Fuller Clifton D, Thomas Charles R, Wong Adrian, Cavanaugh Sean X, Salter Bill J, Herman Terence S, Fuss Martin
Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, TX, USA.
Radiother Oncol. 2006 Oct;81(1):65-72. doi: 10.1016/j.radonc.2006.08.013. Epub 2006 Sep 12.
Clinical and technical parameter analysis of patients treated with ultrasound-based image-guided tomotherapeutic IMRT for gallbladder cancer.
Between 8/2001 and 5/2005, 10 patients with primary tumors of the gallbladder were treated by image-guided IMRT to median doses of 59 Gy. To analyze normal tissue radiation exposure reduction using this novel approach, a virtual plan comparison between actually delivered IMRT plans and re-computed plans with identical inverse planning parameters but more conventional PTV safety margins was conducted.
Average CTV was 379 cm(3), with a mean initial PTV of 834 cm(3). In 9/10 patients, a boost was delivered to a mean CTV(boost) of 171 cm(3) and average PTV(boost) of 241 cm(3). One patient reported RTOG grade 3 acute toxicity. All other patients exhibited Grade 2 or lower acute toxicity. Preliminary median overall survival was 16.7 months (range 3.2-34.9 months), with 5/10 patients alive at analysis. Virtual plan comparison revealed significant organ-at-risk sparing by the enabled PTV margin reduction.
Ultrasound-based image-guided IMRT is a feasible mechanism of delivering conformal radiation doses to tumors of the gallbladder with acceptable toxicity. Early outcome data with this novel radiation planning and delivery technique are encouraging and comparable to previously reported literature.
对接受基于超声图像引导的断层放射治疗调强放疗（IMRT）的胆囊癌患者进行临床和技术参数分析。
在2001年8月至2005年5月期间，10例原发性胆囊肿瘤患者接受了图像引导的调强放疗，中位剂量为59 Gy。为了分析使用这种新方法减少正常组织辐射暴露的情况，对实际交付的调强放疗计划与具有相同逆向计划参数但采用更传统的计划靶区（PTV）安全裕度重新计算的计划进行了虚拟计划比较。
平均临床靶区体积（CTV）为379 cm³，初始平均计划靶区体积（PTV）为834 cm³。在10例患者中的9例中，对平均体积为171 cm³的CTV（增量）和平均体积为241 cm³的PTV（增量）进行了增量照射。1例患者报告出现放射肿瘤学协作组（RTOG）3级急性毒性反应。所有其他患者表现为2级或更低级别的急性毒性反应。初步中位总生存期为16.7个月（范围3.2 - 34.9个月），分析时10例患者中有5例存活。虚拟计划比较显示，通过减小PTV边界可显著减少危及器官的受照剂量。
基于超声的图像引导调强放疗是一种可行的方法，能够以可接受的毒性向胆囊肿瘤提供适形放射剂量。这种新型放射治疗计划和实施技术的早期结果数据令人鼓舞，与先前报道的文献相当。
