适形放疗技术（三维适形放疗和调强放射治疗）在非小细胞肺癌中的应用
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摘要
1.非小细胞肺癌化疗联合三维适形大分割放疗放疗剂量递增的Ⅰ/Ⅱ期临床试验
目的:前瞻性评估应用三维适形放疗技术(three-dimensional conformal radiationtherapy,3DCRT)进行大分割放疗治疗非小细胞肺癌(non-small-cell lung cancer,NSCLC)的可行性和疗效情况。
材料与方法:试验的主要入组标准包括:病理学证实的不能接受手术或手术不能切除的1b-Ⅲb期非小细胞肺癌患者,KPS(Karnmofsky performance)评分≥70,6个月内体重减轻小于5%,以及没有进行过胸部放疗。放疗技术采用3DCRT并要求不进行选择性淋巴结区域照射。放疗采用5次/周的照射,在放疗剂量达50Gy/20次后分割剂量调整为3Gy/次,治疗总剂量从65Gy递增到71Gy。化疗与放疗序贯进行,化疗方案选择第3代化疗药物联合顺铂或者卡铂。毒性反应评价采用CTCAEv3.0标准,剂量限制性毒性(dose-limiting toxicities,DLT)定义为3级或以上放疗相关的肺、食管、心脏和脊髓毒性反应。
结果:从2006年4月至2008年1月共有30例患者入组并完成计划的治疗,其中Ⅰ期患者1例,Ⅱ期患者5例,Ⅲa为12例,Ⅲb期11例,有1例Ⅳ期患者因治疗前错误分期而入组被归入毒性反应评价中分析。19例患者在第一剂量组(65Gy),11例患者为第二剂量组(68Gy),均接受了规定剂量的放疗。所有患者均完成了2个疗程的诱导化疗,而巩固化疗中接受了2程、1程和0程的患者数分别为16、11和3例。所有患者接受的化疗方案均为长春瑞滨加顺铂或者卡铂。目前所有患者的中位随访时间为11(5—23)个月,其中第一剂量组为16(6—23)个月,第二剂量组为9(5—11)个月。到目前为止,无1例患者出现≥3级的放疗相关毒性反应。19例患者发生了放射性肺炎,其中1级为9例,2级为10例。有11例患者出现了放射性肺纤维化,分级均为1级。有3例患者出现了肺不张,其中2例经过纤支镜检查证实为分泌物堵塞支气管所致,还有1例经过9个月的随访排除了肿瘤进展所致。20例患者出现了放射性食管炎,其中1级13例,2级7例。目前共13例患者出现治疗失败,其中包括5例单独的远处转移,2例PTV内肿瘤进展,4例PTV内外肿瘤同时失败,还有2例同时发现局部进展和远处转移。由于随访时间的限制,我们只对第一剂量组的患者进行了相关的生存分析,1年总生存率、肿瘤无进展生存率、局部无进展生存率、以及无远处转移生存率分别为77.8%、40.6%、50.3%and 63.3%。
结论:采用3DCRT技术进行大分割放疗治疗非小细胞肺癌具有可行性,但最终结论还需要更多数据的证明。
2.非小细胞肺癌调强放射治疗的剂量学研究
目的:本研究旨在探索在非小细胞肺癌(non-small cell lung cancer,NSCLC)中,应用调强放射治疗技术(intensity modulated radiation therapy,IMRT)相比于传统的三维适形放疗(three-dimensional conformal radiotherapy,3DCRT)技术减少正常肺照射剂量的可行性,以及不同的设野方法对于IMRT计划质量的影响。
材料与方法:选择2006—2007年本院在ELAKTA Snergy加速器(MLC宽度为1cm)上实施3DCRT的Ⅰ—Ⅲ期NSCLC患者。入组要求:放疗总剂量为65Gy,处方剂量要求至少95%的PTV体积接受处方剂量以上的剂量,至少99%的PTV体积接受处方剂量95%以上的剂量,PTV内大于处方剂量110%的体积不超过20%。关键器官受量的要求为脊髓最大剂量≤45Gy;正常肺V20≤30%;食管V55≤30%和平均剂量≤34Gy;心脏V40≤50%。3DCRT计划选择患者实际治疗的计划。IMRT采用固定野静态调强技术(step and shoot,SMLC-IMRT),每例患者共设计三套:IMRT-7,使用等角度的7个射野,射野的入射角度分别为0°、51°、102°、153°、204°、255°、306°;IMRT-5,使用等角度的5个射野,射野的入射角度为0°、72°、144°、216°、288°;IMRT-5m,使用不等角度的5个射野,设野的方法为从前述IMRT-7的7个射野中去除2个野,若患者的病灶位于左肺,则去除角度为255°、306°的两野,若病灶位于右肺则去除角度为51°、102°的两野。IMRT计划处方剂量要求比3DCRT增加二项,一是PTV内超过处方剂量120%水平连续的体积不大于2cm~3,二是PTV以外超过处方剂量110%水平连续的体积不大于1cm~3。