广义等效均匀剂量生物优化法在食管癌调强计划的应用

Application of Generalized Equivalent Uniform Dose Biological Optimization Method in Intensity-Modulated Planning of Esophageal Cancer

摘要

目的 探讨食管癌调强计划中广义等效均匀剂量生物优化法的应用。方法 选取承德医学院附属医院8例食管癌患者。每位患者使用三种方式进行运算,分别是对心脏和肺采用单目标物理优化法（PlanA）,多目标物理优化法（PlanB）以及广义等效均匀剂量生物优化法（PlanC）。脊髓及其外放的约束条件保持不变,对比3组计划的优劣。结果 在靶区和脊髓以及脊髓外扩剂量没有发生明显变化时,用广义等效均匀剂量生物优化法设计的计划在肺和心脏的大部分均值都下降,PlanA与PlanC对比显示,肺的V5、V10、V20、V30及Dmean均有差异且具有统计学意义（P<0.05）,心脏的V5、V10、V20及Dmean均有差异且具有统计学意义（P<0.05）。PlanB与PlanC对比显示,肺的V5、V10、V20、V30、V40及Dmean均有差异且具有统计学意义（P<0.05）,心脏的V5、V20及Dmean均有差异且具有统计学意义（P<0.05）。在剂量体积直方图（DVH）的显示中,在计划靶区（PTV）曲线没有明显变化且脊髓及脊髓外扩也没有明显变化的情况下,肺和心脏的曲线均有不同程度的左移。并且肺的正常组织并发症概率（NTCP）下降且具有统计学意义（P<0.05）。结论 采用广义等效均匀剂量生物优化法可以降低肺和心脏的照射剂量。广义等效剂量生物优化法要更优于多目标优化法和单目标优化法,可以更好的保护危及器官。

Abstract

Objective To explore the application of generalized equivalent uniform dose biological optimization method in intensity-modulated planning of esophageal cancer. Methods Eight patients with esophageal cancer were selected from the Affiliated Hospital of Chengde Medical University. Each patient used three methods for calculation: single objective physical optimization (planA), multi-objective physical optimization (PlanB) and generalized equivalent uniform dose biological optimization (PlanC) for heart and lung. The constraints of spinal cord and its external radiation remained unchanged, and the advantages and disadvantages of the three groups were compared. Results When there were no significant changes in the target area, spinal cord and spinal cord external expansion dose, most of the mean values of the plan designed by the generalized equivalent uniform dose biological optimization method decreased in the lung and heart. The comparison between PlanA and PlanC showed that V5, V10, V20, V30 and dmean of the lung, there were significant differences in V5, V10, V20 and dmean (P<0.05). The comparison between PlanB and PlanC showed that V5, V10, V20, V30, V40 and dmean of lung were statistically significant (P<0.05), while V5, V20 and dmean of heart were statistically significant (P<0.05). In the display of dose volume histograms (DVH), when there is no significant change in the planning target volume (PTV) curve and there is no significant change in the spinal cord and spinal cord expansion, the curves of lung and heart move to the left in varying degrees. The normal tissue complication probability (NTCP) of lung decreased and was statistically significant (P<0.05). Conclusion The radiation dose of lung and heart can be reduced by using the generalized equivalent uniform dose biological optimization method. Generalized equivalent dose biological optimization method is better than multi-objective optimization method and single objective optimization method, and can better protect endangered organs.

关键词

广义等效均匀剂量生物优化法 / 食管癌 / 单目标优化法 / 多目标优化法

Key words

generalized equivalent uniform dose biological optimization method / thoracic tumor / single objective optimization method / multi objective optimization method

[1] 杜子欧,鄂明艳. 胸部放疗所致心脏疾病研究进展[J]. 现代肿瘤医学,2021,29(22):4055-4059.
[2] 商海焦,罗汉文,梁志文,等. 多目标优化方法在鼻咽癌临床中的剂量学研究[J]. 中国医学物理学杂志,2014,31(2):4744-4747.
[3] 左宇浩,杨振,周剑良,等. 基于广义等效均匀剂量优化的直肠癌计划在固定野和容积旋转调强放疗中的比较[J]. 中国医学物理学杂志,2018,35(2):171-175.
[4] Niemierko A.Reporting and analyzing dose distribution: a conceptof equivalent uniform dose[J]. Med Phys, 1997, 24(1): 103-l10.
[5] Niemierko A.A generalized concept of equivalent uniform dose (EUD)[J]. Med Phys, 1999, 26: 1100.
[6] Wu Q, Mohan R, Niemierko A, et al.Optimization of intensity modulated radiotherapy plans based on the equivalent uniform dose[J]. Int J Radiat Oncol Biol Phys, 2002, 52(1): 224-235.
[7] Choi B, Deasy JO.The generalized concept of equivalent uniform dose function as a basis for intensity modulated treatment planning[J]. Phys Med Biol, 2002, 47: 3579-3589.
[8] Zhu J, Simon A, Haigron P, et al.The benefit of using bladder sub-volume equivalent uniform dose constraints in prostate intensity- modulated radiotherapy planning[J]. Oncotargets Ther, 2016, 9: 7537-7544.
[9] 黄华忠,李小会,万文俊,等. LKB NTCP模型对食管癌调强放疗所致放射性肺损伤的预测价值[J]. 临床肿瘤学杂志,2020,25(5):446-450.
[10] 赵云. 两独立总体T检验的SPSS实现[J]. 统计与决策,2021,37(20):44-47.
[11] Frometa-Castillo T, Pyakuryal A, Wals-Zurita A, et al.Proposals of models for new formulations of the current complication-free cure (P+) and uncomplicated tumor control probability (UTCP) concepts, and total normal tissue complication probability of late complications[J]. Int J Radiat Biol, 2020, 96(7): 847-850.
[12] Lu JY, Lin PX, Huang BT.Calculating the individualized fraction regime in stereotactic body radiotherapy for non-small cell lung cancer based on uncomplicated tumor control probability function[J]. Radiation Oncology, 2019, 14(1): 1-9.
[13] 何赟,郭亚,王亚利,等. 广义等效均匀剂量优化法在左侧乳腺癌调强放疗中的剂量学研究[J]. 现代肿瘤医学,2021,29(21):3825-3829.
[14] 戴相昆,杨丰蔚,杜镭,等. 等效均匀剂量优化法在宫颈癌调强计划中的应用[J]. 中国医学物理学杂志,2015,32(2):290-293.