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剂量计算模型对适形放疗中治疗计划评估的影响:三例研究。

Influence of dose calculation model on treatment plan evaluation in conformal radiotherapy: a three-case study.

作者信息

Miften Moyed M, Beavis Andrew W, Marks Lawrence B

机构信息

Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.

出版信息

Med Dosim. 2002 Spring;27(1):51-7. doi: 10.1016/s0958-3947(02)00088-2.

Abstract

In modern conformal radiotherapy (CRT), we attempt to increase its therapeutic ratio, thus improving the survival chances and/or quality of life for patients. It is common to acknowledge that poor local tumor control or increased normal tissue complications may arise from inaccurate targeting of the tumor, failure to conform the high-dose distribution to the target volume, and inaccurately delivered radiation doses. A further cause for concern is the influence that errors or inaccuracies in the dose calculation may have on the management of radiation therapy. Such errors arise from inherent limitations in the calculation algorithm used, which are more significant in some anatomical sites than others. Furthermore, an estimate of the therapeutic ratio is given by the ratio of tumor control probability (TCP) and normal tissue complication probability (NTCP). The effectiveness of these predictive indicators also depends on the accuracy of the calculated dose distributions in the target and surrounding normal structures. In this work, we compared CRT dose distributions of plans for the treatment of prostate, head-and-neck, and lung tumors using the measurement-based Clarkson and model-based Superposition dose calculation algorithms. Dose-volume histograms (DVHs) for the planning target volume (PTV) and sensitive structures, as well as NTCP and TCP, were compared. Dose distributions, observed in the lung and head-and-neck plans, vary significantly with respect to dose conformity as a function of algorithm used. Differences in the calculated maximum dose of up to 14% were observed in the PTV and sensitive structures for the lung and head-and-neck Clarkson-based plans, respectively, compared to the Superposition-based plans. Furthermore, a difference in the biological outcomes of up to 14% in the NTCP and 4% in the TCP was noticed. The CRT plans show the importance of accurate modeling of the effect of tissue inhomogeneities on dose distributions in the target and critical structures for lung and head-and-neck treatments.

摘要

在现代适形放射治疗(CRT)中,我们试图提高其治疗比,从而提高患者的生存几率和/或生活质量。人们普遍认识到,肿瘤局部控制不佳或正常组织并发症增加可能源于肿瘤靶向不准确、高剂量分布未能与靶区体积相符以及放射剂量传递不准确。另一个令人担忧的原因是剂量计算中的误差或不准确可能对放射治疗管理产生的影响。此类误差源于所用计算算法的固有局限性,在某些解剖部位比其他部位更为显著。此外,治疗比由肿瘤控制概率(TCP)与正常组织并发症概率(NTCP)的比值给出。这些预测指标的有效性还取决于靶区和周围正常结构中计算出的剂量分布的准确性。在这项工作中,我们使用基于测量的克拉克森算法和基于模型的叠加算法,比较了前列腺、头颈部和肺部肿瘤治疗计划的CRT剂量分布。比较了计划靶区(PTV)和敏感结构的剂量体积直方图(DVH),以及NTCP和TCP。在肺部和头颈部计划中观察到的剂量分布,根据所用算法的不同,在剂量适形性方面有显著差异。与基于叠加算法的计划相比,基于克拉克森算法的肺部和头颈部计划在PTV和敏感结构中分别观察到高达14%的计算最大剂量差异。此外,NTCP中高达14%、TCP中高达4%的生物学结果差异也被注意到。CRT计划显示了准确模拟组织不均匀性对肺部和头颈部治疗的靶区和关键结构中剂量分布的影响的重要性。

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