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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

张坤, 杨健, 牛书雷, 许新明. 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[J]. 中华全科医学, 2024, 22(1): 14-17. doi: 10.16766/j.cnki.issn.1674-4152.003320
引用本文: 张坤, 杨健, 牛书雷, 许新明. 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[J]. 中华全科医学, 2024, 22(1): 14-17. doi: 10.16766/j.cnki.issn.1674-4152.003320
ZHANG Kun, YANG Jian, NIU Shulei, XU Xinming. Application of Constrained, Pareto optimization approach in Monaco system intensity modulation mode for Cervical Cancer Radiotherapy[J]. Chinese Journal of General Practice, 2024, 22(1): 14-17. doi: 10.16766/j.cnki.issn.1674-4152.003320
Citation: ZHANG Kun, YANG Jian, NIU Shulei, XU Xinming. Application of Constrained, Pareto optimization approach in Monaco system intensity modulation mode for Cervical Cancer Radiotherapy[J]. Chinese Journal of General Practice, 2024, 22(1): 14-17. 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
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

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

  • 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。

     

  • 图  1  宫颈癌患者治疗计划方案图

    Figure  1.  Treatment Plan for Cervical Cancer Patients

    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

    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
    Constrained模式 Pareto模式 t P Constrained模式 Pareto模式 t P
    HI 1.14±0.03 1.09±0.01 10.000 <0.001 1.13±0.04 1.12±0.05a 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±32.99b 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±62.12c 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。
    下载: 导出CSV

    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
    Constrained模式 Pareto模式 t P Constrained模式 Pareto模式 t P
    膀胱 V20(%) 78.07±6.31 89.30±9.30 6.320 <0.001 85.68±9.42a 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±5.21a 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±5.41a 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±4.78a 81.99±4.51 0.181 0.857
    V30(%) 51.77±6.73 54.21±6.55 1.643 0.104 54.73±6.02a 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±8.68a 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±4.46a 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。
    下载: 导出CSV

    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
    Constrained模式 Pareto模式 t P Constrained模式 Pareto模式 t P
    出束时间(s) 413.22±51.74 417.52±87.73 0.267 0.790 294.64±30.13a 287.16±32.57b 1.066 0.290
    子野数 129.45±12.37 128.90±14.45 0.183 0.855 203.55±8.62a 194.27±11.74b 4.030 <0.001
    机器跳数 900.67±50.47 1 027.81±122.89 6.053 <0.001 1 222.67±114.01a 1 339.73±168.62b 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。
    下载: 导出CSV
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  • 收稿日期:  2023-07-18
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