食管、心脏和脊髓的受量要求与3DCRT相同,对肺则要求V5—V60均比3DCRT低。每套IMRT计划开始的处方剂量为65Gy,并按每2Gy一个阶梯进行递增或递减,直至获得最佳计划。计划比较的参数包括靶区适形指数(conformity index,CI)、异质性指数(heterogeneity index,HI);肺的V5—V60(每5Gy一个梯度,即V5、V10、V15……V60)、平均剂量(mean lung dose,MLD)、正常组织并发症概率(normal tissue complication probability,NTCP);食管的V55和平均剂量(mean esophagus dose,MED);脊髓最大剂量;心脏V40;整个放疗过程的总机器跳数(monitor units,MUs);以及最佳计划的处方剂量。计划间参数值的比较采用配对t检验。
结果:共有21例患者符合入组条件,全部进入本研究。肺的V5—V60、MID及NTCP,三种IMRT计划较3DCRT均有明显降低。IMRT计划间比较发现,V5—V25之间区域,IMRT-5m计划的值较低,而IMRT-7和IMRT-5差别不明显;V30—V40,三种IMRT计划无明显差异;V45—V60,IMRT-5最差,而IMRT-7和IMRT-5m相似。食管和心脏的受量,IMRT较3DCRT降低,而IMRT之间差别不大。IMRT较3DCRT稍提高了脊髓的最大剂量,但除了IMRT-5,其它两种与3DCRT比较均无统计学意义。IMRT-7相比于3DCRT平均可提高靶区剂量5.1Gy(SD=4.6Gy);采用IMRT-5,可提高3.1Gy(SD=5.3Gy);IMRT-5m提高5.5Gy(SD=4.8Gy)。IMRT有更好的靶区适形性但靶区异质性也较大。三种IMRT相比于3DCRT均增加了机器的总MUs,IMRT之间差别不明显。
结论:IMRT对于NSCLC相比于3DCRT能够在剂量学上减少正常肺的受量,从而降低放射性肺损伤发生的可能。通过减少照射野并调整设野的方向可以保证甚至提高IMRT计划的质量。
1.A phaseⅠ/Ⅱdose escalation trial in non-small cell lung cancer using hypofractionated three-dimensional conformal radiation therapy
Purpose:To prospectively assess the feasibility and efficacy of a hypofractionated regimen using three-dimensional conformal radiation therapy(3DCRT) in patients with non-small-cell lung cancer(NSCLC). Materials/Methods:The main eligibility criteria of the trial were: pathologically proved stage 1b-Ⅲb medically inoperable or surgically unresectable NSCLC,Karnofsky performance(KPS)≥70,weight loss＜5%within 6 months and no thoracic radiotherapy before enrollment.The 3DCRT technique was used and no elective nodal irradiation was given. Patients were treated 50Gy/20 fractions with 5 days a week,then doses were delivered at 3Gy per fraction,total radiation dose escalated from 65Gy to 71Gy.Chemotherapy using a third generation agent combined with cisplatin or carboplatin were given sequentially.Toxicity was scored according Common Terminology Criteria for Adverse Events version 3.0, dose-limiting toxicities were defined as≥grade 3 radiotherapy related pulmonary,esophagus,heart or spinal cord toxicities.
