不同放疗技术治疗老年非小细胞肺癌的剂量学对比

Dosimetric Comparison of Different Radiotherapy Techniques in the Treatment of Elderly Non-small Cell Lung Cancer

目的对比三维适形放疗(3D-CRT)、调强放疗(IMRT)对老年非小细胞癌(NSCLC)患者靶区和正常组织剂量学的影响。方法选取2019年5月至2021年5月在商丘市第四人民医院治疗的88例NSCLC患者,按随机数表法分为3D-CRT组(44例)和IMRT组(44例)。3D-CRT组接受3D-CRT技术放疗,IMRT组接受IMRT技术放疗,比较两组患者靶区剂量参数[靶区最大剂量(PTV D_(max))、靶区最小剂量(PTV D_(min))、靶区平均剂量(PTV D_(mean))、靶区适形指数(CI)、靶区剂量均匀性指数(HI)]和正常组织受照剂量参数[肺组织受量(V_(5)、V_(15)、V_(20)、V_(30))、食管受量(V_(50)、V_(60))、心脏受量(V_(40)、V_(60))、脊髓最大受量(D_(max))、脊髓平均受量(D_(mean))],比较两组治疗6周时的疾病缓解率。结果与3D-CRT组比较,IMRT组PTV D_(max)、PTV D_(min)、PTV D_(mean)、CI与HI升高(P<0.05);与3D-CRT组比较,肺V_(20)、肺V_(30)、食管V_(60)、心脏V_(40)、心脏V_(60)、脊髓D_(max)与脊髓D_(mean)均降低(P<0.05);比较两组肺V_(5)与肺V_(10),差异无统计学意义(P>0.05);对比两组疾病总缓解率,差异无统计学意义(P>0.05)。结论3D-CRT与IMRT技术治疗老年NSCLC患者疗效相当,但与3D-CRT技术相比,IMRT技术可提高患者靶区剂量,减少正常组织受照射剂量参数,保护靶区周围正常组织和器官。

Objective To compare the effects of three-dimensional conformal radiotherapy(3D-CRT)and intensity modulated radiotherapy(IMRT)on target and normal tissue dosimetry in elderly patients with non-small cell carcinoma(NSCLC).Methods A total of 88 patients with NSCLC treated in Shangqiu Fourth People’s Hospital from May 2019 to May 2021 were selected and divided into 3D-CRT group(44 cases)and IMRT group(44 cases)by a random number table method.The 3D-CRT group received 3D-CRT radiotherapy,and the IMRT group received IMRT radiotherapy.The target dose parameters[target maximum dose(PTV D_(max)),target minimum dose(PTV D_(min)),target mean dose(PTV D_(mean)),target conformal index(CI),target homogeneity index(HI)]and normal tissue dose parameters[lung tissue dose(V_(5),V_(15),V_(20),V_(30)),esophageal dose(V_(50),V_(60)),cardiac dose(V_(40),V_(60)),spinal cord maximum dose(D_(max)),spinal cord mean dose(D_(mean))]of patients in both groups were compared.The disease remission rate of the two groups at 6 weeks of treatment was compared.Results Compared with 3D-CRT group,PTV D_(max),PTV D_(min),PTV D_(mean),CI and HI were increased in IMRT group(P<0.05).Compared with 3D-CRT group,lung V_(20),lung V_(30),esophagus V_(60),heart V_(40),heart V_(60),spinal cord D_(max) and spinal cord D_(mean) were decreased(P<0.05).There was no difference in lung V_(5) and V_(10) between the two groups(P>0.05).There was no difference in the total remission rate between the two groups(P>0.05).Conclusion 3D-CRT is as effective as IMRT in the treatment of elderly patients with NSCLC,but compared with 3D-CRT,IMRT can increase the target dose of patients,reduce the radiation dose parameters of normal tissues,and protect the normal tissues and organs around the target area.