Dosimetric Differences between Tomo and Monaco Planning Systems and Comparison of Gamma Pass Rates in Preoperative Radiotherapy for Rectal Cancer Patients
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摘要:
目的 探讨Tomo和Monaco计划系统在直肠癌术前放疗中的剂量学差异及Gamma通过率的对比，为临床术前治疗实施方案的正确选择制定提供重要参考。 方法 选取2019年12月至2021年1月期间收治的20例直肠癌术前放疗患者，对这20例直肠癌术前放疗患者分别进行Tomo和Monaco的计划设计，利用剂量体积直方图评价靶区剂量分布以及危及器官的照射剂量，分析比较两个计划系统在计划靶区与危及器官剂量学中的差异，并比较两种计划的Gamma通过率。 结果 Tomo与 Monaco计划均可满足靶区处方剂量要求。Tomo计划PGTV 靶区的HI、CI均优于Monaco计划系统，PCTV靶区的CI也同样优于Monaco计划系统（P < 0.001）。危及器官方面，相较于Monaco计划系统，膀胱Dmean、V50、V40、V30，双侧股骨头Dmean、V30、V20、V15，骨盆V50指标TOMO计划均值较低（P < 0.05）。Tomo的计划机器执行跳数是Monaco的计划机器执行跳数的4.3倍，Tomo的计划机器执行时间是Monaco的计划机器执行时间的1.31倍（P < 0.05）。Tomo计划的Gamma通过率均值比Monaco计划的通过率高（P < 0.05）。 结论 直肠癌术前放疗患者选取Tomo计划系统设计时，可较大的提升肿瘤组织靶区均匀性与适形度，不仅如此，它还降低了肿瘤周围危及器官的受照剂量，计划Gamma通过率较高，但治疗时间较长；Monaco计划系统治疗时间明显缩短。 Abstract:Objectives To investigate the dosimetric differences between TOMO and Monaco planning systems in preoperative radiotherapy for rectal cancer and the comparison of Gamma pass rate, so as to provide a reference for the selection of clinical treatment. Methods A total of 20 patients with preoperative radiotherapy for rectal cancer admitted from December 2019 to January 2021 were selected, TOMO and Monaco planning were performed for these 20 patients respectively. The dose-volume histogram was used to evaluate the dose distribution of the target area and the radiation dose of the organs at risk. The differences between the two planning systems in the dosimetry of the planned target area and endangering organs were analyzed and compared, and the gamma pass rates of the two schemes were compared. Results Both TOMO and Monaco plans could meet the prescription dose requirement of target area. The HI and CI of PGTV target of Tomo plan were better than those of Monaco planning system, and the CI of PCTV target area was also superior to that of Monaco plan system （P < 0.001）. In terms of organs at risk, compared with Monaco planning system, the mean values of Dmean, V50, V40, V30 of bladder, Dmean, V30, V20, V15 of bilateral femoral head, and pelvic V50 indicators in TOMO plan were lower （P < 0.05）. The execution time of Tomo’ s planning machine was 4.3 times that of Monaco’ s, and the execution time of Tomo’ s planning machine was 1.31 times that of Monaco’ s （P < 0.05）. The mean Gamma pass rate of Tomo plan was higher than that of Monaco plan （P < 0.05）. Conclusion The TOMO plan system design for preoperative radiotherapy of rectal cancer patients can significantly improve the target uniformity and conformal degree, and can also reduce the dose of normal tissues. The plan Gamma has a higher pass rate, but the treatment time is longer. The treatment time of Monaco planning system is significantly shortened. -
