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目的分析常规放射治疗计划、三维适形放射治疗(3DCRT)计划和调强适形放射治疗(IMRT)计划治疗非小细胞肺癌(NSCLC)的疗效,评估3DCRT和IMRT与常规治疗的优越性。方法对经病理证实的50例中晚期NSCLC(Ⅲ～Ⅳ期)患者进行回顾性分析,计划靶区处方剂量66Gy,利用治疗计划系统(TPS)对每例患者分别设计常规、3DCRT和IMRT三种放疗计划,通过剂量体积直方图,比较三种计划对肿瘤靶区和正常组织器官的剂量分布。结果 (1)靶区适行度:处方剂量为66Gy时,三维适形放射治疗和调强适形放射治疗达此剂量的计划靶区(PTV)体积和95%PTV体积下的照射剂量均高于常规治疗,同时,调强适形放射治疗均高于三维适形放射治疗。(2)除全肺V20的IMRT检测外,3DCRT和IMRT治疗的肺受剂量均比常规治疗高。在全肺V5和全肺V10检测中,3DCRT比IMRT剂量低,其余检测中3DCRT比IMRT剂量高。(3)三种计划脊髓最大受照剂量均<45Gy。脊髓,食管及心脏受照剂量3DCRT均较常规放疗低,并且差异均有统计学意义(P<0.05)。结论 (1)3DCRT和IMRT较常规放射治疗明显提高了靶区的照射剂量和靶区的准确性,从而在相同处方剂量情况下提高了治疗肿瘤的控制率。(2)3DCRT和IMRT与常规放疗比较,对肺的保护性存在一定的局限性。(3)3DCRT和IMRT在一定程度上可降低正常组织受照剂量和并发症的发生概率,减少正常组织的放射损伤。(4)IMRT在靶区剂量分布上明显优于常规放射治疗和3DCRT,同时能在一定程度上更好的保护正常组织。
Objective To evaluate the efficacy of conventional CRT, 3DCRT and IMRT in the treatment of non-small cell lung cancer (NSCLC) and to evaluate the superiority of 3DCRT and IMRT compared with conventional therapy. Methods Fifty patients with advanced NSCLC (stage Ⅲ ~ Ⅳ) confirmed by pathology were retrospectively analyzed. The planned target dose was 66Gy. Each patient was treated with TPS for routine design, 3DCRT and IMRT Radiotherapy plans, dose-volume histograms, to compare the three plans on the tumor target area and normal tissue and organ dose distribution. Results (1) Target area fitness: At the dose of 66 Gy, three-dimensional conformal radiotherapy and intensity-modulated conformal radiotherapy achieved the planned target volume (PTV) at this dose and the dose at 95% PTV volume In the conventional treatment, at the same time, intensity-modulated conformal radiotherapy were higher than the three-dimensional conformal radiotherapy. (2) In addition to the IMRT of V20 in whole lung, both the doses of 3DCRT and IMRT were higher than those of conventional treatment. In all-lung V5 and whole-lung V10 assays, 3DCRT is lower than the IMRT dose and in the remaining tests, the 3DCRT is higher than the IMRT dose. (3) The maximum doses of the three planned spinal cord were <45Gy. Spinal cord, esophageal and cardiac dose 3DCRT were lower than conventional radiotherapy, and the differences were statistically significant (P <0.05). Conclusions (1) Compared with conventional radiotherapy, 3DCRT and IMRT significantly improve the target dose and the accuracy of the target area, so as to improve the control rate of tumor treatment under the same prescription dose. (2) 3DCRT and IMRT compared with conventional radiotherapy, there are some limitations on the protection of the lungs. (3) 3DCRT and IMRT can reduce the incidence of dose and complications of normal tissue to a certain extent, reduce the radiation damage of normal tissue. (4) IMRT is obviously superior to conventional radiotherapy and 3DCRT in dose distribution of the target area, and at the same time can better protect normal tissues to some extent.