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

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

沧州市人民医院精准放疗中心，河北沧州 061000

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
计量
- 文章访问数: 93
- HTML全文浏览量: 22
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-18
- 网络出版日期: 2024-03-09

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

Precision Radiotherapy Center, Cangzhou People' s Hospital, Cangzhou, Hebei 061000, China

摘要

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。
- Monaco系统 /
- 宫颈癌 /
- 容积旋转调强 /
- 靶区优先模式
Abstract: Objective To explore the application of two optimization methods in Monaco system under intensity modulated radiation therapy (DMLC) and volumetric modulated arc therapy (VMAT) in cervical cancer. Methods A total of 40 patients with cervical cancer who received intensity-modulated radiotherapy in Cangzhou People' s Hospital from January 2020 to December 2022 were selected. After IMRT and VMAT, the effects of the two modes were analyzed. Results Under Constrained Mode, 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], bladder V20 [(78.07±6.31)% vs.(85.68±9.42)%], rectal V20 [(87.58±6.14)% vs.(88.75±5.21)%], rectal V40 [(34.21±6.71)% vs.(37.77±5.41)%], pelvis V20 [(84.74±4.91)% vs.(82.18±4.78)%], pelvis V30 [(51.77±6.73)% vs. (54.73±6.02)%], left femoral head V20 [(42.16±8.40)% vs. (37.37±8.68)%], right femoral head V30 [(9.90±3.43)% vs. (12.32±4.46)%]dose, the differences were significant (P < 0.05). Under the DMLC emphasis, the number of machine jumps in Constrained mode was lower than that in Pareto mode (P < 0.05), under the VMAT emphasis, the number of Pareto mode subfields was lower than that in Constrained mode (P < 0.05), and the number of machine jumps was higher than that in Constrained mode (P < 0.05). Conclusion VMAT technology can meet the radiation requirements of cervical cancer patients, and Pareto mode is better for endangering organ protection.
- Monaco system /
- Cervical cancer /
- Volumetric rotation intensity modulation /
- Target priority mode

HTML全文

图 1 宫颈癌患者治疗计划方案图

Figure 1. Treatment Plan for Cervical Cancer Patients

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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
项目	Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
HI	1.14±0.03	1.09±0.01	10.000	＜0.001	1.13±0.04	1.12±0.05^a	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±32.99^b	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±62.12^c	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
项目		Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
膀胱	V20(%)	78.07±6.31	89.30±9.30	6.320	＜0.001	85.68±9.42^a	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±5.21^a	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±5.41^a	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±4.78^a	81.99±4.51	0.181	0.857
	V30(%)	51.77±6.73	54.21±6.55	1.643	0.104	54.73±6.02^a	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±8.68^a	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±4.46^a	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
变量	Constrained模式	Pareto模式	t值	P值	Constrained模式	Pareto模式	t值	P值
出束时间(s)	413.22±51.74	417.52±87.73	0.267	0.790	294.64±30.13^a	287.16±32.57^b	1.066	0.290
子野数	129.45±12.37	128.90±14.45	0.183	0.855	203.55±8.62^a	194.27±11.74^b	4.030	＜0.001
机器跳数	900.67±50.47	1 027.81±122.89	6.053	＜0.001	1 222.67±114.01^a	1 339.73±168.62^b	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

参考文献(16)