Key words:
- Rectal tumor /
- Tomo plan /
- Monaco plan /
- Dosimetric /
- Gamma passing rate
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表 1 2种计划靶区剂量学参数比较（
$\bar x \pm s $ ）Table 1. Comparison of dosimetric parameters between two planned target area （
$\bar x \pm s $ ）靶区 Tomo Monaco t P PGTV D2（Gy） 51.74 ± 0.51 53.49 ± 0.62 −10.072 0*** D50（Gy） 50.87 ± 0.32 51.83 ± 0.37 −9.830 0*** D98（Gy） 49.79 ± 0.12 49.85 ± 0.30 −0.718 0.482 HI 0.04 ± 0.01 0.07 ± 0.01 −8.232 0*** CI 0.90 ± 0.02 0.81 ± 0.06 6.501 0*** PCTV D2（Gy） 51.42 ± 0.42 52.97 ± 0.49 −11.307 0*** D50（Gy） 47.55 ± 0.69 47.77 ± 0.81 −1.570 0.133 D98（Gy） 44.68 ± 0.23 44.60 ± 0.36 0.867 0.397 CI 0.90 ± 0.02 0.87 ± 0.02 5.162 0*** ***P < 0.001。 
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表 2 2种计划危及器官的剂量学参数比较（
$\bar x \pm s $ ）Table 2. Comparison of dosimetric parameters of two kinds of planned organs endangered （
$\bar x \pm s $ ）OAR Tomo Monaco t P 膀胱 V50（％） 2.19 ± 3.08 2.87 ± 3.61 −3.317 0.004** V40（％） 21.92 ± 11.93 26.07 ± 11.79 −3.188 0.005** V30（％） 38.21 ± 14.57 47.75 ± 14.17 −3.207 0.005** V20（％） 69.22 ± 18.17 75.63 ± 17.90 −1.05 0.307 Dmean（Gy） 27.57 ± 4.52 30.10 ± 4.42 −2.28 0.034* 小肠 V50（％） 0.17 ± 0.30 0.25 ± 0.49 −1.788 0.09 V40（％） 8.27 ± 4.42 8.82 ± 4.89 −1.245 0.228 V30（％） 15.93 ± 7.36 16.93 ± 7.12 −1.513 0.147 V20（％） 30.28 ± 13.85 31.48 ± 11.59 −1.035 0.314 Dmean（Gy） 13.52 ± 4.95 13.57 ± 4.46 −0.22 0.828 左股骨头 V40（％） 0.22 ± 0.43 0.41 ± 0.90 −1.57 0.133 V30（％） 3.16 ± 3.65 5.55 ± 7.01 −2.446 0.024 V20（％） 15.50 ± 9.43 28.56 ± 17.66 −3.189 0.005** V15（％） 35.62 ± 12.62 50.81 ± 22.19 −2.69 0.015* Dmean（Gy） 13.68 ± 2.70 15.99 ± 4.17 −2.72 0.014* 右股骨头 V40（％） 0.26 ± 0.38 0.94 ± 2.18 −1.527 0.143 V30（％） 3.12 ± 2.92 7.40 ± 11.47 −1.984 0.062 V20（％） 16.72 ± 8.36 32.19 ± 20.89 −3.284 0.004** V15（％） 39.85 ± 10.66 54.28 ± 25.55 −2.449 0.024* Dmean（Gy） 14.15 ± 2.24 16.71 ± 4.96 −2.563 0.019* 骨盆 V50（％） 0.61 ± 0.88 0.97 ± 1.60 −1.922 0.07 V40（％） 22.25 ± 6.85 23.31 ± 6.98 −0.987 0.336 V30（％） 45.25 ± 7.43 46.39 ± 10.03 −0.683 0.503 V20（％） 72.49 ± 7.54 74.52 ± 9.07 −1.101 0.285 Dmean（Gy） 28.18 ± 2.53 28.67 ± 2.87 −1.084 0.292 *P < 0.05，**P < 0.01。
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表 3 2种计划的 MU 和 TT 参数比较（
$\bar x \pm s $ ）Table 3. Comparison of MU and TT parameters between the two plans （
$\bar x \pm s $ ）参数 Tomo Monaco t P MU 4685.05 ± 570.24 1090.41 ± 246.35 27.490 0*** TT 5.8 ± 0.68 4.43 ± 0.49 7.199 0*** ***P < 0.001。
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表 4 2种计划的Gamma通过率参数比较（
$\bar x \pm s $ ）Table 4. Comparison of Gamma pass rate parameter comparison between the two plans （
$\bar x \pm s $ ）Gamma通过率标准 Tomo Monaco t P 3％ 2 mm 93.88 ± 2.872 91.50 ± 5.383 2.190 0.041* *P < 0.05。
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