左侧乳腺癌根治术后调强放疗多目标优化与直接子野优化的剂量学比较

摘要/Abstract

摘要： 目的

比较多目标优化（multi-criteria optimization，MCO）与直接子野优化（direct machine parameter optimization， DMPO）在左侧乳腺癌根治术后调强放射治疗（intensity-modulated radiotherapy，IMRT）计划中的剂量学差异，探讨其可行性及优势。

方法

随机抽取基于DMPO算法优化的54例左侧乳腺癌根治术后患者的调强治疗计划，在射野方向等设置条件不变前提下，使用 MCO算法重新优化。比较两种优化算法得到的靶区与危及器官的相关参数，并行配对t检验。

结果

两种优化方法优化均能满足临床要求，且计划靶区（planning target volume，PTV） 95%的处方剂量覆盖率相当（t= -1.228，P> 0.05）；与DMPO-IMRT计划相比，MCO-IMRT计划的Dmax、Dmean更低（t= 11.817，P< 0.001；t= 6.407，P< 0.001），靶区的适形度（conformity index，CI）和均匀度（homogeneity index，HI）更好（t= 4.562，P< 0.001；t= 6.196，P< 0.001）；且危及器官受量明显降低，其中心脏V30、V40、Dmean，对侧肺和双肺的Dmean，患侧肺Dmean、V5、V20、V30，对侧乳腺的Dmax、Dmean，脊髓及脊髓PRV的Dmean显著降低；MCO-IMRT计划的机器跳数高于DMPO-IMRT计划（t= 5.835，P< 0.05）。

结论

在左侧乳腺癌根治术后的调强放射治疗中，与DMPO优化方法相比，MCO优化方法可显著降低危及器官的辐射剂量和靶区的高剂量点，且靶区适形指数、异质性指数等参数更优。

关键词:多目标优化,直接子野优化,乳腺癌,调强治疗

Abstract: Objective

To compare the dosimetric difference between multi-criteria optimization（MCO） and direct machine parameter optimization （DMPO） in intensity-modulated radiotherapy （IMRT） planning after radical mastectomy for left breast cancer， and to explore its feasibility and advantages.

Methods

Fifity-four patients with left breast cancer after radical mastectomy were randomly selected based on the optimization of the DMPO algorithm， and re-optimized using the MCO algorithm under the premise that the setting conditions that the field direction remain unchanged. The relevant parameters were compared of the target area and the organ-at-risk obtained by the two optimization algorithms， and paired t-test in parallel was done.

Results

Both optimization methods met the clinical requirements， and the 95% prescription dose coverage of PTV was equivalent （t= -1.228，P> 0.05）； compared with the DMPO-IMRT plan， the Dmin and Dmean of the MCO-IMRT plan were lower （t= 11.817， 6.407；P<0.05）， and had better conformity （CI） and uniformity （HI） of the target area （t= 4.562，P= 0.000；t= 6.196，P= 0.000）； and the dose of organ at risk（OAR） was significantly reduced， such as the V30， V40， Dmean of heart， the Dmean of contralateral lung and both lungs，the Dmean， V5， V20， V30 of affected lung， the Dmax， Dmean of contralateral breast， the Dmean of spinal cord and spinal cord PRV.And the number of machine hops of the MCO-IMRT plan was higher than that of the DMPO-IMRT plan （t= 5.835，P< 0.05）.

Conclusion

In intensity-modulated radiotherapy after radical mastectomy for left breast cancer， compared with the DMPO optimization method， the MCO optimization method can significantly reduce the radiation dose to the organs at risk and the high dose points of the target area， and the target area conformity index， homogeneity index are better.

Key words:Multi-criteria optimization,direct machine multi-criteria optimization,direct machine parameter optimization,breast cancer,intensity-modulated therapy

王建刚, 侯勇, 王鹏程, 吕心愿. 左侧乳腺癌根治术后调强放疗多目标优化与直接子野优化的剂量学比较[J]. betway必威登陆网址（betway.com ）学报, 2022, 43(4): 267-272.

Jiangang WANG, Yong HOU, Pengcheng WANG, Xinyuan LV. Dosimetric comparison of multi-criteria optimization and direct machine parameter optimization of intensity-modulated radiotherapy after radical mastectomy for left breast cancer[J]. Journal of Shandong First Medical Unversity & Shandong Academy of Medical Sciences, 2022, 43(4): 267-272.

图/表5

图1MCO权重界面与DVH图

表1PTV的剂量参数

parameter	DMPO	MCO	$x ¯$ $±$ s	t	P
Dmax	5 616.37 ± 79.205	5 537.77 ± 74.022	78.600 0 $±$ 48.879 5	11.817	< 0.001
Dmin	2 946.62 ± 653.449	2 813.55 ± 680.064	113.072 2 ± 275.739 2	3.546	< 0.001
PTV95%	98.19 ± 0.775	98.29 ± 0.642	- 0.103 7 ± 0.620 4	- 1.228	0.225
D5	5 412.85 ± 68.069	5 357.51 ± 67.721	55.340 7 ± 25.340 2	7.662	< 0.001
D95	4 925.24 ± 35.124	4 933.66 ± 27.836	- 8.418 5 ± 25.346 2	- 2.441	0.018
Dmean	5 208.55 ± 41.856	5 181.91 ± 41.032	26.642 6 ± 30.556 7	6.407	< 0.001
CI	1.165 9 ± 0.135 92	1.126 7 ± 0.118 81	0.039 26 ± 0.063 24	4.562	< 0.001
HI	1.098 9 ± 0.017 55	1.085 9 ± 0.171 0	0.012 96 ± 0.015 37	6.196	< 0.001