Results:Form Apr.2006 to Jan.2008,30 patients had been enrolled and completed planning treatment.One had stageⅠ,five had stageⅡ,12 had stageⅢa,11 had stageⅢb,one patient with stageⅣwas inadventently enrolled and was included in the toxicity anaysis.There were 19 patients received 65Gy and 11 received 68Gy.All patients had completed 2 cycles induction chemotherapy and 16,11 and 3 patients had received 2 cycles, 1 cycle and 0 cycle consolidation chemotherapy.All of the chemotherapy regiments were navelbine plus cisplatin or carboplatin.No patients developed grade 3 or worse radiation related toxicity.The median follow-up time was 11(5-23) months for all patients,16(6-23) months for group 1(65Gy) and 9(5-11) months for group 2(68Gy).Radiation pneumonitis were observed in 19 patients,where 9 of grade 1 and 10 of grade 2.Pulmonary fibrosis were occurred in 11 patients,all of which were grade 1.Three patients developed grade 1-2 atelectasis between 2-4 months after completion of radiotheray,two of them had been confirmed to due to bronchus excretion by tracheoscope examination and one was comfirmed to have no tumor progression by 9 months follow-up.20 patients developed radiation esophagitis including 13 with grade 1 and 7 with grade 2.At present,13 patients had experienced treatment failure including 5 with isolated distant metastasis,2 with local failure inside PTV,4 with local failure both inside and outside PTV,2 patients with local and distant failure.Because of limited follow-up time,we just analysed the survival status for the patients of group 1(received 65Gy), one year overall survial,progression-free survival,localreginal progression-free and distant-free survival was 77.8%,40.6%,50.3%and 63.3%respectively.
Conclusions:Hypofractionated radiotherapy using 3DCRT in NSCLC is feasibility,however more data are needed to comfirm its outcomes.
2.The Dosimetric Study in Intensity Modulated Radiation Therapy for Non-Small Cell Lung Cancer
Purpose:To investigate whether the technique of intensity modulated radiation therapy(IMRT) could reduce dose to normal lungs compared with three-dimensional conformal radiotherapy(3DCRT) for non-small cell lung cancer(NSCLC),and the impact of different beams' set-up methods to the qulity of IMRT.
Materials and Methods:We selected the patients with stageⅠ-ⅢNSCLC who had received 3DCRT with ELEKTA Snergy LA(1cm MLCs' width) between 2006 and 2007 in our hospital.The eligibity criteria including:total radiation dose was 65Gy;prescription dose should cover more than 95%of the PTV,≥99%of the PTV received≥95% of the prescribed dose,no more than 20%of the PTV could receive≥110%of the prescribed dose;the maximum dose to spinal cord could not exceed 45Gy,V55 of esophagus≤30%and mean esophageal dose≤34Gy,V40 of heart≤50%.Step and shoot was used as our IMRT technique.Three IMRT plans will be designed for each case:IMRT-7 which uses nine equal-spaced beams including 0°,51°,102°,153°,204°, 255°,306°;IMRT-5 with five equal-spaced beams including 0°,72°,144°, 216°,288°;and IMRT-5m which is created from IMRT-7 but excluded 2 fields(51°,102°will be omitted if lesion in the right lung,255°,306°will be excluded if lesion in the left lung).There were two more dose specifications than 3DCRT for the target when planning IMRT:a contiguous volume of no more than 2 cm~3 inside the PTV exceeds 120% of the prescribed dose;no more than 1 cm~3 of contiguous tissue outside the PTV receives≥110%of the prescribed dose.Dose constrains of IMRT for the critical structures were the same as 3DCRT except for lung, which V5-V60 in IMRT should be lower than 3DCRT of the same patient. The prescripation dose for IMRT start from 65Gy,then will be escalated or decreased step by step by 2Gy once a time until the best plan was obtained.The parameters being compared between plans include conformity index(CI),heterogeneity index(HI),V5-V60(in increments of 5 Gy) of lung,mean lung dose(MLD),normal tissue complication probability(NTCP) for lung,V55 and mean dose of esophagus, maximum dose to spinal cord,V40 of heart,total monitor units(MUs), and the prescripation dose of best plan.Statistical analysis is performed using paired student's t-test.
Results:21 patients were enrolled in this study.Compared to 3DCRT,all the three types of IMRTs significantly decreased the V5-V60 of lung, MLD and NTCP.For IMRTs,we found IMRT-5m has lower V5-V25 than the other two;there was no major difference in V30-V40;for V45-V60,IMRT-5 was the worst,IMRT-7 and IMRT-5m were similar. Doses to esophagus and heart were smaller in IMRTs than 3DCRT and similar among IMRTs.The maximum dose to spinal cord was minorly increased by IMRTs,but the defference between 3DCRT and IMRTs did not reach statistically significance except for IMRT-5.IMRTs could increase prescription dose by 5.1Gy(SD=4.6Gy) for IMRT-7,3.1Gy (SD=5.3Gy) for IMRT-5,and 5.5Gy(SD=4.8Gy) for IMRT-5m.The target comformity was higher in IMRTs while heterogeneity was greater. Total MUs of IMRTs were more than 3DCRT,but no significant difference was found between IMRTs.
