【摘要】 目的:研究Monaco放射治疗计划系统中控制点（CP）不同取值对中下段食管癌动态调强放疗（dIMRT）计划的剂量学影响。方法:选取2023年1-6月在商洛市中心医院接受动态调强放疗的13例中下段食管癌患者,在Monaco放疗计划系统中对每例患者分别以CP限值为10、20、30、40、50、60、80、130和200设计9组dIMRT计划,除CP参数外其他优化参数均保持不变,分析靶区和危及器官（OAR）肺部、心脏和脊髓的剂量差异。结果:随着CP限值的增大,靶区最大剂量即2%靶区体积的受照剂量(D_2%)、平均剂量即50%靶区体积的受照剂量(D_50%)和剂量均匀性指数（HI）呈先减小然后趋于平稳;靶区最小剂量即98%靶区体积的受照剂量(D_98%)和靶区适形度指数（CI）呈先增大然后趋于平稳;OAR的各剂量指标差异均无统计学意义（P>0.05）;肺部5、10、20、30Gy剂量的体积百分比(V₅、V₁₀、V₂₀、V₃₀)变化范围分别为1.13%、0.75%、0.29%和0.19%,肺部平均剂量(V_mean)最大偏差18.7 cGy;心脏V₁₀、V₂₀、V₃₀、V₄₀变化范围分别为2.2%、1.23%、1.39%和1.12%,心脏V_mean最大偏差63.85 cGy,脊髓D_max最大偏差70.78 cGy.9组计划实际控制点个数（CP_s）、计划执行时间（DT）、计划复杂度机器跳数与实际控制点个数比值（MU/CP_s）比较,差异具有统计学意义（F=2.857、25.145、135.467,P<0.05）。结论:在中下段食管癌dIMRT计划中,最大CP值设定为40～50,在满足靶区和OAR剂量的前提下能够减少计划的优化时间、子野数目和患者的治疗时间。更多还原

【Abstract】 Objective:To study the dosimetry effects of differently selected values of control point（CP） in Monaco radiotherapy planning system on dynamic intensity modulated radiation therapy（dIMRT） for esophageal cancer of middle and lower segment.Methods:Thirteen patients with esophageal cancer at middle and lower segment who received dIMRT in Shangluo Central Hospital from January to June 2023 were selected.In the Monaco radiotherapy planning system,nine groups of dIMRT plans were designed for each patient according to the 9 kinds of CP limit values（10,20,30,40,50,60,70,80 and 90）.There were not changes in other optimized parameters except CP parameter.The differences of the dosimetry between target region and organs at risk（OAR） included lung,heart and spinal cord were analyzed.Results:With the increase of the CP limit value,the maximum dose of the target region which was radiation dose(D_2%) of 2% volume of target region,the mean dose,which was radiation dose(D_50%) of 50% volume of target region,and the homogeneity index（HI） appeared a trend of gradual stability after reduction,and the radiation dose(D_98%) of 98% volume of target region which was the minimum dose of target region and the conformance index（CI）appeared a trend of gradual stability after increase.There was not significant in each dose indicator of OAR（P>0.05）.The variation ranges of lung at 5,10,20,30 Gy dose(V₅,V₁₀,V₂₀ and V₃₀) were respectively 1.13%,0.75%,0.29% and0.19%,and the maximum deviation of mean dose(V_mean)of lung was 18.7 cGy.The variation ranges of V₁₀,V₂₀,V₃₀ and V₄₀ in the heart were respectively 2.2%,1.23%,1.39% and 1.12%,and the maximum deviation of V_mean in the heart was63.85 cGy,and the maximum deviation of D_max in the spinal-cord was 70.78 cGy.There were statistically significant differences in the actual CP number（CP_s）,execution time（DT） of plan,and ratio value of machine unit（MU） of the complexity of plan to CP_s（MU/CP_s） among the plans of 9 groups（F=2.857,25.145,135.467,P<0.05）,respectively.Conclusion:In the dIMRT plan of esophageal cancer of middle and lower segment,the maximum CP value is set at between 40-50,which can reduce the optimization time of the plan,the number of subfields and the treatment time of patients under the premise of meeting the dose of the target region and the OAR.更多还原