容积调强放射治疗技术在宫颈癌放射治疗中的应用

摘要

ObjectiveTo compare and analyze the dose of two arc, three arc and IMRT in the radiotherapy of cervical cancer.Methods 20 cases of cervical cancer patients diagnosed by pathological diagnosis and surgery and postoperative adjuvant treatment of indications in our hospital from December 2012 to December 2014 were randomly selected as the research objects. Plans of two arc, three arc and IMRT were Designed respectively, and represented by Arc2, Arc3 and IMRT. The dose parameters of the three sets of Radiation Therapy plans were analyzed, and all aspects of the advantages and disadvantages of the above three,such as Dose Volume Histograms(DVH), Target Volume Rate (TVR), Target Dose Coverage, Organs at Risk(OAR) and Normal Tissues, MU, treatment time and planning time were comparrd.ResultsVolumetric modulated arc therapy was better than IMRT in terms of target dose distribution, conformal index, homogeneity index, total MU and treatment time. Arc3 was better than Arc2 on the whole, and the two had almost the same treatment time. IMRT was better than the previous two in terms of planning time. The planning time(min) of IMRT group, Arc2 group and Arc3 group respectively were 25, 35, 40, the treatment time(min) of IMRT group, Arc2 group and Arc3 group respectively were 11.5, 2.25, 3.6, the average MU of IMRT group, Arc2 group and Arc3 group respectively were 2210, 651, 675, the HI of IMRT group, Arc2 group and Arc3 group respectively were (1.11±0.06), (1.06±0.03), (1.04±0.02), and the CI of IMRT group, Arc2 group and Arc3 group respectively were (0.82±0.05), (0.89±0.05), (0.91±0.05). The P value of each parameter was less than 0.05, and the differences were statistically significant. In rectal V20 and V40, V30 and V40 in small intestine, bladder and femoral head V20 and V40, the value had no statistical significance(P>0.05). Rectal dose IMRT group was slightly better than the Arc group. The amount of IMRT V20 group was larger than that of Arc group. The amount of IMRT in bladder and femoral head were higher than those in Arc group, and the difference was statistically significant(P<0.05).ConclusionVolumetric modulated arc therapy(VMAT) is much better than IMRT in terms of radiotheraphy of cervical cancer, and Arc3 is better than Arc2,they can also provide a reference for the radiotherapy of cervical cancer.%目的：比较分析双弧、三弧旋转容积调强放疗技术和三维适形调强放疗技术在宫颈癌放疗中的剂量学差异。方法随机选取2012年12月～2014年12月间我院经病理诊断确诊并接受手术且有术后辅助治疗指征的20例宫颈癌患者作为研究对象，分别设计双弧、三弧容积调强和三维适形调强放疗计划，以Arc2、Arc3和IMRT表示，分析三套放疗计划的剂量学参数，比较三者在剂量体积直方图、靶区适形度、靶区剂量覆盖率、危及器官和正常组织保护、机器跳数和治疗时间以及计划设计时间各方面的优劣。结果容积调强放疗计划在靶区剂量分布、适形度、均匀度、总机器跳数以及治疗时间方面优于IMRT，Arc3整体优于Arc2，二者治疗时间相差无几，IMRT在计划设计时间方面优于前二者。IMRT组、Arc2组和Arc3组分别在计划平均设计时间（min）、计划实际执行时间（min）、机器平均跳数（MU）、靶区均匀性指数以及靶区适形度方面的结果为25、35、40；11.5、2.25、3.6；2210、651、675；（1.11±0.06）、（1.06±0.03）、（1.04±0.02）；（0.82±0.05）、（0.89±0.05）、（0.91±0.05）。各参数间P值均小于0.05，为差异有统计学意义。直肠V20与V40，小肠V30与V40，膀胱V20与V40，股骨头V20与V40的差异无统计学意义（P＞0.05）；直肠受量IMRT组稍优于Arc组；小肠受量V20 IMRT组大于Arc组；膀胱和股骨头受量IMRT组整体高于Arc组。以P＜0.05为差异有统计学意义。结论在宫颈癌临床放疗应用方面容积调强放疗技术明显优于三维适形调强放疗技术，Arc3优于Arc2，能够为宫颈癌患者的治疗提供参考。