Eclipse和Pinnacle计划系统制订的乳腺癌保乳术后容积旋转调强放疗剂量的ArcCHECK验证

ArcCHECK validation of dose of volumetric modulated arc therapy formulated by Eclipse and Pinnacle planning systems after breast conserving surgery

目的应用Eclipse和Pinnacle计划系统制订乳腺癌保乳术后容积旋转调强放疗(VMAT)计划,应用ArcCHECK剂量工具对放疗剂量进行验证,探讨2种计划系统在乳腺癌保乳术后VMAT中的应用价值。方法2022年10月—2023年2月青海大学附属医院保乳术后行VMAT放疗的女性乳腺癌患者24例,分别采用Pinnacle、Eclipse计划系统制订放疗计划,采用剂量体积直方图评价靶区适形度指数、均匀性指数和机器跳数;比较2种计划危及器官的剂量,包括患侧肺V5、V20、最大放疗剂量D_(max)、平均剂量D_(mean),健侧肺V5,心脏V5、V10、V20、D_(max)、D_(mean),健侧乳腺D_(max)、D_(mean),脊髓D_(max)、D_(mean),食管D_(max),臂丛D_(max),左前降支V40,右冠状动脉V40,甲状腺D_(mean),患侧肱骨头V30。应用ArcCHECK剂量验证工具,分析在剂量阈值10%,3%/3mm的标准条件下2种计划的绝对γ通过率。结果(1)Pinnacle计划靶区均匀性指数(0.1907±0.0231)低于Eclipse计划(0.2217±0.0729)(t=1.986,P=0.030),靶区适形度指数(0.8351±0.0112)和机器跳数(372.46±28.23)与Eclipse计划(0.7043±0.0681、320.33±27.42)比较差异均无统计学意义(t=1.986,P=0.651;t=-6.419,P=0.747)。(2)Eclipse计划患侧肺V5、V20、D_(mean),心脏D_(max),健侧乳腺D_(mean),右冠状动脉V40,甲状腺D_(mean),患侧肱骨头V30高于Pinnacle计划(P<0.05),心脏V5、V10、V20、D_(mean),脊髓D_(max),臂丛D_(max)低于Pinnacle计划(P<0.05),余危及器官剂量与Pinnacle计划比较差异均无统计学意义(P>0.05)。(3)Eclipse计划γ通过率[(96.03±0.70)%]与Pinnacle计划[(98.58±0.90)%]比较差异无统计学意义(t=-10.930,P=0.230)。结论乳腺癌患者保乳术后应用Eclipse和Pinnacle计划系统制订VMAT计划均能满足临床应用,达到质量控制要求,Pinnacle计划系统在保护危及器官上优于Eclipse计划系统,Eclipse计划系统靶区剂量均匀性优于Pinnacle计划系统。

Objective To formulate volumetric modulated arc therapy(VMAT)plan by using Eclipse and Pinnacle planning systems after breast conserving surgery for breast cancer,to verify the radiotherapy dose by using ArcCHECK dose tool,and to explore the application values of two planning systems in VMAT after surgery.Methods From October2022 to February 2023,24 female patients with breast cancer received VMAT after breast conserving surgery in Qinghai University Affiliated Hospital.Pinnacle and Eclipse planning systems were used to formulate radiotherapy plans,and dose volume histograms were used to evaluate the conformity index,homogeneity index and machine hops of the target area.The organ-threatening doses of two planning systems were compared including V5,V20,maximum dose(D_(max))and mean dose(D_(mean))to the affected lung,V5 to the healthy lung,V5,V10,V20,and D_(mean)to the heart,D_(max)and D_(mean)to the healthy breast,D_(max)and D_(mean)to the spinal cord,D_(max)to the esophagus,D_(max)to the brachial plexus,V40 to the left anterior descending branch,V40 to the right coronary artery,D_(mean)to the thyroid,and V30 to the affected humeral head.ArcCHECK dosimetry was used to analyze theγpass rates of two planning systems under standard conditions of 10%and 3%/3 mm dose threshold.Results(1)The target area homogeneity index of Pinnacle planning system(0.1907±0.0231)was lower than that of Eclipse planning system(0.2217±0.0729)(t=1.986,P=0.030),and there were no significant differences in conformity index and number of machine hops between Pinnacle planning system(0.8351±0.0112,372.46±28.23)and Eclipse planning system(0.7043±0.0681,320.33±27.42)(t=1.986,P=0.651;t=-6.419,P=0.747).(2)V5,V20 and D_(mean)to the affected lung,D_(max)to the heart,D_(mean)to the healthy breast,V40 to the right coronary artery,D_(mean)to the thyroid,and V30 to the affected humeral head of Eclipse planning system were higher than those of Pinnacle planning system(P<0.05),V5,V10,V20,D_(mean)to the heart,D_(max)to the spinal cord and D_(max)to the brachial plexus of Eclipse planning system were lower than those of Pinnacle planning system(P<0.05),and the other organ-threatening doses showed no significant differences between two systems(P>0.05).(3)There was no significant difference in theγpass rate between Eclipse planning system[(96.03±0.70)%]and Pinnacle planning system[(98.58±0.90)%](t=-10.930,P=0.230),Conclusions The VMAT plans formulated by Eclipse and Pinnacle planning systems after breast conserving surgery can meet the clinical application and quality control requirements.Pinnacle planning system is superior to Eclipse planning system in protecting organs at risk.The homogeneity of target area of Eclipse planning system is better than that of Pinnacle planning system.