广义等效均匀剂量优化方法在鼻咽癌调强放射治疗计划中的应用研究

doi:10.19401/j.cnki.1007-3639.2023.03.011

摘要/Abstract

摘要：

背景与目的：在制订鼻咽癌的调强放射治疗（intensity-modulated radiotherapy，IMRT）计划时，通过比较传统的剂量-体积（dose-volume，DV）物理优化方法，与联合运用DV物理优化方法和广义等效均匀剂量（generalized equivalent uniform dose optimization，gEUD）优化方法的鼻咽癌放疗计划中的剂量学差异，探讨不同的优化方法对IMRT计划中危及器官（organ at risk，OAR）的保护作用。 方法：随机选取2019—2021年复旦大学附属眼耳鼻喉科医院收治的鼻咽癌患者50例，将每例计划都同时采用两组优化方案进行优化计算：A组仅采用传统的DV物理优化方法；B组采用联合DV优化和gEUD优化方法，其中gEUD的a值分别选取1、2、5、10和20。通过分别观察采用不同的优化方案及不同的a值所获得的腮腺和口腔等OAR的剂量数据结果，从而评估两组优化方案的剂量学差异。 结果：比较分析两组方案的计划数据，其中靶区的剂量学指标差异无统计学意义（P>0.05）。但在腮腺和口腔的保护方面，B组优化方案的结果明显优于A组。对腮腺和口腔而言，gEUD的a值对腮腺和口腔平均剂量的影响比较明显。 结论：鼻咽癌放疗计划中，联合使用物理优化和生物优化能在满足靶区剂量要求的同时，更好地保护腮腺和口腔等较大体积的并联性OAR。

关键词: 广义等效均匀剂量, 鼻咽癌, 调强放射治疗

Abstract:

Background and purpose: In the design of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma, the traditional dose-volume (DV) physical optimization method is compared with the combined use of the DV physical optimization method and the generalized equivalent uniform dose (gEUD) optimization. This study aimed to investigate dosimetry differences in radiotherapy planning for nasopharyngeal carcinoma using gEUD method, to explore the effect of different optimization methods on the protection of organ at risk (OAR) in IMRT planning. Methods: Fifty patients with nasopharyngeal carcinoma in Eye & ENT Hospital of Fudan University from 2019 to 2021 were randomly selected, and two optimization plans were used for each case at the same time for optimization calculation. Group A used the traditional DV physical optimization method, while group B combined DV optimization and gEUD optimization methods adopted, in which gEUD was selected as a=1, 2, 5, 10 and 20. We evaluated the results of OAR dose data obtained by using different optimization schemes and different a values. Results: The planned data of the two plans were compared and analyzed, and there was no statistically significant difference in the dosimetry index of the target area between groups (P>0.05). However, in terms of the protection of the parotid gland and oral cavity, the results of the optimization plan of group B were significantly better compared with group A. The a value of gEUD had more obvious influence on the average dose of the parotid gland and the oral cavity. Conclusion: In the radiotherapy plan for nasopharyngeal carcinoma, the combined use of physical optimization and biological optimization can not only meet the target dose requirements but also better protect the parotid gland, oral cavity and other endangered OAR.

Key words: Generalized equivalent uniform dose, Nasopharyngeal carcinoma, Intensity-modulated radiotherapy

中图分类号:

唐天赐, 翟周诗佳, 李省苇, 王孝深, 倪晓晨. 广义等效均匀剂量优化方法在鼻咽癌调强放射治疗计划中的应用研究[J]. 中国癌症杂志, 2023, 33(3): 274-281.

TANG Tianci, ZHAI Zhoushijia, LI Shengwei, WANG Xiaoshen, NI Xiaochen. Application of generalized equivalent uniform dose optimization in the treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy[J]. China Oncology, 2023, 33(3): 274-281.

