Monaco计划系统不同通量平滑方式对直肠癌术后容积旋转调强放射治疗计划影响的分析

doi:10.3969/j.issn.1006-6233.2021.11.025

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Abstract Objective: To investigate the dosimetric differences of volume rotary intensity modulated radiotherapy (VMAT) plan designed by three different flux smoothing methods in Monaco plan system. Methods: 16 patients with rectal cancer were randomly selected to design VMAT plans (FSH, FSM, FSL) by three different fluence smoothing modes under the same optimized conditions and used the Monaco 5.11 TPS and the VersaHD accelerator model. The dose verification was measured by matrixx detector. The parameters mainly included the target volume and OAR dose-volume histogram, as well as conformity index (CI), homogeneity index (HI), dose gradient index (GI), monitor unit (MU), control point (CP), beam time (T) and gamma pass rate (GRP) were considered. Results: Ci of FSL was significantly better than that of FSM and FSH, hi was slightly better than that of FSM and FSH, GI was similar to that of FSM, and both were better than that of FSH group. Both FSL and FSM had obvious advantages in increasing D_min and D_98% of PTV. Compared with FSH, FSL and FSM could increase by 2.84% (P<0.05). In oar, D_mean, V₃₀, V₄₀ and FSL of bladder were lower than those of FSM and FSH, with the maximum of 3.76% and 7.01% (P<0.05); D_mean, V₂₀ and FSL of the right femoral head decreased by 9.10% compared with FSM and FSH (P<0.05); FSL and FSM were slightly better than FSH in the protection of left femoral head; In terms of intestinal protection, the results of the three were similar. The average values of FSH and FSM were 15.93% and 8.68% lower than that of FSL for CP, were decreased by 14.30% and 8.33% for mu, 13.39% and 6.91% for t (P<0.05). The difference was statistically significant (P<0.05). The planned GRP of the three groups was greater than 99% under the standard of 3% / 3mm, which met the clinical requirements. However, under the higher standard of 1% / 1mm and 2% / 2mm, the GRP of FSH and FSM was similar, which was significantly higher than that of FSL (P<0.05). Conclusion: In the postoperative VMAT plan for rectal cancer, the dosimetric parameters and GRP of FSH, FSM and FSL can meet the clinical requirements. FSL is superior to FSM and FSH in improving the quality of the plan, reducing the radiation dose and toxic and side effects of bladder and femoral head; FSH and FSM are better than FSL in improving the efficiency of plan implementation. Therefore, when designing the plan, we should comprehensively consider the clinical requirements and individual differences of patients, and give priority to FSM, which can not only meet the better plan quality, but also improve the plan implementation efficiency.

Key words： Fluence smoothing modes Dosimetry Monaco treatment planning system Rectal cancer Volumetric-modulated arc therapy

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2021.11.025 OR http://www.hbyxzzs.cn/EN/Y2021/V27/I11/1888

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