南方医科大学学报

南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (4): 773-779.doi: 10.12122/j.issn.1673-4254.2024.04.20

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妇科肿瘤近距离三维后装放疗不同优化方法的剂量学分析比较

凌宝珍，陈 利，张 俊，曹新平，叶伟军，欧阳翼，迟 峰，丁振华   

  1. 南方医科大学公共卫生学院放射医学系，广东 广州 510515；中山大学肿瘤防治中心//华南恶性肿瘤防治全国重点实验室//肿瘤医学协同创新中心，广东 广州 510060
  • 发布日期:2024-04-29

Dosimetric analysis of different optimization algorithms for three-dimensional brachytherapy for gynecologic tumors

LING Baozhen, CHEN Li, ZHANG Jun, CAO Xinping, YE Weijun, OUYANG Yi, CHI Feng, DING Zhenhua   

  1. Department of Radiation Medicine, School of Public Health, Southern Medical University, Guangzhou 510515, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
  • Published:2024-04-29

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摘要： 目的 比较妇科肿瘤近距离三维后装放疗计划4种不同优化方法的剂量学差异，为妇科肿瘤三维后装治疗优化方法的选用提供依据。方法 回顾性选取CT引导下三维后装腔内联合组织间插植/组织间插植的妇瘤患者110例，依据原始图像重新制定4组计划，分别为基于图形优化的正向计划Gro，基于模拟退火逆向优化算法IPSA1、IPSA2（IPSA2是在IPSA1基础上增加体积剂量限值），以及基于混合逆向优化算法HIPO。比较4组计划中CTV的体积剂量参数V200、V150、V100、D90、D98、适形度指数CI，以及膀胱、直肠、乙状结肠D2cc、D1cc、D0.1cc剂量参数。结果 正向计划优化时间相较于逆向优化时间较长，其次是HIPO优化。剂量学方面对比，逆向优化HIPO计划的HRCTV D90、D98、V100参数优于正向优化和IPSA，逆向优化IPSA1、IPSA2、HIPO三组的HRCTV D90、V100高于正向优化Gro，差异有统计学意义（P<0.05）；4组计划靶区适形指数CI接近，差异无统计学意义（P>0.05）；危及器官方面，HIPO计划的膀胱、直肠D2cc所受剂量低于其他3组，对于膀胱吸收剂量，正向优化Gro与IPSA1、HIPO相比差异有统计学意义（P<0.05）；对于直肠，IPSA1、IPSA2、HIPO组的D2cc、D1cc参数优于Gro，差异有统计学意义（P<0.05）；4组计划的乙状结肠剂量参数接近，差异无统计学意义（P>0.05）。结论 对于妇科肿瘤近距离三维后装放疗计划，正向与逆向优化均能满足临床要求，使用逆向HIPO优化可实现更好的靶区覆盖以及减少膀胱、直肠受量，设计时间也可接受，在计划首次优化时推荐使用，实际临床可结合图形优化人工微调以获得更为个体化的计划剂量分布。

关键词: 妇科肿瘤；后装放疗；逆向优化；IPSA；HIPO

Abstract: Objective To investigate the dosimetric difference between manual and inverse optimization in 3-dimensional (3D) brachytherapy for gynecologic tumors. Methods This retrospective study was conducted among a total of 110 patients with gynecologic tumors undergoing intracavitary combined with interstitial brachytherapy or interstitial brachytherapy. Based on the original images, the brachytherapy plans were optimized for each patient using Gro, IPSA1, IPSA2 (with increased volumetric dose limits on the basis of IPSA1) and HIPO algorithms. The dose- volume histogram (DVH) parameters of the clinical target volume (CTV) including V200, V150, V100, D90, D98 and CI, and the dosimetric parameters D2cc, D1cc, and D0.1cc for the bladder, rectum, and sigmoid colon were compared among the 4 plans. Results Among the 4 plans, Gro optimization took the longest time, followed by HIPO, IPSA2 and IPSA1 optimization. The mean D90, D98, and V100 of HIPO plans were significantly higher than those of Gro and IPSA plans, and D90 and V100 of IPSA1, IPSA2 and HIPO plans were higher than those of Gro plans (P<0.05), but the CI of the 4 plans were similar (P>0.05). For the organs at risk (OARs), the HIPO plan had the lowest D2cc of the bladder and rectum; the bladder absorbed dose of Gro plans were significantly greater than those of IPSA1 and HIPO (P<0.05). The D2cc and D1cc of the rectum in IPSA1, IPSA2 and HIPO plans were better than Gro (P<0.05). The D2cc and D1cc of the sigmoid colon did not differ significantly among the 4 plans. Conclusion Among the 4 algorithms, the HIPO algorithm can better improve dose coverage of the target and lower the radiation dose of the OARs, and is thus recommended for the initial plan optimization. Clinically, the combination of manual optimization can achieve more individualized dose distribution of the plan.

Key words: gynecologic tumors; brachytherapy; inverse optimization; IPSA; HIPO