图/表 5

图1

图2

图3

图4

表1

参考文献 20

[1]	CHEN Y P, ISMAILA N, CHUA M L K, et al. Chemotherapy in combination with radiotherapy for definitive-intent treatment of stage Ⅱ-ⅣA nasopharyngeal carcinoma: CSCO and ASCO guideline[J]. J Clin Oncol, 2021, 39(7): 840-859. doi: 10.1200/JCO.20.03237
[2]	PANG H W, SUN X Y, YANG B, et al. A quality control method for intensity-modulated radiation therapy planning based on generalized equivalent uniform dose[J]. J Appl Clin Med Phys, 2018, 19(3): 276-282. doi: 10.1002/acm2.12331 pmid: 29696777
[3]	庞皓文, 孙小杨, 杨波. 剂量体积联合等效均匀剂量优化在鼻咽癌调强放疗危及器官优化中的应用[J]. 肿瘤防治研究, 2018, 45(3): 160-162.
	PANG H W, SUN X Y, YANG B. Application of dose-volume combined with equivalent uniform dose optimization in optimization of OAR in IMRT on nasopharyngeal carcinoma[J]. Cancer Res Prev Treat, 2018, 45(3): 160-162.
[4]	YOU R, LIU Y P, HUANG P Y, et al. Efficacy and safety of locoregional radiotherapy with chemotherapy vs chemotherapy alone in de novo metastatic nasopharyngeal carcinoma: a multicenter phase 3 randomized clinical trial[J]. JAMA Oncol, 2020, 6(9): 1345-1352. doi: 10.1001/jamaoncol.2020.1808
[5]	弓健, 姚凯宁, 王美娇, 等. 直肠癌术前容积调强放射治疗计划子野形状控制参数优化研究[J]. 中华肿瘤防治杂志, 2021, 28(8): 626-632.
	GONG J, YAO K N, WANG M J, et al. Aperture shape controller parameter optimization of volumetric modulated radiotherapy plans in preoperative radiotherapy for rectal cancer[J]. Chin J Cancer Prev Treat, 2021, 28(8): 626-632.
[6]	WU Q W, DJAJAPUTRA D, WU Y, et al. Intensity-modulated radiotherapy optimization with gEUD-guided dose-volume objectives[J]. Phys Med Biol, 2003, 48(3): 279-291. pmid: 12608607
[7]	NIEMIERKO A. Reporting and analyzing dose distributions: a concept of equivalent uniform dose[J]. Med Phys, 1997, 24(1): 103-110. doi: 10.1118/1.598063 pmid: 9029544
[8]	杨惠惠, 刘金刚, 王兴, 等. 等效均匀剂量优化方法在直肠癌逆向调强放疗中的应用研究[J]. 中国辐射卫生, 2020, 29(6): 682-685.
	YANG H H, LIU J G, WANG X, et al. Application of equivalent uniform dose optimization in the treatment of rectal cancer with intensity-modulated radiotherapy[J]. Chin J Radiol Heal, 2020, 29(6): 682-685.
[9]	WU Q W, DJAJAPUTRA D, LIU H H, et al. Dose sculpting with generalized equivalent uniform dose[J]. Med Phys, 2005, 32(5): 1387-1396. pmid: 15984690
[10]	周麟, 姜杉, 杨志永, 等. 等效均匀剂量在宫颈癌腔内联合插植近距离治疗中的应用[J]. 中华放射肿瘤学杂志, 2020, 29(7): 546-550.
	ZHOU L, JIANG S, YANG Z Y, et al. Application of equivalent uniform dose optimization in intracavitary/interstitial brachytherapy for cervical cancer[J]. Chin J Radiat Oncol, 2020, 29(7): 546-550.
[11]	贾晓斌, 董晓庆, 袁峥玺, 等. 剂量-体积联合等效均匀剂量优化在舌癌放疗中的应用研究[J]. 医疗卫生装备, 2019, 40(9): 37-41.
	JIA X B, DONG X Q, YUAN Z X, et al. Application of dose-volume combined with equivalent uniform dose optimizationin to tongue cancer radiotherapy[J]. Chin Med Equip J, 2019, 40(9): 37-41.
[12]	DE MARZI L, FEUVRET L, BOULÉ T, et al. Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy[J]. Br J Radiol, 2015, 88(1048): 20140413.
[13]	CHOI B, DEASY J O. The generalized equivalent uniform dose function as a basis for intensity-modulated treatment planning[J]. Phys Med Biol, 2002, 47(20): 3579-3589. pmid: 12433121
[14]	廖雄飞, Jack Yang, 黎杰, 等. 前列腺癌调强放疗计划等效均匀剂量法优化研究[J]. 中华放射肿瘤学杂志, 2013, 22(2): 143-146.
	LIAO X F, YANG J, LI J, et al. The application of equivalent uniform dose in planning optimization of intensity-modulated radiotherapy for prostate cancer[J]. Chin J Radiat Oncol, 2013, 22(2): 143-146.
[15]	FOGLIATA A, THOMPSON S, STRAVATO A, et al. On the gEUD biological optimization objective for organs at risk in Photon Optimizer of Eclipse treatment planning system[J]. J Appl Clin Med Phys, 2018, 19(1): 106-114. doi: 10.1002/acm2.12224 pmid: 29152846
[16]	许卓华, 黄海欣, 杨慧, 等. 容积旋转调强在局部晚期鼻咽癌放疗中的剂量学特点[J]. 中国医学物理学杂志, 2020, 37(7): 863-866.
	XU Z H, HUANG H X, YANG H, et al. Dosimetric characteristics of volumetric modulated arc therapy for locally advanced nasopharyngeal carcinoma[J]. Chin J Med Phys, 2020, 37(7): 863-866.
[17]	陈凯. 鼻咽癌调强放疗中等效均匀剂量优化法对腮腺保护作用的研究[D]. 昆明: 昆明医科大学, 2017.
	CHEN K. The effect of equivalent uniform dose optimization method on protection of parotid gland in the radiotherapy of nasopharyngeal carcinoma[D]. Kunming: Kunming Medical University, 2017.
[18]	乐文友, 戴建荣, 高黎. 鼻咽癌调强放疗等效均匀剂量优化方法对腮腺的保护作用[J]. 中华放射肿瘤学杂志, 2006, 15(6): 484-488.
	YUE W Y, DAI J R, GAO L. Intensity-modulated radiation therapy for nasopharyngeal carcinoma parotid sparing with euivalent uiform dose optimization[J]. Chin J Radiat Oncol, 2006, 15(6): 484-488.
[19]	ALLEN L X, ALBER M, DEASY J O, et al. The use and QA of biologically related models for treatment planning: short report of the TG-166 of the therapy physics committee of the AAPM[J]. Med Phys, 2012, 39(3): 1386-1409. doi: 10.1118/1.3685447 pmid: 22380372
[20]	冯紫薇. 基于先验知识的放疗计划自动优化技术的研究与临床应用[D]. 济南: 山东师范大学, 2018.
	FENG Z W. A study of knowledge-based radiation optimization for automatic radiation planning and clinical application[D]. Jinan: Shandong Normal University, 2018.