Conclusions:IMRT can reduce the dose to normal lungs in NSCLC so that potentially decrease the risk of radiation lung injury.Use fewer beams and modified beam angles could result in similar,even better plan quality.
目的:前瞻性评估应用三维适形放疗技术(three-dimensional conformal radiationtherapy,3DCRT)进行大分割放疗治疗非小细胞肺癌(non-small-cell lung cancer,NSCLC)的可行性和疗效情况。
材料与方法:试验的主要入组标准包括:病理学证实的不能接受手术或手术不能切除的1b-Ⅲb期非小细胞肺癌患者,KPS(Karnmofsky performance)评分≥70,6个月内体重减轻小于5%,以及没有进行过胸部放疗。放疗技术采用3DCRT并要求不进行选择性淋巴结区域照射。放疗采用5次/周的照射,在放疗剂量达50Gy/20次后分割剂量调整为3Gy/次,治疗总剂量从65Gy递增到71Gy。化疗与放疗序贯进行,化疗方案选择第3代化疗药物联合顺铂或者卡铂。毒性反应评价采用CTCAEv3.0标准,剂量限制性毒性(dose-limiting toxicities,DLT)定义为3级或以上放疗相关的肺、食管、心脏和脊髓毒性反应。
结果:从2006年4月至2008年1月共有30例患者入组并完成计划的治疗,其中Ⅰ期患者1例,Ⅱ期患者5例,Ⅲa为12例,Ⅲb期11例,有1例Ⅳ期患者因治疗前错误分期而入组被归入毒性反应评价中分析。19例患者在第一剂量组(65Gy),11例患者为第二剂量组(68Gy),均接受了规定剂量的放疗。所有患者均完成了2个疗程的诱导化疗,而巩固化疗中接受了2程、1程和0程的患者数分别为16、11和3例。所有患者接受的化疗方案均为长春瑞滨加顺铂或者卡铂。目前所有患者的中位随访时间为11(5—23)个月,其中第一剂量组为16(6—23)个月,第二剂量组为9(5—11)个月。到目前为止,无1例患者出现≥3级的放疗相关毒性反应。19例患者发生了放射性肺炎,其中1级为9例,2级为10例。有11例患者出现了放射性肺纤维化,分级均为1级。有3例患者出现了肺不张,其中2例经过纤支镜检查证实为分泌物堵塞支气管所致,还有1例经过9个月的随访排除了肿瘤进展所致。20例患者出现了放射性食管炎,其中1级13例,2级7例。目前共13例患者出现治疗失败,其中包括5例单独的远处转移,2例PTV内肿瘤进展,4例PTV内外肿瘤同时失败,还有2例同时发现局部进展和远处转移。由于随访时间的限制,我们只对第一剂量组的患者进行了相关的生存分析,1年总生存率、肿瘤无进展生存率、局部无进展生存率、以及无远处转移生存率分别为77.8%、40.6%、50.3%and 63.3%。
结论:采用3DCRT技术进行大分割放疗治疗非小细胞肺癌具有可行性,但最终结论还需要更多数据的证明。
2.非小细胞肺癌调强放射治疗的剂量学研究
目的:本研究旨在探索在非小细胞肺癌(non-small cell lung cancer,NSCLC)中,应用调强放射治疗技术(intensity modulated radiation therapy,IMRT)相比于传统的三维适形放疗(three-dimensional conformal radiotherapy,3DCRT)技术减少正常肺照射剂量的可行性,以及不同的设野方法对于IMRT计划质量的影响。
材料与方法:选择2006—2007年本院在ELAKTA Snergy加速器(MLC宽度为1cm)上实施3DCRT的Ⅰ—Ⅲ期NSCLC患者。入组要求:放疗总剂量为65Gy,处方剂量要求至少95%的PTV体积接受处方剂量以上的剂量,至少99%的PTV体积接受处方剂量95%以上的剂量,PTV内大于处方剂量110%的体积不超过20%。关键器官受量的要求为脊髓最大剂量≤45Gy;正常肺V20≤30%;食管V55≤30%和平均剂量≤34Gy;心脏V40≤50%。3DCRT计划选择患者实际治疗的计划。IMRT采用固定野静态调强技术(step and shoot,SMLC-IMRT),每例患者共设计三套:IMRT-7,使用等角度的7个射野,射野的入射角度分别为0°、51°、102°、153°、204°、255°、306°;IMRT-5,使用等角度的5个射野,射野的入射角度为0°、72°、144°、216°、288°;IMRT-5m,使用不等角度的5个射野,设野的方法为从前述IMRT-7的7个射野中去除2个野,若患者的病灶位于左肺,则去除角度为255°、306°的两野,若病灶位于右肺则去除角度为51°、102°的两野。IMRT计划处方剂量要求比3DCRT增加二项,一是PTV内超过处方剂量120%水平连续的体积不大于2cm~3,二是PTV以外超过处方剂量110%水平连续的体积不大于1cm~3。食管、心脏和脊髓的受量要求与3DCRT相同,对肺则要求V5—V60均比3DCRT低。每套IMRT计划开始的处方剂量为65Gy,并按每2Gy一个阶梯进行递增或递减,直至获得最佳计划。计划比较的参数包括靶区适形指数(conformity index,CI)、异质性指数(heterogeneity index,HI);肺的V5—V60(每5Gy一个梯度,即V5、V10、V15……V60)、平均剂量(mean lung dose,MLD)、正常组织并发症概率(normal tissue complication probability,NTCP);食管的V55和平均剂量(mean esophagus dose,MED);脊髓最大剂量;心脏V40;整个放疗过程的总机器跳数(monitor units,MUs);以及最佳计划的处方剂量。计划间参数值的比较采用配对t检验。
结果:共有21例患者符合入组条件,全部进入本研究。肺的V5—V60、MID及NTCP,三种IMRT计划较3DCRT均有明显降低。IMRT计划间比较发现,V5—V25之间区域,IMRT-5m计划的值较低,而IMRT-7和IMRT-5差别不明显;V30—V40,三种IMRT计划无明显差异;V45—V60,IMRT-5最差,而IMRT-7和IMRT-5m相似。食管和心脏的受量,IMRT较3DCRT降低,而IMRT之间差别不大。IMRT较3DCRT稍提高了脊髓的最大剂量,但除了IMRT-5,其它两种与3DCRT比较均无统计学意义。IMRT-7相比于3DCRT平均可提高靶区剂量5.1Gy(SD=4.6Gy);采用IMRT-5,可提高3.1Gy(SD=5.3Gy);IMRT-5m提高5.5Gy(SD=4.8Gy)。IMRT有更好的靶区适形性但靶区异质性也较大。三种IMRT相比于3DCRT均增加了机器的总MUs,IMRT之间差别不明显。
