脑转移瘤全脑二野逆向调强、二野正向调强、二野常规放疗的疗效、剂量学及费用的对比研究

A Comparative Study on the Efficacy,Dosimetry and Cost of Two-field Reverse Intensity Modulation,Two-field Forward Intensity Modulation and Two-field Conventional Radiotherapy for Brain Metastases

目的:比较三种二野全脑放疗技术在生存、剂量学、费用方面的差异。方法:通过回顾性分析2016年3月至2021年3月,宜春市人民医院收治的脑转移患者92例。按放疗技术不同分逆向调强、正向调强、常规放疗三组,比较三组一般临床特征、危及器官、放疗参数、费用以及OS和iPFS。结果:①调强的OS和iPFS均优于常规计划(P<0.05),而正向和逆向调强相近(P>0.05)。②逆向调强计划的CI、HI优于正向调强,而正向又优于常规计划(P<0.05);但常规计划在子野数、机器跳数、治疗时间方面少于正向,而正向又少于逆向调强计划(P<0.05)。调强计划的危及器官最高剂量均低于常规计划,而逆向又低于正向调强计划。③费用逆向调强多于正向,而正向又多于常规计划;但效费比常规计划最低(P<0.05),逆向和正向调强计划相近(P>0.05)。结论:正向调强计划具有设计相对简单易行、剂量分布较均匀、危及器官剂量低、生存期长、性价比较高等特点。故三种全脑二野放疗技术优选正向调强。

Objective:To compare the differences in survival,dosimetry and cost of three two-field whole brain radiotherapy techniques.Methods:92 patients with brain metastases admitted to Yichun People’s Hospital from March 2016 to March 2021 were retrospectively analyzed.According to different radiotherapy techniques,the objects were divided into three groups:reverse intensity modulation group,forward intensity modulation group and conventional radiotherapy group.The general clinical characteristics,organs at risk,radiotherapy parameters,cost,OS and iPFS of the three groups were compared.Results:(1)The OS and iPFS of intensity modulation plan were superior to the conventional(P<0.05),but the reverse and forward intensity modulation were similar(P>0.05)(2)The CI and HI of the reverse plan were superior to the forward plan and then better than the conventional plan(P<0.05).Howev-er,the subfield number,machine jump number and treatment time of the conventional plan were smaller than those of the forward and then the reverse intensity modulation plan(P<0.05).The maximum dose of organs at risk in the intensity modulation plan was lower than that in the conventional plan,and the reverse dose was lower than that in the positive intensity modulation plan.(3)The cost of the reverse intensity modulation was stronger than that of forward intensity modulation,and the Cost-effectiveness ratio was the lowest than that of conventional plan(P<0.05),and the reverse intensity modulation was similar to that of forward intensity modulation(P>0.05).Conclusion:The forward intensity modulation plan is simple and easy to design,and has the advantages of low endangering organ dose,moderate machine loss,long survival time and high cost performance.Therefore,the forward intensity modulation technique is recommended for two-field radiotherapy of whole brain.