【摘要】 目的 比较胸上段食管癌三维适形放射治疗(3D-CRT)与调强放射治疗(IMRT)放疗剂量学的差异,为临床医师选择放疗方案提供参考。方法 收集25例胸上段食管癌病例(临床分期为Ⅰ~Ⅲ期),应用0ncentra三维放射治疗计划系统分别对每一位患者的靶区进行3D-CRT和IMRT治疗计划设计,拟定95%PTV处方剂量为60 Gy。通过剂量体积直方图(DVH)参数,对95%等剂量线所包括的PTV体积百分比(V95)、靶区适形度指数(CI)、剂量不均匀指数(HI)和危及器官所受照射剂量进行对比分析。结果 IMRT和3D-CRT两种不同放疗计划:V95分别为(99.91±0.14)%、(95.73±4.14)%,差异有统计学意义(P<0.05);靶区最大剂量Dmax分别为(6658.26±215.29)cGy、(6664.20±465.16)cGy,差异没有统计学意义(P>0.05);靶区最小剂量Dmin分别为(5458.88±184.06)cGy、(4541.60±599.0)cGy,差异有统计学意义(P<0.05);靶区平均剂量Dmean分别为(6232.80±53.00)cGy、(6105.78±163.34)cGy,差异有统计学意义(P<0.05);CI值分别为(0.76±0.04)、(0.57±0.05),差异有统计学意义(P<0.05);HI值分别为1.07±0.02、1.12±0.06,差异有统计学意义(P<0.05);脊髓最大剂量分别为(3889.68±712.69)cGy、(4337.48±178.49)cGy,差异有统计学意义(P<0.05);双肺V20分别为(20.94±5.32)%、(21.90±6.94)%,差异没有统计学意义(P>0.05);双肺V10分别为(35.39±11.41)%、(29.0±8.80)%,差异有统计学意义(P<0.05),双肺V5分别为(44.95±15.55)%、(37.27±11.93)%,差异有统计学意义(P<0.05)。结论 调强放疗在胸上段食管癌治疗中显示出95%等剂量线所包括的PTV体积、靶区适形度及靶区内平均剂量、脊髓保护方面均优于3D-CRT技术;但是双肺低剂量照射区域有所增加,肺损伤的风险就有可能增大。更多还原

【Abstract】 Objective To compare the dosimetry between three- dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiotherapy(IMRT)in the treatment of upper thoracic esophageal carcinoma,and to provide references to choose radiotherapy program for clinical physician.Methods twenty- five cases with upper esophageal carcinoma(clinical stage Ⅰ- Ⅲ stage) were treated by 3DCRT and IMRT at the concentra three- dimensional radiation treatment planning system.The different exposure doses between target area and effected organs were compared by dose volume hi8togram(DVH)with the planed target volume(PTV).which must reach 95%of the prescriptive doses.Results Two different radiotherapy plans of IMRT and 3DCRT:V95,(99.91 ±0.14)%,(95.73 ±4.14)%respectively,P <0.05;targeting maximum doses(Dmax)were(6658.26± 215.29)cGy,(6664.20 ±465.16)cGy,P >0.05;targeting minimum dose(Dmin) were(5 458.88 ± 184.06)cGy,(4 541.60 ± 599.0) cGy,P < 0.05;targeting average doses(Dmean) were(6 232.80 ± 53.00) cGy and(6 105.78±163.34)cGy,P<0.05.CI values were(0.76 ±0.04) and(0.57 ± 0.05),P <0.05;HI values were(1.07 ± 0.02) and(1.12 ± 0.06),P < 0.05;Spinal cord maximum dose(3 889.68 ± 712.69) cGy,(4 337.48 ± 178.49)cGy,/>< 0.05;Lung V20(20.94 ±5.32)%,(21.90 ± 6.94)%,P >0.05;Lung V10(35.39 ± 11.41)%,(29.0 ±8.80)%,P<0.05,Lung V5(44.95 ± 15.55)%,(37.27 ±11.93)%,P<0.05.Conclusion Intensity- modulated radiotherapy is better than 3DCRT technology in showing PTV volume,target conformal degrees and the mean index,spinal cord protection,However,The risk of lung injury could be increased with the enlarged area of low- dose irradiation in lung.更多还原