结论:IMRT对于NSCLC相比于3DCRT能够在剂量学上减少正常肺的受量,从而降低放射性肺损伤发生的可能。通过减少照射野并调整设野的方向可以保证甚至提高IMRT计划的质量。
1.A phaseⅠ/Ⅱdose escalation trial in non-small cell lung cancer using hypofractionated three-dimensional conformal radiation therapy
Purpose:To prospectively assess the feasibility and efficacy of a hypofractionated regimen using three-dimensional conformal radiation therapy(3DCRT) in patients with non-small-cell lung cancer(NSCLC). Materials/Methods:The main eligibility criteria of the trial were: pathologically proved stage 1b-Ⅲb medically inoperable or surgically unresectable NSCLC,Karnofsky performance(KPS)≥70,weight loss＜5%within 6 months and no thoracic radiotherapy before enrollment.The 3DCRT technique was used and no elective nodal irradiation was given. Patients were treated 50Gy/20 fractions with 5 days a week,then doses were delivered at 3Gy per fraction,total radiation dose escalated from 65Gy to 71Gy.Chemotherapy using a third generation agent combined with cisplatin or carboplatin were given sequentially.Toxicity was scored according Common Terminology Criteria for Adverse Events version 3.0, dose-limiting toxicities were defined as≥grade 3 radiotherapy related pulmonary,esophagus,heart or spinal cord toxicities.
Results:Form Apr.2006 to Jan.2008,30 patients had been enrolled and completed planning treatment.One had stageⅠ,five had stageⅡ,12 had stageⅢa,11 had stageⅢb,one patient with stageⅣwas inadventently enrolled and was included in the toxicity anaysis.There were 19 patients received 65Gy and 11 received 68Gy.All patients had completed 2 cycles induction chemotherapy and 16,11 and 3 patients had received 2 cycles, 1 cycle and 0 cycle consolidation chemotherapy.All of the chemotherapy regiments were navelbine plus cisplatin or carboplatin.No patients developed grade 3 or worse radiation related toxicity.The median follow-up time was 11(5-23) months for all patients,16(6-23) months for group 1(65Gy) and 9(5-11) months for group 2(68Gy).Radiation pneumonitis were observed in 19 patients,where 9 of grade 1 and 10 of grade 2.Pulmonary fibrosis were occurred in 11 patients,all of which were grade 1.Three patients developed grade 1-2 atelectasis between 2-4 months after completion of radiotheray,two of them had been confirmed to due to bronchus excretion by tracheoscope examination and one was comfirmed to have no tumor progression by 9 months follow-up.20 patients developed radiation esophagitis including 13 with grade 1 and 7 with grade 2.At present,13 patients had experienced treatment failure including 5 with isolated distant metastasis,2 with local failure inside PTV,4 with local failure both inside and outside PTV,2 patients with local and distant failure.Because of limited follow-up time,we just analysed the survival status for the patients of group 1(received 65Gy), one year overall survial,progression-free survival,localreginal progression-free and distant-free survival was 77.8%,40.6%,50.3%and 63.3%respectively.
