Andic Fundagul, Baz Cifci Sule, Ors Yasemin, Niang Umar, Dirier Ahmet, Adli Mustafa
Department of Radiation Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
J Exp Clin Cancer Res. 2009 Jan 7;28(1):2. doi: 10.1186/1756-9966-28-2.
This study aimed to analyze three-dimensional (3D) dosimetric data of conventional two-dimensional (2D) palliative spinal bone irradiation using different reference points and treatment plans with respect to the International Commission on Radiation Units and Measurements (ICRU) Report 50.
Forty-five simulation CT scans of 39 patients previously treated for thoraco-lumbar spinal bone metastases were used. Three different treatment plans were created: (1) single posterior field plans using the ICRU reference points (ICRUrps); (2) single posterior field plans using the International Bone Metastasis Consensus Working Party reference points (IBMCrps); (3) two opposed anterior-posterior (AP-PA) field plans using the ICRUrps. The intended dose range for planning target volume (PTV) was 90% to 110% of the prescribed dose for AP-PA field plans. Cumulative dose-volume histograms were generated for each plan, and minimum, maximum and mean doses to the PTV, medulla spinalis, esophagus and intestines were analyzed.
The mean percentages of minimum, maximum and mean PTV doses +/- standard deviation were, respectively, 91 +/- 1.3%, 108.8 +/- 1.3% and 99.7 +/- 1.3% in AP-PA field plans; 77.3 +/- 2.6%, 122.2 +/- 4.3% and 99.8 +/- 2.6% in ICRUrp single field plans; and 83.7 +/- 3.3%, 133.9 +/- 7.1% and 108.8 +/- 3.3% in IBMCrp single field plans. Minimum doses of both single field plans were significantly lower (p < 0.001) while maximum doses were significantly higher (p < 0.001) than AP-PA field plans. Minimum, maximum and mean doses were higher in IBMCrp single field plans than in ICRUrp single field plans (p < 0.001). The mean medulla spinalis doses were lower in AP-PA field plans than single posterior field plans (p < 0.001). Maximum doses for medulla spinalis were higher than 120% of the prescribed dose in 22 of 45 (49%) IBMCrp single field plans. Mean esophagus and intestinal doses were higher (p < 0.001) in AP-PA field plans than single field plans, however, less than 95% of the prescribed dose.
In palliative spinal bone irradiation, 2D conventional single posterior field radiotherapy did not accomplish the ICRU Report 50 recommendations for PTV dose distribution, while the AP-PA field plans did achieve the intended dose ranges with a homogenous distribution and reasonable doses to the medulla spinalis, esophagus and intestines.
本研究旨在根据国际辐射单位与测量委员会（ICRU）第50号报告，分析使用不同参考点和治疗计划的传统二维（2D）姑息性脊柱骨照射的三维（3D）剂量学数据。
使用了39例先前接受胸腰椎脊柱骨转移治疗患者的45次模拟CT扫描。创建了三种不同的治疗计划：（1）使用ICRU参考点（ICRUrps）的单后野计划；（将国际骨转移共识工作组参考点（IBMCrps）的单后野计划；（3）使用ICRUrps的两前后对穿野（AP-PA）计划。AP-PA野计划的计划靶体积（PTV）的预定剂量范围为处方剂量的90%至110%。为每个计划生成累积剂量体积直方图，并分析PTV、脊髓、食管和肠道的最小、最大和平均剂量。
AP-PA野计划中PTV最小、最大和平均剂量的平均百分比±标准差分别为91±1.3%、108.8±1.3%和99.7±1.3%；ICRUrps单野计划中分别为77.3±2.6%、122.2±4.3%和99.8±2.6%；IBMCrps单野计划中分别为83.7±3.3%、133.9±7.1%和108.8±3.3%。两个单野计划的最小剂量均显著低于AP-PA野计划（p<0.001），而最大剂量显著高于AP-PA野计划（p<0.001）。IBMCrps单野计划中的最小、最大和平均剂量高于ICRUrps单野计划（p<0.001）。AP-PA野计划中的脊髓平均剂量低于单后野计划（p<0.001）。45个IBMCrps单野计划中有22个（49%）的脊髓最大剂量高于处方剂量的120%。AP-PA野计划中的食管和肠道平均剂量高于单野计划（p<0.001），但低于处方剂量的95%。
在姑息性脊柱骨照射中，二维传统单后野放疗未达到ICRU第50号报告对PTV剂量分布的建议，而AP-PA野计划确实实现了预定剂量范围，且剂量分布均匀，对脊髓、食管和肠道的剂量合理。
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