Abstract：Objective To design the IMRT plans with pulmonary-protection function based on pulmonary ventilation images. Methods The peak-exhale and peak-inhale CT data of 16 patients with lung cancer were put into the pulmonary ventilation analysis system to get the three dimensional pulmonary ventilation distribution images. And functional lungs whose Jacobin ratios were 0.5, 0.7, and 0.9 were delineated automatically by the system. Then two kinds of 5-field IMRT plans with the same angle settings of all the 16 patients were designed. Conventional IMRT plans were designed according to the anatomical information of the targets and normal tissues in CT positioning images. Three kinds of f-IMRT (function-intensity-modulated radiation therapy) plans which combined pulmonary ventilation images with CT images and added dose constraint to functional lungs were also designed. The differences of dose distributions in conventional IMRT plans and f-IMRT plans were compared. Results Both IMRT and f-IMRT plans can meet the clinical requirements. There is no significant difference in the exposure dose of heart, esophagus and spinal cord between IMRT plans and f-IMRT plans (P>0.05). Compared with IMRT plans, the V5, V10, and V20 of the total lung in f-IMRT plans decreased significantly (P<0.05); the V5, V10, and V20 of the functional lung in f0.7-IMRT plans decreased significantly (P<0.05); the V5, V10, V20, and V30 of the functional lung in f0.9-IMRT plans decreased significantly (P<0.05). Conclusion The exposure dose of the functional lung can be significantly reduced in f-IMRT plans guided by pulmonary ventilation images, which would be used to protect the pulmonary functions and improve the living quality of patients with lung cancer.
张书旭，王锐濠，余辉，林生趣，张国前，齐斌，雷怀宇. 肺通气功能分布引导的调强放疗计划设计研究[J]. 中国医疗设备, 2014, 29(10): 15-18.
ZHANG Shu-xu, WANG Rui-hao, YU Hui, LIN Sheng-qu,ZHANG Guo-qian, Qi Bin, LEI Huai-yu. Research on the Design of IMRT Plans Guided by Pulmonary Ventilation Images. China Medical Devices, 2014, 29(10): 15-18.
Mazeron R,Etienne-Mastroianni B,Perol D,et al.Predictive factors of late radiation fibrosis:a prospective study in non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2010,77(1):38-43.
[3]
Graham MV,Purdy JA,Emami B,et al.Clinical dose-volume histogram analysis forpneumonitisafter 3D treatment for non-small cell lung cancer (NSCLC)[J].Int J Radiat Oncol Biol Phys,1999,45(2):323-329.
[4]
Woel RT,Munley MT,Hollis D,et al.The time course of radiation therapy-induced reductions in regional perfusion:A prospective study with 5 years of follow-up[J].Int J Radiat Oncol Biol Phys,2002,52(1):58-67.
[8]
Yin Y,Chen JH,Li BS,et al.Protection of lung function by introducing single photon emission computed tomography lung perfusion image into radiotherapy planning of lung cancer[J].Chin Med J (Engl),2009,122(5):509-513.
Shioyama Y,Jang SY,Liu HH,et al.Preserving functional lung using perfusion imaging and intensity-modulated radiation therapy for advanced-stage non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2007,68(5):1349-1358.
[9]
Lavrenkov K,Singh S,Christian JA,et al.Effective avoidance of a functional spect-perfused lung using intensity modulatedradiotherapy (IMRT) for non-small cell lung[J].Radiother Oncol,2009,91(3):349-352.
[10]
Stavngaard T,Sogaard LV,Mortensen J,et al.Hyperpolarized 3He MRI and 81mKr SPECT in chronic obstructive pulmonary disease[J].Eur J Nucl Med Mol Imaging,2005,32(4):448-457.
[12]
Shioyama Y,Jang SY,Liu HH,et al.Preserving functional lung using perfusion imaging and intensity-modulated radiation therapy for advanced-stage non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2007,68(5):1349-1358.
