首页|直肠癌调强放疗的临床计划质量优化和评估

直肠癌调强放疗的临床计划质量优化和评估

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目的:采用PlanIQ软件评估直肠癌调强放射治疗临床治疗计划和再优化计划的质量，为调强放疗计划筛选和优化提供方法和工具。方法:回顾性随机选取20例接受调强放疗的直肠癌患者，调强放疗技术(IMRT)和旋转容积调强技术(VMAT)计划各10例。(1)临床治疗计划设计(TP):IMRT计划采用5野等间距照射，VMAT计划采用2个360°弧旋转照射。处方剂量为PTV1:50 Gy/25 f;PTV2:45 Gy/25 f。所有计划均采用直接机器参数优化，且要求95%等剂量线能覆盖100%靶区体积，危及器官(OARs)参考耐受剂量标准来限制。计划完成后由医生审核确认，并经过计划剂量验证后实施治疗。(2)治疗计划再优化设计(RP):由1名有10年经验的计划设计者对20例TP计划进行重新优化，保持照射技术和照射野条件不变，根据个人经验重新调整计划优化条件和参数，直到OARs剂量尽可能低，且不影响PTV的目标覆盖率。用PlanIQ软件分别对TP和RP计划质量进行量化评估。两组计划之间剂量DVH参数和计划质量指数(PQI)行非参数的Wilcoxon符号秩检验。结果:RP计划的各DVH参数均优于TP计划，其中PTV1的Dmax、小肠的V45 Gy和Dmax以及结肠的V45 Gy的差异具有统计学意义(P<0。05)。IMRT组、VMAT组和所有患者的RP计划的质量评分均高于TP计划，差异具有统计学意义(P<0。05)，其PQI分别为(88。55±3。35 vs 86。61±4。63，P=0。005)、(89。72±3。15 vs 87。21±3。04，P=0。028)和(89。14±3。22vs86。91±3。22，P=0。001)。结论:计划再优化可以进一步提高直肠癌调强放疗的临床计划质量，PlanIQ软件为放疗计划质量控制和优质计划筛选提供了一种有效工具。
Quality re-optimization and assessment of radiotherapy plan for rectal cancer
Objective To evaluate the quality of treatment planning(TP)and re-optimization planning(RP)of radiotherapy for rectal cancer using PlanIQ software,thereby providing methods and tools for the screening and optimization of radiotherapy plans.Methods Twenty patients with rectal cancer who received radiotherapy were selected retrospectively,with 10 cases of intensity-modulated radiotherapy(IMRT)and 10 of volumetric modulated arc therapy(VMAT).(1)TP:IMRT plan involved 5-field irradiation,and VMAT plan involved two 360°arcs.The prescription doses were 50 Gy/25 f for PTV1 and 45 Gy/25 f for PTV2.All plans underwent direct machine parameter optimization and required 95%isodose lines to cover 100%of the target volume.Organs-at-risk(OAR)were limited by reference to tolerated dose standards.After the planning was completed,the plans were reviewed and confirmed by a physician,and the treatment was implemented after dose verification.(2)RP:a physicist with 10 years of experience re-optimized the 20 TP plans,with the irradiation technique and field setting unchanged.The re-optimization involved adjusting planning conditions and parameters based on individual experience until the dose to OAR was minimized while without affecting PTV coverage.The quality of TP plans and RP plans were quantitatively evaluated using PlanIQ software.Non-parametric Wilcoxon signed rank test was performed for dose-volume histogram parameters and plan quality index between two groups.Results The dose-volume histogram parameters in RP plans were superior to those in TP plans,and the differences in the Dmax of PTV1,the V45 Gy and Dmax of small intestine,and the V45 Gy of colon were statistically significant(P<0.05).The quality scores of RP plans for IMRT group,VMAT group and all patients were significantly higher than those of TP plans(P<0.05),with plan quality index of 88.55±3.35 vs 86.61±4.63(P=0.005),89.72±3.15 vs 87.21±3.04(P=0.028),and 89.14±3.22 vs 86.91±3.22(P=0.001),respectively.Conclusion RP can further improve the quality of radiotherapy plan for rectal cancer.PlanIQ software serves as an effective tool for quality control and screening of radiotherapy planning.

rectal cancerintensity-modulated radiotherapyradiotherapy plan quality controlPlanIQplan screening

黄霖、刘懿梅、陈美宁、黄劭敏、邓小武、彭应林、张煜

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南方医科大学生物医学工程学院,广东广州 510515

潮州市中心医院肿瘤科,广东潮州 521000

中山大学肿瘤防治中心/华南肿瘤学国家实验室/肿瘤医学协同创新中心放疗科,广东广州 510060

直肠癌 调强放疗计划 放疗计划质量控制 PlanIQ 计划筛选

国家重点研发计划国家自然科学基金中华国际医学交流基金会肿瘤精准放疗星火计划广州市科技计划广州市科技计划

2022YFC2402304120053162019-N-11-20202206010154202206010180

2024

10.3969/j.issn.1005-202X.2024.02.001

中国医学物理学杂志
南方医科大学,中国医学物理学会

中国医学物理学杂志

CSTPCD
影响因子：0.483
ISSN：1005-202X
年,卷(期)：2024.41(2)
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