表1PTV的剂量参数

parameter	DMPO	MCO	$x ¯$ $±$ s	t	P
Dmax	5 616.37 ± 79.205	5 537.77 ± 74.022	78.600 0 $±$ 48.879 5	11.817	< 0.001
Dmin	2 946.62 ± 653.449	2 813.55 ± 680.064	113.072 2 ± 275.739 2	3.546	< 0.001
PTV95%	98.19 ± 0.775	98.29 ± 0.642	- 0.103 7 ± 0.620 4	- 1.228	0.225
D5	5 412.85 ± 68.069	5 357.51 ± 67.721	55.340 7 ± 25.340 2	7.662	< 0.001
D95	4 925.24 ± 35.124	4 933.66 ± 27.836	- 8.418 5 ± 25.346 2	- 2.441	0.018
Dmean	5 208.55 ± 41.856	5 181.91 ± 41.032	26.642 6 ± 30.556 7	6.407	< 0.001
CI	1.165 9 ± 0.135 92	1.126 7 ± 0.118 81	0.039 26 ± 0.063 24	4.562	< 0.001
HI	1.098 9 ± 0.017 55	1.085 9 ± 0.171 0	0.012 96 ± 0.015 37	6.196	< 0.001

图2同一患者MCO与DMPO横断面、冠状面、矢状面的剂量分布

表2危及器官的剂量学参数

Target	parameter	DMPO	MCO	$x ¯$ $±$ s	t	P
患侧肺	V5	52.28 ± 5.582	50.65 ± 5.356	1.629 6 ± 1.270 2	9.428	< 0.001
	V20	25.53 ± 3.325	23.77 ± 3.220	1.761 1 ± 1.229 1	10.529	< 0.001
	V30	16.58 ± 2.286	15.88 ± 2.252	0.700 0 ± 0.753 6	6.826	< 0.001
	Dmean	1 302.79 ± 135.960	1 251.18 ± 133.571	51.611 1 ± 39.389 1	9.629	< 0.001
对侧肺	Dmean	101.51 ± 81.839	95.72 ± 79.984	5.781 5 ± 9.997 5	4.250	< 0.001
全肺	Dmean	650.00 ± 98.213	623.30 ± 95.709	26.696 3 ± 18.556 2	10.572	< 0.001
心脏	V30	3.54 ± 2.046	2.96 ± 2.186	0.575 9 ± 0.779 0	5.433	< 0.001
	V40	1.19 ± 1.220	1.04 ± 1.199	0.155 6 ± 0.488 9	2.291	0.026
	Dmean	523.66 ± 143.172	473.99 ± 133.429	47.668 5 ± 53.539 7	6.817	< 0.001
对侧乳腺	Dmax	2 533.07 ± 1317.877	2 422.58 ± 1418.498	110.490 7 ± 332.714 4	2.440	0.018
对侧乳腺	Dmean	180.39 ± 114.363	137.82 ± 86.574	42.566 7 ± 50.703 7	6.169	< 0.001
脊髓	Dmax	2 439.37 ± 793.357	2 272.25 ± 756.011	167.111 0 ± 250.015 0	4.912	< 0.001
脊髓 PRV	Dmax	3 223.91 ± 914.266	3 073.24 ± 883.073	150.666 7 ± 333.647 2	3.318	0.002

表2危及器官的剂量学参数

Target	parameter	DMPO	MCO	$x ¯$ $±$ s	t	P
患侧肺	V5	52.28 ± 5.582	50.65 ± 5.356	1.629 6 ± 1.270 2	9.428	< 0.001
	V20	25.53 ± 3.325	23.77 ± 3.220	1.761 1 ± 1.229 1	10.529	< 0.001
	V30	16.58 ± 2.286	15.88 ± 2.252	0.700 0 ± 0.753 6	6.826	< 0.001
	Dmean	1 302.79 ± 135.960	1 251.18 ± 133.571	51.611 1 ± 39.389 1	9.629	< 0.001
对侧肺	Dmean	101.51 ± 81.839	95.72 ± 79.984	5.781 5 ± 9.997 5	4.250	< 0.001
全肺	Dmean	650.00 ± 98.213	623.30 ± 95.709	26.696 3 ± 18.556 2	10.572	< 0.001
心脏	V30	3.54 ± 2.046	2.96 ± 2.186	0.575 9 ± 0.779 0	5.433	< 0.001
	V40	1.19 ± 1.220	1.04 ± 1.199	0.155 6 ± 0.488 9	2.291	0.026
	Dmean	523.66 ± 143.172	473.99 ± 133.429	47.668 5 ± 53.539 7	6.817	< 0.001
对侧乳腺	Dmax	2 533.07 ± 1317.877	2 422.58 ± 1418.498	110.490 7 ± 332.714 4	2.440	0.018
对侧乳腺	Dmean	180.39 ± 114.363	137.82 ± 86.574	42.566 7 ± 50.703 7	6.169	< 0.001
脊髓	Dmax	2 439.37 ± 793.357	2 272.25 ± 756.011	167.111 0 ± 250.015 0	4.912	< 0.001
脊髓 PRV	Dmax	3 223.91 ± 914.266	3 073.24 ± 883.073	150.666 7 ± 333.647 2	3.318	0.002

图3MCO与DMPO剂量体积直方图比较

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