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目的被动散射质子治疗(passive-scattering proton therapy,PSPT)是临床最常用的质子放疗方式。调强质子治疗(intensity modulated proton therapy,IMPT)实现了剂量强度的调制,能进一步优化剂量分布,但在多发性肝癌中是否有优势尚不明确。本研究比较PSPT和IMPT在多发性肝癌中靶区剂量分布和正常肝脏受量的差异,为临床应用提供剂量学参考。方法 2013-08-10-2015-11-25淄博万杰肿瘤医院诊断为多发性肝癌患者10例,CT定位扫描,勾画靶区和周围正常组织,分别制定PSTP计划和IMPT计划,两个计划的处方剂量均为60Gy。应用剂量体积直方图(dosevolume histogram,DVH)比较2种不同质子治疗技术靶区的剂量分布和正常肝脏组织的受照剂量。结果 IMPT计划靶区的均匀性指数(homogeneity index,HI,t=3.563,P=0.006)和适形指数(conformal index,CI,t=-7.444,P<0.001)均优于PSPT计划,差异均有统计学意义。IMPT计划正常肝脏V_5(t=6.751,P<0.001)、V_(10)(Z=-2.803,P=0.005)、V_(15)(t=7.232,P<0.001)、V_(20)(t=9.694,P<0.001)、V_(25)(Z=-2.803,P=0.005)、V_(30)(t=8.407,P<0.001)、V_(35)(t=11.667,P<0.001)、V_(40)(Z=-2.803,P=0.005)和正常肝脏平均剂量(mean dose to normal liver,MDTNL,Z=-2.803,P=0.005)均明显低于PSPT计划,差异有统计学意义。结论 IMPT能改善多发性肝癌靶区的剂量分布,并降低正常肝脏的受照剂量,为临床应用提供了重要依据。IMPT有望提高多发性肝癌放疗疗效并降低并发症。
Purpose Passive-scattering proton therapy (PSPT) is the most commonly used proton therapy in clinical practice. Intensity modulated proton therapy (IMPT) modulates dose intensity and further optimizes dose distribution, but it is unclear whether there is an advantage in multiple liver cancer. This study compared PSPT and IMPT target area dose distribution in multiple liver cancer and normal liver volume differences, for clinical application of dosimetry reference. Methods 2013-08-10-2015-11-25 Zibo Wanjie Tumor Hospital diagnosed 10 cases of multiple liver cancer patients, CT scan, outline the target area and the surrounding normal tissue, respectively, the development of PSTP plan and IMPT plan, the two plans Prescription dose is 60Gy. Dose volume histogram (DVH) was used to compare the dose distribution of the two target sites of different proton therapy techniques and the dose of normal liver tissue. Results The homogeneity index (HI, t = 3.563, P = 0.006) and conformal index (CI, t = -7.444, There is statistical significance. (P = 0.001), V_ (10) (Z = -2.803, P = 0.005), V_ (15) (t = 7.232, P_0.001), V_ (20) (P = 0.001), V_ (25) (Z = -2.803, P = 0.005), V_ (30) (t = 8.407, , V 40 (Z = -2.803, P = 0.005) and mean dose to normal liver (MDTNL, Z = -2.803, P = 0.005) were significantly lower than those of PSPT . Conclusion IMPT can improve the dose distribution of multiple liver cancer target area and reduce the dose of normal liver, which provides an important basis for clinical application. IMPT is expected to improve the radiotherapy efficacy and reduce the complications of multiple liver cancer.