【摘要】 目的:探讨非小细胞肺癌（non-small cell lung cancer,NSCLC）胸内不同三维空间位置原发肿瘤靶区选择精确放射治疗的优势。方法:2006年11月至2009年7月完成调强适形放疗（IMRT）或三维适形放疗（3D-CRT）的51例初治的Ⅲ期+Ⅳ期NSCLC患者,将已完成的IMRT和3D-CRT计划病例分别重新设计三维适形放疗（r3DCRT）和调强放疗（rIMRT）计划,统计分析两组放射性肺损伤发生率,在射野数目、方向、靶区和危及器官的剂量体积相似时的正常肺剂量体积变化。结果:按"坐标"分区后不论3D-CRT组还是IMRT组,IMRT的肺V₂₀显著低于3D-CRT（均P<0.05）,多数空间分布病灶的平均肺剂量也显著降低;IMRT组在内区、中区病灶的肺V₅₀显著降低（均P<0.05）,而外区、上下区相似;rIMRT的肺V5在外区、中区、内区显著低于3 D-CRT（均P<0.05）;两组放射性肺损伤发生率无显著性差异。结论:对Ⅲ+Ⅳ期NSCLC不同三维空间位置胸内病灶,相同计划设计参数条件下IMRT显著降低正常肺剂量体积,尤其是原发肿瘤位于内区和中区时的优势更明显。更多还原

【Abstract】 Objective:To study the precise radiotherapy in three dimensional different spatial location of thoracic target for stage Ⅲ-Ⅳ non-small cell lung cancer(NSCLC) through comparison of lung injury incidence and lung dose-volume parameters.Methods:Fifty-one stage Ⅲ + Ⅳ untreated NSCLC patients accepted IMRT or 3D-CRT treatment from November 2006 to July 2009.Completed IMRT or 3D-CRT plans was redesigned as r3D-CRT or rIMRT plans respectively.The radiation pulmonary injury incidence and the lung dose-volume parameters under the similar beam number and direction,target dose and risk organ dose volume were analyzed.Results:By setting the "coordinates" partitions on the completed and redesigned plans,lung V20 were significantly lower in IMRT than in 3D-CRT(P <0.05),mean lung dose at different spatial partitions also showed significantly lower tendency in IMRT than in 3D-CRT(P <0.05);Lung V50 were significantly lower in IMRT than that in r3D-CRT in middle area and internal area of lung(P < 0.05) but similar in IMRT and r3D-CRT in outside area,upper and lower area.Lung V5 were significantly lower in rIMRT group than in 3D-CRT group in outside area,middle area and internal area of lung(P < 0.05).There was no significant difference of acute radiation pneumonitis and pulmonary fibrosis incidence in IMRT group and in 3D-CRT group.Conclusion:For a different threedimensional spatial location of intrathoracic lesions in III + IV NSCLC,the same plan design parameters under the conditions of IMRT significantly reduce the normal lung dose volume.This advantage is more obvious when the primary tumor is located in the internal area and middle area of lung.更多还原