摘要
目的 探讨椎形束CT(D-CBCT)在肺癌容积旋转调强(VMAT)计划精准治疗中的临床应用.方法 选取2019年10月～2022年10月在南通市第三人民医院放射治疗科就诊的100例肺癌患者.根据CBCT扫描模式不同,分为4D组(n=57)和3D组(n=43).比较两组患者放疗摆位误差、内靶区(ITV)体积、靶区剂量、心脏受照剂量和肿瘤控制效果.结果 在校正前后和治疗后,两组各摆位误差绝对值无统计学差异(P＞0.05);4D组患者中下叶肿瘤ITV体积低于3D组(P＜0.05);4D组的最大剂量(Dmax)、最小剂量(Dmin)和平均剂量(Dmean)靶区剂量均高于3D组(P＜0.05);4D组的V10、V20、V30及平均受量(Dmean)等心脏受照剂量均低于3D组(P＜0.05);4D组和3D组患者的客观有效率无明显差异(P＞0.05).结论 可将D-CBCT应用于肺癌容积旋转调强计划精准治疗中,尤其采用4D-CBCT可更好提供靶区剂量,减少肺癌患者的中下叶肿瘤ITV体积和心脏受照剂量.
Abstract
Objective The aim of this study was to investigate the clinical application of cone-beam CT(D-CBCT)in the precise treatment of lung cancer by volumetric modulated arc therapy(VMAT)program.Methods A total of 100 patients with lung cancer treated in Radiotherapy Department of Nantong Third People's Hospital were enrolled and divided into 4D group(n=57)and 3D group(n=43)according to CBCT scan modes between October 2019 and October 2022.The radiotherapy setup errors,internal target volume(ITV)volume,target dose,cardiac exposure dose and tumor control effect in the two groups were compared.Results Before and after correction and after treatment,the difference in absolute values of setup errors between the two groups was not statistically significant(P＞0.05).ITV volume of middle and inferior lobe tumors in 4D group was smaller than that in 3D group(P＜0.05),maximum dose(Dmax),minimum dose(Dmin)and mean dose(Dmean)were higher than those in 3D group(P＜0.05),V10,V20,V30 and mean exposure dose(Dmean)were lower than those in 3D group(P＜0.05).There was no significant difference in objective response rate between the two groups(P＞0.05).Conclusion The application of D-CBCT,especially 4D-CBCT in precise treatment of lung cancer by VMAT program can better provide target dose,reduce ITV volume of middle and inferior lobes and cardiac exposure dose.
维普
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