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基于放射生物学指标的螺旋断层放射治疗与基于多叶准直器的调强放射治疗的治疗计划比较

Treatment plan comparison between helical tomotherapy and MLC-based IMRT using radiobiological measures.

作者信息

Mavroidis Panayiotis, Ferreira Brigida Costa, Shi Chengyu, Lind Bengt K, Papanikolaou Nikos

机构信息

Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Sweden.

出版信息

Phys Med Biol. 2007 Jul 7;52(13):3817-36. doi: 10.1088/0031-9155/52/13/011. Epub 2007 May 31.

Abstract

The rapid implementation of advanced treatment planning and delivery technologies for radiation therapy has brought new challenges in evaluating the most effective treatment modality. Intensity-modulated radiotherapy (IMRT) using multi-leaf collimators (MLC) and helical tomotherapy (HT) are becoming popular modes of treatment delivery and their application and effectiveness continues to be investigated. Presently, there are several treatment planning systems (TPS) that can generate and optimize IMRT plans based on user-defined objective functions for the internal target volume (ITV) and organs at risk (OAR). However, the radiobiological parameters of the different tumours and normal tissues are typically not taken into account during dose prescription and optimization of a treatment plan or during plan evaluation. The suitability of a treatment plan is typically decided based on dosimetric criteria such as dose-volume histograms (DVH), maximum, minimum, mean and standard deviation of the dose distribution. For a more comprehensive treatment plan evaluation, the biologically effective uniform dose (D) is applied together with the complication-free tumour control probability (P(+)). Its utilization is demonstrated using three clinical cases that were planned with two different forms of IMRT. In this study, three different cancer types at different anatomical sites were investigated: head and neck, lung and prostate cancers. For each cancer type, a linac MLC-based step-and-shoot IMRT plan and a HT plan were developed. The MLC-based IMRT treatment plans were developed on the Philips treatment-planning platform, using the Pinnacle 7.6 software release. For the tomotherapy HiArt plans, the dedicated tomotherapy treatment planning station was used, running version 2.1.2. By using D as the common prescription point of the treatment plans and plotting the tissue response probabilities versus D for a range of prescription doses, a number of plan trials can be compared based on radiobiological measures. The applied plan evaluation method shows that in the head and neck cancer case the HT treatment gives better results than MLC-based IMRT in terms of expected clinical outcome P(+) of 62.2% and 46.0%, D to the ITV of 72.3 Gy and 70.7 Gy, respectively). In the lung cancer and prostate cancer cases, the MLC-based IMRT plans are better over the clinically useful dose prescription range. For the lung cancer case, the HT and MLC-based IMRT plans give a P(+) of 66.9% and 72.9%, D to the ITV of 64.0 Gy and 66.9 Gy, respectively. Similarly, for the prostate cancer case, the two radiation modalities give a P(+) of 68.7% and 72.2%, D to the ITV of 86.0 Gy and 85.9 Gy, respectively. If a higher risk of complications (higher than 5%) could be allowed, the complication-free tumour control could increase by over 40%, 2% and 30% compared to the initial dose prescription for the three cancer cases, respectively. Both MLC-based IMRT and HT can encompass the often-large ITV required while they minimize the volume of the organs at risk receiving high doses. Radiobiological evaluation of treatment plans may provide an improved correlation of the delivered treatment with the clinical outcome by taking into account the dose-response characteristics of the irradiated targets and normal tissues. There may exist clinical cases, which may look dosimetrically similar but in radiobiological terms may be quite different. In such situations, traditional dose-based evaluation tools can be complemented by the use of P(+)--D diagrams to effectively evaluate and compare treatment plans.

摘要

放射治疗中先进治疗计划和实施技术的快速应用,在评估最有效的治疗方式方面带来了新的挑战。使用多叶准直器(MLC)的调强放射治疗(IMRT)和螺旋断层放射治疗(HT)正成为流行的治疗实施模式,其应用和有效性仍在持续研究中。目前,有几种治疗计划系统(TPS)可以根据用户定义的针对内部靶区(ITV)和危及器官(OAR)的目标函数来生成和优化IMRT计划。然而,在治疗计划的剂量处方和优化过程中,或在计划评估期间,通常没有考虑不同肿瘤和正常组织的放射生物学参数。治疗计划的适用性通常根据剂量学标准来决定,如剂量体积直方图(DVH)、剂量分布的最大值、最小值、平均值和标准差。为了进行更全面的治疗计划评估,将生物学有效均匀剂量(D)与无并发症肿瘤控制概率(P(+))一起应用。使用两种不同形式的IMRT计划的三个临床病例展示了其应用。在本研究中,对位于不同解剖部位的三种不同癌症类型进行了研究:头颈癌、肺癌和前列腺癌。对于每种癌症类型,制定了基于直线加速器MLC的静态调强放射治疗计划和螺旋断层放射治疗计划。基于MLC的IMRT治疗计划是在飞利浦治疗计划平台上,使用Pinnacle 7.6软件版本制定的。对于螺旋断层放射治疗HiArt计划,使用了专用的螺旋断层放射治疗计划工作站,运行版本为2.1.2。通过将D作为治疗计划的共同处方点,并针对一系列处方剂量绘制组织反应概率与D的关系图,可以根据放射生物学指标比较多个计划试验。所应用的计划评估方法表明,在头颈癌病例中,就预期临床结果P(+)而言,螺旋断层放射治疗比基于MLC的IMRT效果更好,分别为62.2%和46.0%,ITV的D分别为72.3 Gy和70.7 Gy。在肺癌和前列腺癌病例中,在临床有用的剂量处方范围内,基于MLC的IMRT计划更好。对于肺癌病例,螺旋断层放射治疗计划和基于MLC的IMRT计划的P(+)分别为66.9%和72.9%,ITV的D分别为64.0 Gy和66.9 Gy。同样,对于前列腺癌病例,两种放射治疗方式的P(+)分别为68.7%和72.2%,ITV的D分别为86.0 Gy和85.9 Gy。如果允许更高的并发症风险(高于5%),与三种癌症病例的初始剂量处方相比,无并发症肿瘤控制分别可提高超过40%、2%和30%。基于MLC的IMRT和螺旋断层放射治疗都可以涵盖通常较大的ITV,同时将接受高剂量的危及器官体积最小化。通过考虑受照射靶区和正常组织的剂量反应特征,治疗计划的放射生物学评估可能会使所实施的治疗与临床结果之间的相关性得到改善。可能存在一些临床病例,其在剂量学上看起来相似,但在放射生物学方面可能有很大差异。在这种情况下,可以使用P(+) - D图来补充传统基于剂量的评估工具,以有效地评估和比较治疗计划。

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