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| IMRT与SIB-SBRT治疗大体积晚期非小细胞肺癌的剂量学对比分析 |
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| 投稿时间：2025-05-30 修订日期：2026-04-29 |
| DOI： |
| 中文关键词: 调强放疗 同步整合推量立体定向体部放疗 大体积 晚期非小细胞肺癌 剂量学[1] |
| 英文关键词: Intensity-modulated radiotherapy synchronized integrated thrust stereotactic body radiotherapy large volume advanced non-small cell lung cancer dosimetry |
| 基金项目:2022江苏省卫健委医学科研面上项目（M2022051）；2024常州市卫健委重大课题（ZD202325）；人才项目（刘俊）：常州卫生健康拔尖人才（2024CZBJ022） |
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| 中文摘要: |
| 【目的】分析调强放疗(IMRT)与立体定向体部放疗(SIB-SBRT)治疗大体积晚期非小细胞肺癌(NSCLC)的剂量学差异。【方法】本研究回顾性分析2022年1月-2024年12月在我院接受放射治疗的直径大于5cm的晚期非小细胞肺癌患者22例,分别制定IMRT与SIB-SBRT计划。比较两组患者计划靶区(PTV)、肿瘤靶区(GTVboost)、均匀性指数(HI)、适形性指数(CI)、靶区覆盖度(TC)、PTV及GTVboost生物效应剂量(PTV-BED、GTVboost-BED)、脊髓最大剂量、双肺V5、V20、V30、双肺平均剂量、心脏V30、V40、心脏平均剂量。【结果】SIB-SBRT组PTV实际剂量与IMRT组无显著差异(P＞0.05)；但SIB-SBRT组GTVboost实际剂量高于IMRT组,差异显著(P＜0.05)；SIB-SBRT计划TC、CI、HI水平与IMRT计划无显著差异(P＞0.05)。两组PTV-BED、GTVboost-BED比较,SIB-SBRT组PTV-BED与IMRT组相仿,差异无统计学意义(P＞0.05)；SIB-SBRT组GTVboost-BED显著高于IMRT组(P＜0.05)。两组双肺V20、V30及心脏V30、V40水平比较,差异无统计学意义(P＞0.05)；SIB-SBRT组脊髓最大剂量、双肺V5、双肺平均剂量、心脏平均剂量水平显著低于IMRT组(P＜0.05)。【结论】针对＞5cm晚期NSCLC患者,尽管IMRT在靶区的适形性和剂量分布的均匀性方面略显优势。然而SIB-SBRT显著提高了GTVboost区域的剂量和BED,并且在减少正常组织的辐射剂量(尤其是肺V5和心脏的平均剂量)方面显示出其优势。因此,SIB-SBRT提高了肿瘤核心区域照射剂量,并有可能克服大体积肿块放射抗拒,这样一种新型的放射治疗方法值得进一步探索和研究。 |
| 英文摘要: |
| 【Objective】To analyze the dosimetric difference between intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SIB-SBRT) for the treatment of high-volume advanced non-small cell lung cancer (NSCLC).【Methods】In this study, we retrospectively analyzed 22 patients with advanced non-small cell lung cancer with a diameter greater than 5 cm who underwent radiation therapy in our hospital from January 2022 to December 2024, and developed IMRT and SIB-SBRT plans respectively. We compared the planned target zone (PTV), tumor target zone (GTVboost), homogeneity index (HI), conformity index (CI), target coverage (TC), PTV and GTVboost bioeffect dose (PTV-BED, GTVboost-BED), spinal cord maximal dose, bilungual V5, V20, V30, bilungual mean dose in the two groups, Cardiac V30, V40, Cardiac mean dose.【Results】The actual dose of PTV in the SIB-SBRT group was not significantly different from that of the IMRT group (P > 0.05); however, the actual dose of GTVboost in the SIB-SBRT group was higher than that of the IMRT group, and the difference was significant (P < 0.05); the levels of TC, CI, and HI in the SIB-SBRT program were not significantly different from those in the IMRT program (P > 0.05). Comparison of PTV-BED and GTVboost-BED between the two groups, PTV-BED in the SIB-SBRT group was similar to that in the IMRT group, with no statistically significant difference (P > 0.05); GTVboost-BED in the SIB-SBRT group was significantly higher than that in the IMRT group (P < 0.05). Comparison of the levels of bipulmonary V20 and V30 and cardiac V30 and V40 between the two groups showed no statistically significant difference (P > 0.05); the levels of spinal maximal dose, bipulmonary V5, bipulmonary mean dose, and cardiac mean dose in the SIB-SBRT group were significantly lower than those in the IMRT group (P < 0.05).【Conclusion】For patients with >5 cm advanced NSCLC, although IMRT has a slight advantage in terms of target area conformability and homogeneity of dose distribution. However, SIB-SBRT significantly increased the dose and BED in the GTVboost region and showed its advantage in reducing the radiation dose to normal tissues (especially the average dose to lung V5 and heart). Therefore, SIB-SBRT increased the irradiation dose to the core tumor region and had the potential to overcome the large volume mass radiation resistance, and such a novel radiation therapy approach deserves further exploration and investigation. |
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