Monaco系统调强模式下Constrained、Pareto优化方式在宫颈癌调强放疗中的应用

张坤; 杨健; 牛书雷; 许新明

doi:10.16766/j.cnki.issn.1674-4152.003320

Monaco系统调强模式下Constrained、Pareto优化方式在宫颈癌调强放疗中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003320

沧州市人民医院精准放疗中心，河北沧州 061000

基金项目:

河北省2021年度医学科学研究课题 20211665

详细信息

通讯作者:
杨健，E-mail：yangjian_y1@163.com

中图分类号: R737.33 R730.55
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出版历程
- 收稿日期: 2023-07-18
- 网络出版日期: 2024-03-09

Application of Constrained, Pareto optimization approach in Monaco system intensity modulation mode for Cervical Cancer Radiotherapy

Precision Radiotherapy Center, Cangzhou People' s Hospital, Cangzhou, Hebei 061000, China

摘要

摘要: 目的探索动态调强(DMLC)、容积旋转调强(VMAT)下Monaco系统中2种优化方式在宫颈癌中的应用效果。方法选取2020年1月—2022年12月于沧州市人民医院接受调强放疗40例宫颈癌患者，在IMRT、VMAT后，分析2种模式的影响。结果 Constrained模式中Dmean[(5 225.41±32.53)cGy vs.(5 205.84±32.99)cGy]、Dmax[(5 585.46±51.64)cGy vs.(5 635.99±62.12)cGy]、膀胱V20[(78.07±6.31)% vs.(85.68±9.42)%]、直肠V20[(87.58±6.14)% vs.(88.75±5.21)%]、直肠V40[(34.21±6.71)% vs.(37.77±5.41)%]、骨盆V20[(84.74±4.91)% vs.(82.18±4.78)%]、骨盆V30[(51.77±6.73)% vs. (54.73±6.02)%]、左股骨头V20[(42.16±8.40)% vs. (37.37±8.68)%]、右股骨头V30[(9.90±3.43)% vs. (12.32±4.46)%]剂量，差异均有统计学意义(P＜0.05)。在DMLC强调下，Constrained模式的机器跳数低于Pareto模式(P＜0.05)，VMAT强调下，Pareto模式子野数低于Constrained模式(P＜0.05)，机器跳数高于Constrained模式(P＜0.05)。结论 VMAT技术能够满足宫颈癌患者放疗需求，且Pareto模式对危及的器官保护更优。
- Monaco系统 /
- 宫颈癌 /
- 容积旋转调强 /
- 靶区优先模式
Abstract: Objective To explore the application of two optimization methods in Monaco system under intensity modulated radiation therapy (DMLC) and volumetric modulated arc therapy (VMAT) in cervical cancer. Methods A total of 40 patients with cervical cancer who received intensity-modulated radiotherapy in Cangzhou People' s Hospital from January 2020 to December 2022 were selected. After IMRT and VMAT, the effects of the two modes were analyzed. Results Under Constrained Mode, Dmean [(5 225.41±32.53)cGy vs.(5 205.84±32.99)cGy], Dmax [(5 585.46±51.64)cGy vs.(5 635.99±62.12)cGy], bladder V20 [(78.07±6.31)% vs.(85.68±9.42)%], rectal V20 [(87.58±6.14)% vs.(88.75±5.21)%], rectal V40 [(34.21±6.71)% vs.(37.77±5.41)%], pelvis V20 [(84.74±4.91)% vs.(82.18±4.78)%], pelvis V30 [(51.77±6.73)% vs. (54.73±6.02)%], left femoral head V20 [(42.16±8.40)% vs. (37.37±8.68)%], right femoral head V30 [(9.90±3.43)% vs. (12.32±4.46)%]dose, the differences were significant (P < 0.05). Under the DMLC emphasis, the number of machine jumps in Constrained mode was lower than that in Pareto mode (P < 0.05), under the VMAT emphasis, the number of Pareto mode subfields was lower than that in Constrained mode (P < 0.05), and the number of machine jumps was higher than that in Constrained mode (P < 0.05). Conclusion VMAT technology can meet the radiation requirements of cervical cancer patients, and Pareto mode is better for endangering organ protection.
- Monaco system /
- Cervical cancer /
- Volumetric rotation intensity modulation /
- Target priority mode

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图 1 宫颈癌患者治疗计划方案图

Figure 1. Treatment Plan for Cervical Cancer Patients

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图 2 靶区剂量不同角度分布情况

注：A为靶区剂量的横断位的剂量分布；B为靶区剂量的冠状位的剂量分布；C为靶区剂量的矢状位的剂量分布。

Figure 2. Distribution of different dose angles in the target area

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表 1 VMAT和DMLC强调下Monaco系统2种优化方式对靶区剂量的影响比较(n=40)

Table 1. Comparison of target dose between two Monaco system optimization methods underthe highlights of VMAT and DMLC(n=40)

项目	DMLC(9F)				VMAT
项目	Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
HI	1.14±0.03	1.09±0.01	10.000	＜0.001	1.13±0.04	1.12±0.05^a	0.710	0.480
CI	0.78±0.02	0.82±0.04	5.657	＜0.001	0.78±0.04	0.79±0.04	1.118	0.267
Dmean(cGy)	5 225.41±32.53	5 170.68±21.47	8.881	＜0.001	5 205.84±32.99^b	5 178.28±48.96	2.952	0.004
Dmax(cGy)	5 585.46±51.64	5 688.28±118.97	5.014	＜0.001	5 635.99±62.12^c	5 661.69±106.81	1.315	0.192
注：与DMLC(9F)强调下Pareto模式的HI比较，t=4.602，^aP＜0.05；与DMLC(9F)强调下Constrained模式的Dmean比较，t=2.671，^bP＜0.05；与DMLC(9F)强调下Constrained模式的Dmax比较，t=3.956，^cP＜0.05。

