Lindsay Patricia E, El Naqa Issam, Hope Andrew J, Vicic Milos, Cui Jing, Bradley Jeffrey D, Deasy Joseph O
Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Med Phys. 2007 Jan;34(1):334-46. doi: 10.1118/1.2400826.
An important unresolved issue in outcomes analysis for lung complications is the effect of poor or completely lacking heterogeneity corrections in previously archived treatment plans. To estimate this effect, we developed a novel method based on Monte Carlo (MC) dose calculations which can be applied retrospectively to RTOG/AAPM-style archived treatment plans (ATP). We applied this method to 218 archived nonsmall cell lung cancer lung treatment plans that were originally calculated either without heterogeneity corrections or with primitive corrections. To retrospectively specify beam weights and wedges, beams were broken into Monte Carlo-generated beamlets, simulated using the VMC++ code, and mathematical optimization was used to match the archived water-based dose distributions. The derived beam weights (and any wedge effects) were then applied to Monte Carlo beamlets regenerated based on the patient computed tomography densities. Validation of the process was performed against five comparable lung treatment plans generated using a commercial convolution/superposition implementation. For the application here (normal lung, esophagus, and planning target volume dose distributions), the agreement was very good. Resulting MC and convolution/superposition values were similar when dose distributions without heterogeneity corrections or dose distributions with corrections were compared. When applied to the archived plans (218), the average absolute percent difference between water-based MC and water-based ATPs, for doses above 2.5% of the maximum dose was 1.8+/-0.6%. The average absolute percent difference between heterogeneity-corrected MC and water-based ATPs increased to 3.1+/-0.9%. The average absolute percent difference between the MC heterogeneity-corrected and the ATP heterogeneity-corrected dose distributions was 3.8+/-1.6% (available in 132/218 archives). The entire dose-volume-histograms for lung, tumor, and esophagus from the different calculation methods, as well as specific dose metrics, were compared. The average difference in maximum lung dose between water-based ATPs and heterogeneity-corrected MC dose distributions was -1.0+/-2.1 Gy. Potential errors in relying on primitive heterogeneity corrections are most evident from a comparison of maximum lung doses, for which the average MC heterogeneity-corrected values were 5.3+/-2.8 Gy less than the ATP heterogeneity-corrected values. We have demonstrated that recalculation of archived dose distributions, without explicit information about beam weights or wedges, is feasible using beamlet-based optimization methods. The method provides heterogeneity-corrected dose data consistent with convolution-superposition calculations and is one feasible approach for improving dosimetric data for outcomes analyses.
肺部并发症结果分析中一个重要的未解决问题是,先前存档的治疗计划中异质性校正不佳或完全缺乏异质性校正的影响。为了评估这种影响,我们开发了一种基于蒙特卡罗(MC)剂量计算的新方法,该方法可追溯应用于RTOG/AAPM格式的存档治疗计划(ATP)。我们将此方法应用于218个存档的非小细胞肺癌肺部治疗计划,这些计划最初的计算要么没有进行异质性校正,要么采用了原始校正。为了追溯确定射束权重和楔形板,将射束分解为蒙特卡罗生成的子射束,使用VMC++代码进行模拟,并采用数学优化来匹配存档的基于水模体的剂量分布。然后将导出的射束权重(以及任何楔形板效应)应用于根据患者计算机断层扫描密度重新生成的蒙特卡罗子射束。针对使用商业卷积/叠加算法生成的五个可比肺部治疗计划对该过程进行了验证。对于此处的应用(正常肺、食管和计划靶体积剂量分布),一致性非常好。比较无异质性校正的剂量分布或有异质性校正的剂量分布时,所得的MC值和卷积/叠加值相似。应用于存档计划(218个)时,对于高于最大剂量2.5%的剂量,基于水模体的MC与基于水模体的ATP之间的平均绝对百分比差异为1.8±0.6%。经异质性校正的MC与基于水模体的ATP之间的平均绝对百分比差异增加到3.1±0.9%。经MC异质性校正与ATP异质性校正的剂量分布之间的平均绝对百分比差异为3.8±1.6%(在132/218个存档中可用)。比较了不同计算方法得出的肺、肿瘤和食管的整个剂量体积直方图以及特定剂量指标。基于水模体的ATP与经异质性校正的MC剂量分布之间最大肺剂量的平均差异为-1.0±2.1 Gy。从最大肺剂量的比较中可以最明显地看出依赖原始异质性校正的潜在误差,经MC异质性校正的平均剂量值比ATP异质性校正的值低5.3±2.8 Gy。我们已经证明,在没有关于射束权重或楔形板的明确信息的情况下,使用基于子射束的优化方法重新计算存档剂量分布是可行的。该方法提供了与卷积叠加计算一致的经异质性校正的剂量数据,是一种改善结果分析剂量学数据的可行方法。