论文部分内容阅读
目的:比较射波刀、螺旋断层治疗(Tomo)、Edge加速器、Trilogy加速器和伽马刀5种设备在胰腺癌立体定向放疗中剂量学上的优劣。方法:回顾分析10例射波刀治疗的胰腺癌患者临床资料，分别由5家单位5种设备按照统一计划设计要求进行计划设计。完成后的计划统一导入MIM软件平台提取评估参数。主要参数包括计划靶区的Dn min、Dn mean、Dn max、适形指数(CI和nCI)、均匀指数(HI)、梯度指数(GI)、覆盖率和胃肠Dn max及体积剂量等。n 结果:Trilogy获得最优CI和nCI (n P<0.001)；伽马刀HI最差(n P<0.001)；GI射波刀最优，伽马刀次之，Tomo和Edge相对最弱(n P<0.001)；Edge加速器和Trilogy加速器获得最大PTV Dn min值，射波刀和Tomo组获得较小PTV Dn min值(n P<0.001)；伽马刀组获得了最大的PTV Dn max、Dn mean(n P<0.001)。危及器官方面，射波刀组获得最低的空回肠Dn max及Dn 5cmn 3(n P<0.001)、胃Dn max(n P＝0.003)、十二指肠Dn max(n P＝0.001)、Dn 5cmn 3(n P<0.001)及Dn 10cmn 3(n P＝0.005)、脊髓Dn max及Dn 0.35cmn 3(n P<0.001)；伽马刀组空回肠Dn max最大；Edge加速器组十二指肠Dn 5cmn 3最高(n P<0.001)；Tomo组脊髓Dn max及Dn 0.35cmn 3最高(n P<0.001)。n 结论:5种放疗设备均能很好地完成满足临床要求的胰腺癌立体定向放疗计划。射波刀和伽马刀拥有更优的剂量跌落梯度，Trilogy加速器和Edge加速器拥有更优的靶区适形性，射波刀胃肠道剂量保护相对更优。“,”Objective:To compare the dose distribution among CyberKnife, Tomotherapy, Edge, Triology and γ-knife in stereotactic body radiation therapy (SBRT) for pancreatic cancer.Methods:Clinical data of 10 panreatic cancer patients receiving CyberKinife treatment were retrospectively analyzed. The treatment plans were designed by five apparatuses from five centers according to the uniform requirement. All plans were transferred to MIM system for the extraction of parameters, which mainly included Dn min, Dn mean and Dn max of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, Dn max and dose-volume of the stomach and bowel.n Results:The best CI and nCI were obtained in Triology (n P<0.001), and the worst HI was found in γ-knife (n P<0.001). The best GI was found in CyberKnife, followed by γ-knife and Tomotherapy, and Edge showed the worst GI (n P<0.001). The highest Dn min of PTV was found in both Edge and Triology, while lower Dn min of PTV was found in CyberKnife and Tomotherapy (n P<0.001). Additionally, γ-knife provided the highest Dn mean and Dn max of PTV (n P<0.001). Regarding the organs at risk, the lowest Dn max and Dn 5cmn 3 of the bowel (n P<0.001), Dn max of the stomach (n P=0.003), Dn max(n P=0.001), Dn 5cmn 3 (n P<0.001) and Dn 10cmn 3 (n P=0.005) of the duodenum, Dn max(n P<0.001) and Dn 0.35cmn 3 (n P<0.001) of the spinal cord were found in CyberKnife. The highest Dn max of the bowel was found in γ-knife. Furthermore, the highest D n 5cmn 3 of the duodenum was demonstrated in Edge (n P<0.001) and Tomotherapy provided the highest Dn max(n P<0.001) and Dn 0.35cmn 3 of the spinal cord (n P<0.001).n Conclusions:All five radiotherapy apparatuses can meet the requirement of SBRT for pancreatic cancer. More rapid dose fall-off could be obtained via CyberKnife and γ-knife. Triology and Edge provide better target conformity. CyberKnife can better protect the gastrointestinal tract.