Conclusions:Hypofractionated radiotherapy using 3DCRT in NSCLC is feasibility,however more data are needed to comfirm its outcomes.
2.The Dosimetric Study in Intensity Modulated Radiation Therapy for Non-Small Cell Lung Cancer
Purpose:To investigate whether the technique of intensity modulated radiation therapy(IMRT) could reduce dose to normal lungs compared with three-dimensional conformal radiotherapy(3DCRT) for non-small cell lung cancer(NSCLC),and the impact of different beams' set-up methods to the qulity of IMRT.
Materials and Methods:We selected the patients with stageⅠ-ⅢNSCLC who had received 3DCRT with ELEKTA Snergy LA(1cm MLCs' width) between 2006 and 2007 in our hospital.The eligibity criteria including:total radiation dose was 65Gy;prescription dose should cover more than 95%of the PTV,≥99%of the PTV received≥95% of the prescribed dose,no more than 20%of the PTV could receive≥110%of the prescribed dose;the maximum dose to spinal cord could not exceed 45Gy,V55 of esophagus≤30%and mean esophageal dose≤34Gy,V40 of heart≤50%.Step and shoot was used as our IMRT technique.Three IMRT plans will be designed for each case:IMRT-7 which uses nine equal-spaced beams including 0°,51°,102°,153°,204°, 255°,306°;IMRT-5 with five equal-spaced beams including 0°,72°,144°, 216°,288°;and IMRT-5m which is created from IMRT-7 but excluded 2 fields(51°,102°will be omitted if lesion in the right lung,255°,306°will be excluded if lesion in the left lung).There were two more dose specifications than 3DCRT for the target when planning IMRT:a contiguous volume of no more than 2 cm~3 inside the PTV exceeds 120% of the prescribed dose;no more than 1 cm~3 of contiguous tissue outside the PTV receives≥110%of the prescribed dose.Dose constrains of IMRT for the critical structures were the same as 3DCRT except for lung, which V5-V60 in IMRT should be lower than 3DCRT of the same patient. The prescripation dose for IMRT start from 65Gy,then will be escalated or decreased step by step by 2Gy once a time until the best plan was obtained.The parameters being compared between plans include conformity index(CI),heterogeneity index(HI),V5-V60(in increments of 5 Gy) of lung,mean lung dose(MLD),normal tissue complication probability(NTCP) for lung,V55 and mean dose of esophagus, maximum dose to spinal cord,V40 of heart,total monitor units(MUs), and the prescripation dose of best plan.Statistical analysis is performed using paired student's t-test.
Results:21 patients were enrolled in this study.Compared to 3DCRT,all the three types of IMRTs significantly decreased the V5-V60 of lung, MLD and NTCP.For IMRTs,we found IMRT-5m has lower V5-V25 than the other two;there was no major difference in V30-V40;for V45-V60,IMRT-5 was the worst,IMRT-7 and IMRT-5m were similar. Doses to esophagus and heart were smaller in IMRTs than 3DCRT and similar among IMRTs.The maximum dose to spinal cord was minorly increased by IMRTs,but the defference between 3DCRT and IMRTs did not reach statistically significance except for IMRT-5.IMRTs could increase prescription dose by 5.1Gy(SD=4.6Gy) for IMRT-7,3.1Gy (SD=5.3Gy) for IMRT-5,and 5.5Gy(SD=4.8Gy) for IMRT-5m.The target comformity was higher in IMRTs while heterogeneity was greater. Total MUs of IMRTs were more than 3DCRT,but no significant difference was found between IMRTs.
Conclusions:IMRT can reduce the dose to normal lungs in NSCLC so that potentially decrease the risk of radiation lung injury.Use fewer beams and modified beam angles could result in similar,even better plan quality.
引文
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