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目的通过偏左肺布野设计在胸中下段食管癌放疗计划设计中剂量学差异的比对,探讨肺受照射体积剂量与放射性肺炎发生概率(NTCP)的关系。方法选择2013年10月至2014年10月40例胸中下段食管癌患者,每例患者均由物理师设计两组调强放疗计划,A组偏左肺布野照射野固定为0°、30°、80°、150°、200°,B组全肺布野照射野分为0°、60°、150°、210°、300°。结果 A组,左肺V5为(52.13±9.29),右肺V5和V15分别为(43.73±9.80)、(12.73±8.65),与B组左肺的V5(55.89±8.18)及右肺V5(48.51±9.11)和V15(20.67±8.21)相比明显较低,差异有统计学意义(P均<0.05)。A组左肺V15为(31.13±7.63)与B组左肺V15(29.33±6.74)相比,差异无统计学意义(P>0.05)。A组,左肺的V30为(6.92±8.10),右肺V20、V30分别为(8.53±5.82)、(4.81±3.85)均明显低于B组左肺的V30(8.93±3.88),及右肺V20(11.21±5.90)和V30(5.05±3.72),差异有统计学意义(P均<0.05)。而A组左肺V20为(20.03±5.31)与B组左肺V20(19.17±4.74)相比差异无统计学意义(P>0.05)。结论对于胸中下段食管癌患者采用调强放疗时,实施偏左肺布野设计可明显减少双肺正常组织受照射的体积和剂量,降低放射性肺炎的发生率,增加放射治疗的安全性。
OBJECTIVE: To compare the dosimetric differences in the radiotherapy planning design of esophageal carcinoma in the middle and lower thoracic esophagus through the design of the left-sided lung cloth field, and to explore the relationship between the volume dose of lung irradiation and the incidence of radiation pneumonitis (NTCP). Methods Forty patients with lower thoracic esophageal cancer from October 2013 to October 2014 were enrolled in this study. Two surgeons were enrolled in this study. Each group of patients underwent radiofrequency ablation and radiation therapy. The left field of group A was fixed at 0 ° and 30 °, 80 °, 150 °, 200 °, B group lung field cloth field of radiation is divided into 0 °, 60 °, 150 °, 210 °, 300 °. Results The V5 and V15 in the left lung were (52.13 ± 9.29) and (43.73 ± 9.80) and (12.73 ± 8.65) in the right lung in group A, respectively, which were significantly lower than those in the left lung (55.89 ± 8.18) and right lung V5 48.51 ± 9.11) was significantly lower than that of V15 (20.67 ± 8.21) (P <0.05). The V15 of left lung in group A was (31.13 ± 7.63) compared with that of left lung V15 in group B (29.33 ± 6.74), there was no significant difference (P> 0.05). In group A, the left lung V30 was (6.92 ± 8.10) and the right lung V20 and V30 were (8.53 ± 5.82) and (4.81 ± 3.85) respectively, which were significantly lower than those of the left lung in group B (8.93 ± 3.88) Lung V20 (11.21 ± 5.90) and V30 (5.05 ± 3.72), the difference was statistically significant (P all <0.05). However, the V20 of left lung in group A was (20.03 ± 5.31) and the difference of left V20 (19.17 ± 4.74) in group B was not statistically significant (P> 0.05). Conclusions For patients with lower thoracic esophageal cancer with intensity-modulated radiotherapy, the implementation of the left-sided cloth design can significantly reduce the volume and dose of normal lung tissue irradiation, reduce the incidence of radiation pneumonitis and increase the safety of radiation therapy.