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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (7): 55-60.doi: 10.6040/j.issn.1671-7554.0.2016.1098

• 临床医学 • 上一篇    下一篇

放射性125I粒子植入与外放疗治疗颈椎转移瘤剂量学对比分析

曹倩倩1,姜玉华1,李玉亮2,杨瑞杰3,刘路3,张喜乐3,王俊杰3   

  1. 1.山东大学第二医院肿瘤防治中心, 山东 济南 250033;2.山东大学第二医院介入医学科, 山东 济南 250033;3.北京大学第三医院放疗科, 北京 100191
  • 收稿日期:2016-09-02 出版日期:2017-07-10 发布日期:2017-07-10
  • 通讯作者: 王俊杰. E-mail:junjiewang_edu@sina.cn E-mail:junjiewang_edu@sina.cn
  • 基金资助:
    山东大学第二医院青年基金(Y2015010009)

A dosimetric analysis of cervical metastases between radioactive 125I seeds implantation and external beam radiation therapy

CAO Qianqian1, JIANG Yuhua1, LI Yuliang2, YANG Ruijie3, LIU Lu3, ZHANG Xile3, WANG Junjie3   

  1. 1. Cancer Center, Second Hospital of Shandong University, Jinan 250033, China;
    2. Interventional Medical Center, Second Hospital of Shandong University, Jinan 250033;
    3. Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China
  • Received:2016-09-02 Online:2017-07-10 Published:2017-07-10

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摘要： 目的 对比放射性125I粒子植入与不同外放疗技术治疗颈椎转移瘤的靶区及危及器官剂量分布,为临床治疗方式选择提供依据。 方法 随机选取10例颈椎转移瘤患者,三维适形放射治疗(3D-CRT)计划为单前野加双侧斜后野,调强适形放射治疗(IMRT)为5野等分,选用2弧容积旋转调强放疗(VMAT)。将Oncentra治疗计划系统中的图像传输到粒子计划系统,制定近距离放疗(LDR)术前模拟计划。 结果 脊髓剂量相同时,LDR的D90和D95生物等效剂量(BED)分别为(184.15±25.84 )Gy、(161.45±26.35 )Gy。VMAT、IMRT、3D-CRT对应的靶区 D95 BED 2 Gy/f时分别为:(120.52±10.66)Gy、(119.19±10.91)Gy、(96.24±28.65)Gy;3 Gy/f时分别为:(122.19±7.54)Gy、(122.37±8.19)Gy、(95.94±24.70)Gy。靶区各参数与LDR相比,均服从正态分布,配对t检验差异具有统计学意义(P=0.00)。VMAT、IMRT与LDR比较,黏膜V5差异无统计学意义(P=0.16,0.34),只有3D-CRT高于LDR(P=0.00)。黏膜V30、Dmean LDR均低于3种外放疗技术(P=0.00)。其余甲状腺、腮腺、下颌骨各参数,LDR最低,差异具有统计学意义(P=0.00)。 结论 3D-CRT、IMRT、VMAT单次2 Gy及3 Gy分割方案与LDR相比,脊髓剂量相同时,LDR的靶区剂量更高,同时有效地保护周围危及器官。对于放疗后复发的颈椎椎体转移瘤,LDR具有剂量学优势。

关键词: 颈椎肿瘤, 外放疗, 125I粒子, 剂量学, 近距离治疗

Abstract: Objective To compare the gross tumor volume(GTV)and dose distributions for organs at risk(OAR)between external beam radiation therapy(EBRT)and low-dose rate(LDR)brachytherapy in the treatment of cervical vertebral metastases, in order to provide the basis for clinical treatment. Methods A total of 10 patients were randomly selected. Three-dimensional conformal radiotherapy(3D-CRT)planning was a single forth one with two oblique radiation fields. Intensity modulated radiotherapy(IMRT)planning included five equal radiation fields, and 2-arc volumetric-modulated arc radiotherapy(VMAT)was adopted. The images from Oncentra treatment planning system(TPS)were delivered to Prowess TPS to formulate LDR brachytherapy pre-operative simulation plan. Results For the same dose of spinal cord, the biologically effective dose(BED)of D90 and D95 of LDR were(184.15±25.84)Gy and(161.45±26.35)Gy. When the fraction scheme was 2 Gy/f, the D95 BED of VMAT, IMRT and 3D-CRT were(120.52±10.66)Gy,(119.19±10.91)Gy and(96.24±28.65)Gy. When the fraction scheme was 3 Gy/f, the 山 东 大 学 学 报 (医 学 版)55卷7期 -曹倩倩,等.放射性125I粒子植入与外放疗治疗颈椎转移瘤剂量学对比分析 \=-D95 BED 3 Gy/f of VMAT, IMRT and 3D-CRT were(122.19±7.54)Gy,(122.37±8.19)Gy and(95.94±24.70)Gy. All parameters complied with the normal distribution, P=0.00 after paired t test. There was no statistical difference in V5 of the mucosa among VMAT, IMRT and LDR(P=0.16, 0.34), and V5 of the mucosa of 3D-CRT was higher than that in LDR(P=0.00). The V30 and Dmean of LDR were less than those of 3D-CRT, VMAT and IMRT, statistically(P=0.00). Other parameters of the thyroid gland, parotid gland and mandible were significantly different between LDR and 3D-CRT, VMAT and IMRT(P=0.00). Conclusion When the fraction schemes were 2 Gy/f and 3 Gy/f, 3D-CRT, IMRT and VMAT had lower GTV doses than LDR, which could protect the OARs at the same time. Therefore, as to the cervical vertebral metastases after EBRT, LDR is a good choice for salvage treatment.

Key words: Cervical tumor, External Beam Radiation Therapy, Dosimetry, Brachytherapy, 125I seeds

中图分类号: 

  • R738.1
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