[1]	刘娜, 张明军, 吴翠娥, 等. 基于Monaco计划系统的最小子野面积设置值对宫颈癌调强放疗计划的影响[J]. 安徽医科大学学报, 2022, 57(5): 811-815. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202205026.htm LIU N, ZHANG M J, WU C E, et al. The impact of setting the minimum field area based on the Monaco planning system on the intensity modulated radiotherapy plan for cervical cancer[J]. Acta Univ Med Anhui, 2022, 57(5): 811-815. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202205026.htm
[2]	周涛琪, 陈俊, 周欣, 等. 基于HSP70信号通路探究三七总皂苷对宫颈癌MPO活性及放疗敏感性的作用机制[J]. 中华全科医学, 2022, 20(4): 565-569. doi: 10.16766/j.cnki.issn.1674-4152.002401 ZHOU T Q, CHEN J, ZHOU X, et al. Exploring the mechanism of action of Panax notoginseng saponins on MPO activity and radiation sensitivity in cervical cancer based on the HSP70 signaling pathway[J]. Chinese Journal of General Practice, 2022, 20(4): 565-569. doi: 10.16766/j.cnki.issn.1674-4152.002401
[3]	SANCHEZ-NIETO B, MEDINA-ASCANIO K N, RODRIGUEZ-MONGUA J L, et al. Study of out-of-field dose in photon radiotherapy: a commercial treatment planning system versus measurements and Monte Carlo simulations[J]. Med Phys, 2020, 47(9): 4616-4625. doi: 10.1002/mp.14356
[4]	HASANI M, FARHOOD B, GHORBANI M, et al. Effect of computed tomography number-relative electron density conversion curve on the calculation of radiotherapy dose and evaluation of Monaco radiotherapy treatment planning system[J]. Australas Phys Eng Sci Med, 2019, 42(2): 489-502. doi: 10.1007/s13246-019-00745-6
[5]	邓建国, 苏世达, 陈利, 等. MONACO计划系统控制点数量对晚期鼻咽癌动态调强治疗计划质量影响[J]. 中华肿瘤防治杂志, 2021, 28(6): 456-460, 468. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL202106011.htm DENG J G, SU S D, CHEN L, et al. The impact of the number of control points in the MONACO planning system on the quality of dynamic intensity modulated treatment plans for advanced nasopharyngeal carcinoma[J]. Chin J Cancer Prevention and Treatment, 2021, 28(6): 456-460, 468. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL202106011.htm
[6]	AYALA R, RUIZ G, VALDIVIELSO T. Automatizing a nonscripting TPS for optimizing clinical workflow and reoptimizing IMRT/VMAT plansy[J]. Med Dosim, 2019, 44(4): 409-414. doi: 10.1016/j.meddos.2019.02.006
[7]	DAMME A V, ROMBAUT J, MAKAR A, et al. Completion surgery after intensity-modulated arc therapy for locally advanced cervical cancer: long-term follow-up and update on surgical outcome and oncologic results of a unique tertiary care single-center retrospective cohort[J]. World J Surg Oncol, 2023, 21(1): 2-11. doi: 10.1186/s12957-022-02878-7
[8]	王成, 陈维军, 李玉成, 等. 优化角度分组对宫颈癌容积旋转调强计划剂量分布的影响[J]. 科学技术与工程, 2021, 21(15): 6236-6241. doi: 10.3969/j.issn.1671-1815.2021.15.018 WANG C, CHEN W J, LI Y C, et al. The effect of optimizing angle grouping on the dose distribution of cervical cancer volume rotation intensity modulation plan[J]. Chin Sci Citation Database, 2021, 21(15): 6236-6241. doi: 10.3969/j.issn.1671-1815.2021.15.018
[9]	韩胜, 彭小东, 袁珂, 等. 体电子密度对术后宫颈癌放射治疗计划剂量精确度的影响研究[J]. 中华放射医学与防护杂志, 2021, 41(2): 140-145. HAN S, PENG X D, YUAN K, et al. Study on the Effect of Volume Electron Density on the Dose Accuracy of Postoperative Cervical Cancer Radiotherapy Plan[J]. Chin J Radiol Med Prot, 2021, 41(2): 140-145.
[10]	陈菲, 张确, 李政欢. 臂架角度增量对宫颈癌术后VMAT计划质量的影响[J]. 医疗卫生装备, 2021, 42(6): 60-64. https://www.cnki.com.cn/Article/CJFDTOTAL-YNWS202106012.htm CHEN F, ZHANG Z, LI Z H. The effect of arm angle increment on the quality of VMAT plan after cervical cancer surgery[J]. Chin Med Equipment J, 2021, 42(6): 60-64. https://www.cnki.com.cn/Article/CJFDTOTAL-YNWS202106012.htm
[11]	LEI C, HUANG M, LI N, et al. Intensity-modulated radiotherapy combined with intracavitary brachytherapy for locally advanced cervical cancer with uterus didelphys[J]. Gynecol Oncol Rep, 2021, 36(3): 100724. DOI: 10.1016/j.gore.2021.100724.
[12]	GOSWAMI B, JAIN R K, YADAV S, et al. A dosimetric study of volumetric arc modulation with rapidArc versus intensity-modulated radiotherapy in cervical cancer patients[J]. J Clin Diagn Res, 2021, 15(5): XC01-XC05. DOI: 10.7860/JCDR/2021/48635.14863.
[13]	潘香, 杨毅, 侯宇, 等. 基于Monaco的不同布野方式在左乳腺癌保乳术后调强放疗中的剂量学差异[J]. 实用临床医药杂志, 2021, 25(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202101001.htm PAN X, YANG Y, HOU Y, et al. Dosimetric differences in base note radiotherapy for left breast cancer after breast conserving surgery with different field layout based on Monaco[J]. J Clin Med Prac, 2021, 25(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202101001.htm
[14]	付春鹏, 陈昌舜, 徐智, 等. 基于Monaco计划系统蒙特卡罗算法的脊柱植入钛合金对靶区及周围组织剂量分布的影响研究[J]. 中国医学装备, 2022, 19(6): 21-24. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202206005.htm FU C P, CHEN C S, XU Z, et al. Study on the effect of spinal implantation of titanium alloy on the dose distribution in the target area and surrounding tissues based on the monte carlo algorithm of the monaco planning system[J]. Chin Med Equipment, 2022, 19(6): 21-24. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202206005.htm
[15]	柏晗, 吴星娆, 陈飞虎, 等. 宫颈癌外照射Pinnacle与Monaco系统容积调强物理方案的比较分析及方案质量评估模型的创建[J]. 肿瘤预防与治疗, 2019, 32(1): 61-66. Comparative analysis of physical schemes for volume intensity modulation of pinnacle and monaco systems for external irradiation of cervical cancer and creation of a quality evaluation model for the schemes[J]. J Canc Control Treat, 2019, 32(1): 61-66.
[16]	葛双, 王寻, 叶书成, 等. 宫颈癌双弧容积旋转调强放射治疗中两种优化模式的剂量学比较研究[J]. 中国医学装备, 2020, 17(10): 40-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202010012.htm GE S, WANG X, YE S C, et al. Dosimetric comparison of two optimization modes in dual arc volume rotation intensity modulated radiation therapy for cervical cancer[J]. Chin Med Equipment, 2020, 17(10): 40-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202010012.htm