南方医科大学学报2025，Vol.45Issue(3)：643-649,7.DOI:10.12122/j.issn.1673-4254.2025.03.22
预后导向的肺癌调强放疗计划优化新方法
Prognosis-guided optimization of intensity-modulated radiation therapy plans for lung cancer
摘要
Abstract
Objective To propose a new method for optimizing radiotherapy planning for lung cancer by incorporating prognostic models that take into account individual patient information and assess the feasibility of treatment planning optimization directly guided by minimizing the predicted prognostic risk.Methods A mixed fluence map optimization objective was constructed,incorporating the outcome-based objective and the physical dose constraints.The outcome-based objective function was constructed as an equally weighted summation of prognostic prediction models for local control failure,radiation-induced cardiac toxicity,and radiation pneumonitis considering clinical risk factors.These models were derived using Cox regression analysis or Logistic regression.The primary goal was to minimize the outcome-based objective with the physical dose constraints recommended by the clinical guidelines.The efficacy of the proposed method for optimizing treatment plans was tested in 15 cases of non-small cell lung cancer in comparison with the conventional dose-based optimization method(clinical plan),and the dosimetric indicators and predicted prognostic outcomes were compared between different plans.Results In terms of the dosemetric indicators,D95%of the planning target volume obtained using the proposed method was basically consistent with that of the clinical plan(100.33%vs 102.57%,P=0.056),and the average dose of the heart and lungs was significantly decreased from 9.83 Gy and 9.50 Gy to 7.02 Gy(t=4.537,P<0.05)and 8.40 Gy(t=4.104,P<0.05),respectively.The predicted probability of local control failure was similar between the proposed plan and the clinical plan(60.05%vs 59.66%),while the probability of radiation-induced cardiac toxicity was reduced by 1.41%in the proposed plan.Conclusion The proposed optimization method based on a mixed objective function of outcome prediction and physical dose provides effective protection against normal tissue exposure to improve the outcomes of lung cancer patients following radiotherapy.关键词
预后引导计划优化/调强放疗计划/计划逆向优化Key words
prognosis-guided treatment planning optimization/intensity-modulated radiation therapy/inverse planning optimization引用本文复制引用
李华莉,宋婷,刘嘉雯,李永宝,姜兆静,窦文,周凌宏..预后导向的肺癌调强放疗计划优化新方法[J].南方医科大学学报,2025,45(3):643-649,7.基金项目
国家自然科学基金(82472117,82272131) （82472117,82272131）
广东省基础与应用基础研究基金(2024A1515011831,2024A1515010820) Supported by National Natural Science Foundation of China(82472117,82272131). （2024A1515011831,2024A1515010820）
