To investigate the clinical application of multi-criteria optimization(MCO)in radiotherapy for cervical cancer.Methods A retrospective analysis was performed on the clinical data of 15 patients who received radiotherapy for cervical cancer in Shandong Cancer Hospital and Institute.A fixed field intensity-modulated radiotherapy plan was re-optimized using 9 fields on the Halcyon platform,with the goal of achieving a target coverage of>95%and the lowest dose to organs at risk.The plan was refined until it reached the goal(Plan I)and was calculated using MCO to reach the goal(Plan MI),and the quality assurance verification was performed.The Wilcoxon rank-sum test was used to compare design time,target coverage,radiation dose to organs at risk,and number of monitor units between the plans.Results Both plans met the clinical requirements.There were no significant differences in target dose indices between Plan I and Plan MI(P>0.05).Plan MI reduced the maximum dose to the small intestine by 0.51 Gy(P<0.05).There was no significant difference in dose coverage between the bladder and the rectum(P>0.05).Compared with Plan I,Plan MI saved 34.04 min in design time(P<0.05).Conclusion MCO can improve the optimization and adjustment,significantly shorten the design time,and improve the efficiency of the plan.