nucВестник НЯЦ РКNNC RK Bulletin1729-75161729-7885Национальный ядерный центр Республики Казахстан10.52676/1729-7885-2026-1-198-206nuc-1004Research ArticleСтатьиСРАВНИТЕЛЬНЫЙ АНАЛИЗ ДОЗОВЫХ РАСПРЕДЕЛЕНИЙ И ОРГАННЫХ ДОЗ ПРИ 3D-CRT, IMRT И VMAT В СООТВЕТСТВИИ С ПРОТОКОЛАМИ QUANTEC И RTOG: ОСОБЕННОСТИ ПЛАНИРОВАНИЯ, ПРЕИМУЩЕСТВА И ОГРАНИЧЕНИЯCOMPARATIVE ANALYSIS OF DOSE DISTRIBUTIONS AND ORGAN DOSES IN 3D-CRT, IMRT AND VMAT ACCORDING TO QUANTEC AND RTOG PROTOCOLS: PLANNING FEATURES, ADVANTAGES AND LIMITATIONShttps://orcid.org/0009-0005-3700-9812МергенбаеваА. Д.MergenbayevaA. D.

Медицинский физик

Семей

Semey

inur.mergenbayeva@mail.ruhttps://orcid.org/0000-0003-0379-5315ТанатаровС. З.TanatarovS. Z.

Директор

Семей

Semey

sayat68@mail.ruhttps://orcid.org/0009-0009-4893-9264ИдиновМ. Т.IdinovM. T.

Главный инженер

Семей

Semey

idinov_medet@list.ruhttps://orcid.org/0000-0002-4553-356XКенжинаЛ. Б.KenzhinaL. B.

Советник по науке

Семей

Semey

laurakenzhina@yandex.ruhttps://orcid.org/0009-0003-0004-8354АтантаеваБ. Ж.AtantayevaB. Zh.

Заместитель директора

Семей

Semey

bayan_atantaeva@mail.ruhttps://orcid.org/0009-0009-4069-889XАйткалиевС. М.AitkaliyevS. M.

Заведующий отделением медицинских физиков

Семей

Semey

seka_asm@mail.ruhttps://orcid.org/0009-0005-8621-9381АлибековаА. Д.AlibekovaA. D.

Медицинский физик

Семей

Semey

aigul-aiko@mail.ruhttps://orcid.org/0009-0009-3782-2693ТусуповаА. Д.TussupovaA. D.

Медицинский физик

Семей

Semey

tusupova.83@mail.ruhttps://orcid.org/0009-0008-2171-9037ЕлемесоваН. А.ElemessovaN. A.

Медицинский физик

Семей

Semey

elemesovanazgul1996@mail.ruhttps://orcid.org/0009-0009-6660-8848СабековЕ. О.SabekovE. O.

Врач-радиолог

Семей

Semey

isabek.erganat.67@gmail.comКГП «Центр ядерной медицины и онкологии» УЗ области АбайКазахстан“Center of Nuclear Medicine and Oncology” of Abay Regional Health DepartmentKazakhstan20262504202601198206Copyright © Мергенбаева А.Д., Танатаров С.З., Идинов М.Т., Кенжина Л.Б., Атантаева Б.Ж., Айткалиев С.М., Алибекова А.Д., Тусупова А.Д., Елемесова Н.А., Сабеков Е.О., 20262026Мергенбаева А.Д., Танатаров С.З., Идинов М.Т., Кенжина Л.Б., Атантаева Б.Ж., Айткалиев С.М., Алибекова А.Д., Тусупова А.Д., Елемесова Н.А., Сабеков Е.О.Mergenbayeva A.D., Tanatarov S.Z., Idinov M.T., Kenzhina L.B., Atantayeva B.Z., Aitkaliyev S.M., Alibekova A.D., Tussupova A.D., Elemessova N.A., Sabekov E.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journals.nnc.kz/jour/article/view/1004

Исследование выполнено на базе Центра ядерной медицины и онкологии (г. Семей) и посвящено сравнительному дозиметрическому анализу параметров планирования дистанционной лучевой терапии при местно-распространённом раке шейки матки. Проведено сопоставление трёхмерной конформной лучевой терапии (3D-CRT), лучевой терапии с модуляцией интенсивности (IMRT) и объёмно-модулированной дуговой терапии (VMAT) с точки зрения качества дозовых распределений и дозовой нагрузки на органы риска. Планирование выполнено для 25 пациенток с использованием линейного ускорителя TrueBeam с ежедневной верификацией укладки на основе IGRT/CBCT. Качество планов оценивали по данным дозово-объёмных гистограмм с использованием параметров D95% для PTV, индексов конформности (CI) и гомогенности (HI), а также абсолютных дозовых характеристик (Dmean, Dmax) для органов риска в сопоставлении с рекомендациями протоколов RTOG и QUANTEC. Анализ показал, что методика VMAT продемонстрировала наилучшие дозиметрические показатели с высоким индексом конформности CI = 1,03±0,02 и низким индексом гомогенности HI = 0,09±0,02, обеспечивая более равномерное и точное покрытие PTV по сравнению с IMRT и 3D-CRT. Ключевым результатом стало существенное снижение дозовой нагрузки на органы риска малого таза: при использовании VMAT суммарное снижение дозы составило в среднем 25–30% относительно 3D-CRT, при этом средняя доза на прямую кишку (Dmean) снизилась до 33,0 Гр. Дополнительным пре- имуществом VMAT явилось сокращение среднего времени сеанса облучения до 5–7 минут, что снижает риск внутрифракционных смещений. Полученные данные подтверждают дозиметрические преимущества VMAT и обосновывают целесообразность её применения в условиях регионального онкологического центра.

The study was conducted at the Center of Nuclear Medicine and Oncology (Semey) and is devoted to a comparative dosimetric analysis of external beam radiotherapy planning parameters for locally advanced cervical cancer. Three- dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) were compared in terms of dose distribution quality and dose burden to organs at risk. Treatment planning was performed for 25 patients using a TrueBeam linear accelerator with daily patient setup verification based on IGRT/CBCT. Plan quality was evaluated using dose–volume histograms, including D95% for the planning target volume (PTV), conformity index (CI) and homogeneity index (HI), as well as absolute dose parameters (Dmean, Dmax) for organs at risk, in accordance with RTOG criteria and QUANTEC recommendations. The analysis demonstrated that VMAT provided the most favorable dosimetric performance, with a high conformity index (CI = 1,03±0,02) and a low homogeneity index (HI = 0,09±0,02), ensuring more uniform and accurate PTV coverage compared with IMRT and 3D-CRT. A key finding was a substantial reduction in dose burden to pelvic organs at risk: VMAT resulted in an average 25–30% reduction in overall dose compared with 3D-CRT, while the mean dose to the rectum (Dmean) decreased to 33,0 Gy. In addition, VMAT significantly reduced the average treatment delivery time to 5–7 minutes, thereby lowering the risk of intrafraction motion. The obtained results confirm the dosimetric advantages of VMAT and substantiate its feasibility for routine clinical use in a regional oncology center.

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The authors declare that there are no conflicts of interest present.