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表 2 VMAT和DMLC强调下Monaco系统2种优化方式对各脏器OAR剂量影响比较(n=40)

Table 2. Comparison of OAR dose of each organ between two Monaco system optimization methods underthe highlights of VMAT and DMLC(n=40)

项目		DMLC(9F)				VMAT
项目		Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
膀胱	V20(%)	78.07±6.31	89.30±9.30	6.320	＜0.001	85.68±9.42^a	86.32±11.64	0.270	0.788
	V30(%)	53.23±7.85	62.19±11.09	4.171	＜0.001	56.58±7.69	59.07±11.45	1.142	0.257
	V40(%)	36.50±8.23	41.64±10.49	2.438	0.017	37.31±6.54	39.02±8.61	1.000	0.320
	Dmax(cGy)	5 390.49±47.35	5 382.71±80.68	0.526	0.600	5 394.86±44.02	5 383.31±82.39	0.782	0.437
直肠	V20(%)	87.58±6.14	88.45±7.98	0.546	0.586	88.75±5.21^a	91.67±5.72	2.387	0.019
	V30(%)	63.55±7.79	70.59±12.99	2.940	0.004	62.05±7.04	68.19±8.64	3.484	0.001
	V40(%)	34.21±6.71	43.45±10.54	4.677	＜0.001	37.77±5.41^a	44.00±10.05	3.452	0.001
	Dmax(cGy)	5 188.37±109.15	5227.99±119.49	1.548	0.126	5 227.73±111.53	5 260.55±107.04	1.343	0.183
小肠	V20(%)	52.55±8.02	56.93±11.14	2.018	0.047	52.38±8.56	53.00±9.54	0.306	0.760
	V30(%)	25.22±8.05	28.47±10.36	1.567	0.121	26.56±8.43	27.58±9.55	0.506	0.614
	V40(%)	12.87±5.23	13.82±6.09	0.748	0.456	13.12±5.41	13.91±6.73	0.579	0.565
	Dmax(cGy)	5 369.15±55.20	5315.11±75.77	3.646	＜0.001	5 364.67±68.09	5 343.46±106.51	1.061	0.292
骨盆	V20(%)	84.74±4.91	84.05±6.55	0.931	0.542	82.18±4.78^a	81.99±4.51	0.181	0.857
	V30(%)	51.77±6.73	54.21±6.55	1.643	0.104	54.73±6.02^a	55.59±6.60	0.609	0.544
	V40(%)	28.83±5.52	30.38±5.46	1.263	0.210	29.69±5.60	31.00±6.84	0.937	0.352
	Dmax(cGy)	5 348.97±46.82	5318.17±75.66	2.189	0.032	5 356.55±63.37	5 341.06±89.59	0.893	0.375
左股骨头	V20(%)	42.16±8.40	39.00±11.15	1.429	0.157	37.37±8.68^a	38.23±11.92	0.368	0.714
	V30(%)	11.06±4.12	10.89±4.29	0.180	0.857	12.10±4.49	12.90±6.06	0.665	0.508
	V40(%)	2.30±1.55	2.47±1.73	0.463	0.645	2.60±1.89	2.99±2.44	0.799	0.427
	Dmax(cGy)	4 287.90±386.03	4 270.68±374.73	0.202	0.840	4 279.21±405.63	4 316.52±396.96	0.416	0.679
右股骨头	V20(%)	40.41±8.18	37.65±10.26	1.330	0.187	40.66±10.73	38.37±10.97	0.944	0.348
	V30(%)	9.90±3.43	11.05±3.80	1.421	0.159	12.32±4.46^a	12.50±5.38	0.163	0.871
	V40(%)	2.07±1.48	2.34±1.62	0.778	0.439	2.48±1.73	2.64±1.92	0.392	0.696
	Dmax(cGy)	4 234.55±466.62	4 219.71±369.73	0.158	0.875	4 266.47±429.13	4 264.63±422.65	0.019	0.985
注：与DMLC(9F)强调下Constrained模式的膀胱V20、直肠V20、直肠V40、骨盆V20、骨盆V30、左股骨头V30、右股骨头V30比较，t=4.245、2.074、2.612、2.363、2.073、2.508、2.720，^aP＜0.05。

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表 3 VMAT和DMLC强调下Monaco系统2种优化方式对机器参数的影响比较(n=40)

Table 3. Comparison of machine parameters between two Monaco system optimization methods underthe highlights of VMAT and DMLC(n=40)

变量	DMLC(9F)				VMAT
变量	Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
出束时间(s)	413.22±51.74	417.52±87.73	0.267	0.790	294.64±30.13^a	287.16±32.57^b	1.066	0.290
子野数	129.45±12.37	128.90±14.45	0.183	0.855	203.55±8.62^a	194.27±11.74^b	4.030	＜0.001
机器跳数	900.67±50.47	1 027.81±122.89	6.053	＜0.001	1 222.67±114.01^a	1 339.73±168.62^b	3.637	＜0.001
注：与DMLC(9F)强调下Constrained模式的出束时间、子野数、机器跳数比较，t=12.526、31.083、16.334，^aP＜0.05，与DMLC(9F)强调下Pareto模式的出束时间、子野数、机器跳数比较，t=8.810、22.206、9.455，^bP＜0.05。

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