非均整模式联合呼吸门控对立体定向放疗早期非小细胞肺癌患者摆位误差及剂量分布的影响

Influence of flattening filter free mode combined with active breathing control on setup error and dose distribution in patients with early stage non-small cell lung cancer in stereotactic radiotherapy

目的:研究了非均整模式(FFF)联合呼吸门控(ABC)对立体定向放疗(SBRT)早期非小细胞肺癌(NSCLC)患者摆位误差及剂量分布的影响。方法:纳入早期NSCLC患者64例,根据放疗方法的不同分为对照组和ABC组各32例。对照组在SBRT中行FFF模式,ABC组在SRBT中行FFF联合ABC治疗。比较两组的靶区体积、摆位误差、靶区的剂量分布、危及器官(OAR)剂量分布以及安全性。结果:ABC组大体肿瘤体积(GTV)、计划靶体积(PTV),头脚、左右、前后的摆位误差均低于对照组,差异具有统计学意义(均P<0.05)。ABC组靶区D min、适形指数(CI)均高于对照组,差异具有统计学意义(均P<0.05)。ABC组脊髓、食管、心脏、近端支气管树(PBT)、患侧肺以及健侧肺的剂量分布参数均低于对照组,差异具有统计学意义(均P<0.05)。ABC组不良反应发生率明显高于对照组,差异具有统计学意义(P<0.05)。结论:FFF模式联合ABC应用于早期NSCLC患者SBRT治疗中,可有效缩小靶体积、摆位误差,降低对OVR的照射量,且安全性好。

Objective:To investigate the effect of flattening filter free(FFF)mode combined with active breathing control(ABC)on the setup error and dose distribution in patients with early-stage non-small cell lung cancer(NSCLC)undergoing stereotactic radiotherapy(SBRT).Methods:A total of 64 patients with early stage NSCLC were included and divided into control group and ABC group according to different radiotherapy methods,with 32 cases in each group.The control group underwent FFF mode in SBRT,and the ABC group underwent FFF combined with ABC treatment in SRBT.The target volume,setup error,target dose distribution,organ at risk(OAR)dose distribution and safety were compared between the two groups.Results:The gross tumor volume(GTV),planned target volume(PTV),head-to-foot,left-right,and front-to-back positioning errors in the ABC group were lower than those in the control group(all P<0.05).The target volume D min and CI in the ABC group were higher than those in the control group(all P<0.05).The dose distribution parameters of spinal cord,esophagus,heart,proximal bronchial tree(PBT),ipsilateral lung and healthy lung in ABC group were lower than those in control group(all P<0.05).The incidence of adverse reactions in the ABC group was significantly higher than that in the control group(P<0.05).Conclusion:The application of FFF mode combined with ABC in SBRT treatment of early NSCLC patients can effectively reduce the target volume,setup error,and reduce the exposure to OVR,with good safety.