非小细胞肺癌不同放射治疗计划的剂量学研究.DOCVIP

临床医学论文-非小细胞肺癌不同放射治疗计划的剂量学研究 【摘要】? 目的 研究比较非小细胞肺癌(NSCLC)不同照射方法的优劣。方法 应用Topslane三维治疗计划系统，对经病理证实的30例NSCLC患者均设计四种放射治疗计划：常规放疗、常规加三维适形放疗、三维适形选择性淋巴结照射（ENI）和三维适形累及野照射（IFI）。各计划总放疗剂量均为66Gy。通过剂量体积直方图(DVH)、靶区适形指数(CI)、 肿瘤控制概率(TCP)正常组织并发症概率(NTCP)评价各治疗计划效果。结果 常规放疗、常规加适形放疗、ENI和IFI的CI分别为0.09、0.15、0.21、0.27；TCP分别为94.7%、96.9%、97.1%、97.5%；全肺接受≥20Gy照射体积百分比(V20)分别为25.7%、25.1%、23.6%、21.8%；NTCP分别为7.8%、7.9%、6.8%、5.6%；食管接受≥45Gy照射体积百分比(V45)分别为31.3%、31.0%、23.2%、19.7%；心脏受照射平均剂量分别为25.7Gy、24.7Gy、15.1Gy、14.3Gy；脊髓受照射的最大剂量分别为42.6Gy、42.1Gy、39.4Gy、38.4Gy。结论 三维适形放射治疗较常规放射治疗提高了靶区的照射剂量和肿瘤控制概率，可降低正常组织受照剂量和正常组织并发症的概率。 【关键词】? 非小细胞肺癌；放射疗法；适形；剂量体积直方图 　　Abstract： Objective? Using three dimensional treatment planning system,to assess the dosimetric of different radiation therapy planning and to obtain a better technique in the treatment of non- small cell lung cancer. Methods?Using the Topslane treatment planning system,thirty pathologically proved patients of non-small cell lung cancer were selected in this study. Four different methods of radiotherapy planning were used for each case, which were conventional radiation, conventional plus conformal radiation, elective nodal irradiation (ENI) and involved-field irradiation (IFI). The total radiation dose was 66 Gy. Dose volume histogram(DVH), nomal tissue complication probability(NTCP), tumor control probability (TCP) and conformity index (CI) were used to assess the target volume dosimetric distribution and NTCP. Results? TCP of conventional radiation，conventional plus conformal radiation，ENI and IFI groups were 94.7%，96.9%，97.1%，97.5%；CI were 0.09，0.15，0.21，0.27, respectively；the total lung volume received radiation 20 Gy(V20)were 25.7%，25.1%，23.6%，21.8%；NTCP were 7.8%，7.9%，6.8%，5.6%, respectively.The total esophageal volume received radiation 45Gy(V45) were 31.3%，31.0%，23.2%，19.7%. The mean dose at the heart were 25.7Gy，24.7Gy，15.1Gy，14.3Gy. The maximum dose at the spinal cord were 42.6Gy，42.1Gy，39.4Gy，38.4Gy. Conclusion? Compared with the conventional radio