Structure	Parameter	A group	B₁ group		B₂ group		B₅ group		B₁₀ group		B₂₀ group
PTV	D_mean	7 121.46±167.04	7 115.02±157.41		7 106.04±149.05		7 109.2±146.43		7 106.7±151.03		7 113.28±147.98
	D₉₈	6 866.87±135.06	6 859.84±133.6		6 857.01±139.66		6 862.56±131.89		6 864.23±134.58		6 864.41±133.87
	D₂	7 292.99±157.81	7 287.76±152.43		7 287.71±155.64		7 288.89±156.37		7 289.1±161.87		7 291.89±157.13
	V₁₀₇	0.98±3.23	0.8±2.63		692.23±4888.96		0.87±2.89		2.1±8.8		0.87±2.58
	CI	1.53±0.44	1.52±0.45		1.51±0.43		1.52±0.44		1.52±0.45		1.53±0.44
	HI	0.06±0.01	0.06±0.01		0.06±0.01		0.06±0.01		0.06±0.01		0.06±0.01
Parotid	D_mean	4 305.02±584.88	3 831.22±504		3 780.97±543.13		3 825.66±582.64		3 965.74±578.42		4 109.34±571.65
	D₅₀	4 092.29±720.91	3 518.68±627.2		3 461.21±666.58		3 572.34±670.93		3 800.71±638.01		4 015.14±627.37
	D₂₅	5 107.84±590.56	4 838.85±628.94		4 671.12±661.18		4 533.07±717.54		4 586.36±690.39		4 720.04±655.62
Oral	D_mean	3 790.13±466.4	3 498.63±339.79		3 425.17±328.67		3 395.11±386.07		3 483.29±451.14		3 590.58±459.17
	D₅₀	3 713.92±456.64	3 400.71±323.27		3 338.72±327.46		3 324.02±375.62		3 452.37±431.52		3 581.94±438.62
Structure	Parameter	P value
Structure	Parameter	B₁ group vs A group		B₂ group vs A group		B₅ group vs A group		B₁₀ group vs A group		B₂₀ group vs A group
PTV	D_mean	0.843		0.627		0.697		0.644		0.796
	D₉₈	0.794		0.720		0.872		0.922		0.927
	D₂	0.867		0.867		0.896		0.904		0.972
	V₁₀₇	0.761		0.320		0.856		0.400		0.846
	CI	0.860		0.757		0.872		0.894		0.938
	HI	0.822		0.613		0.966		0.921		0.890
Parotid	D_mean	0.000		0.000		0.000		0.004		0.09
	D₅₀	0.000		0.000		0.000		0.035		0.569
	D₂₅	0.030		0.001		0.000		0.000		0.003
Oral	D_mean	0.001		0.000		0.000		0.001		0.034
	D₅₀	0.000		0.000		0.000		0.004		0.144