摘要目的 探讨多中心计划设计方法(M-ISO)在全中枢神经系统放疗(CSI)中的应用价值.方法 选取在本院已接受螺旋断层放射治疗(HT)的10例CSI患者的治疗计划,将此10例患者带有靶区及危及器官的CT图像通过网络传输至Eclipse 11.0计划系统,重新用M-ISO进行计划优化,比较两种计划中靶区、危及器官的受照剂量、治疗时间和机器跳数的差异.结果 两种计划设计方案得到的靶区剂量均能满足临床要求.D98％、D2％和HI参数HT组优于M-ISO组(t=2.822、2.333、4.743,P＜0.05),D50％、Dmean和CI参数M-ISO组优于HT组(t=5.259、3.685、8.835,P＜0.05);HT组计划对左右中耳、左右腮腺、颌下腺、甲状腺和肾脏的保护优于M-ISO组(t=4.365、5.416、2.674、3.077、2.782、2.607、4.659,P＜0.05),而M-ISO组胰腺和小肠的受照剂量优于HT组(t=5.265、5.935,P＜0.05);正常组织受照剂量M-ISO组V10、V20和V36均低于HT组(t=3.57、3.701、2.602,P＜0.05),而两组V5差异无统计学意义;M-ISO组计划在治疗时间、机器跳数两项参数明显优于HT组(t=8.477、19.313,P＜0.05),均值分别减少41.0％和94.1％.结论 多中心计划设计方法应用在全中枢调强放疗中能够满足剂量学临床要求,缩短治疗时间,减少机器损耗,可以作为一种新的计划设计方案推广.

abstractsObjective To explore the application value of multi-ISO center planning method in intensity-modulated radiotherapy for carniospinal irradiation.Methods Ten patients treated with craniospinal irradiation with helical tomotherapy were selected.For these patients, new plans were designed with multi-ISO centers planning method on the treatment planning system (TPS) named Eclipse 11.0.Dose distribution to the tumor, OARs and normal tissue, the treatment time and the monitor units (MUs) of the two plans were compared.Results The plans designed in two groups satisfied all clinical requirements.For the tumor target (PTV) , the difference of D95％ between two groups was not statistical significant, while D9s ％ , D2 ％ and HI in HT group were superior to M-ISO group (t =2.822,2.333,4.743, P ＜0.05) , D50％ , D and CI in M-ISO group were superior to HT group (t =5.259,3.685,8.835 ,P ＜ 0.05).The dose of OARs such as cochlea, parotid, submandibular gland, thyroid gland and kidney in HT group was lower than M-ISO group (t =4.365,5.416,2.674,3.077,2.782,2.607,4.659,P ＜0.05) , and the dose of pancreas and small bowel was higher than M-ISO group (t =5.265,5.935, P ＜ 0.05).Differences were not significant for V5 of normal tissue between two groups;while V10, V20 and V36 of normal tissue in M-ISO group were lower than HT group (t =3.57,3.701,2.602, P ＜ 0.05).M-ISO group reduced 41.0％ of the treatment time by average and reduced 94.1％ MUs by average.Conclusions Intensity-modulated radiotherapy for carniospinal irradiation with multi-ISO centers planning method not only met the requirements of clinical dosimetry, but also shorten the treatment time, reduced the damage to the machine.Multi-ISO centers planning method might be promoted as a new design scheme.