McIntosh Alyson, Dunlap Neal, Sheng Ke, Geezey Constance, Turner Benton, Blackhall Leslie, Weiss Geoffrey, Lappinen Eric, Larner James M, Read Paul W
Department of Radiation Oncology, University of Virginia, Charlottesville, USA.
Med Dosim. 2010 Winter;35(4):280-6. doi: 10.1016/j.meddos.2009.09.002. Epub 2009 Oct 29.
Helical tomotherapy-based STAT radiation therapy (RT) uses an efficient software algorithm for rapid intensity-modulated treatment planning, enabling conformal radiation treatment plans to be generated on megavoltage computed tomography (MVCT) scans for CT simulation, treatment planning, and treatment delivery in one session. We compared helical tomotherapy-based STAT RT dosimetry with standard linac-based 3D conformal plans and standard helical tomotherapy-based intensity-modulated radiation therapy (IMRT) dosimetry for palliative treatments of whole brain, a central obstructive lung mass, multilevel spine disease, and a hip metastasis. Specifically, we compared the conformality, homogeneity, and dose with regional organs at risk (OARs) for each plan as an initial step in the clinical implementation of a STAT RT rapid radiation palliation program. Hypothetical planning target volumes (PTVs) were contoured on an anthropomorphic phantom in the lung, spine, brain, and hip. Treatment plans were created using three planning techniques: 3D conformal on Pinnacle³, helical tomotherapy, and helical tomotherapy-based STAT RT. Plan homogeneity, conformality, and dose to OARs were analyzed and compared. STAT RT and tomotherapy improved conformality indices for spine and lung plans (CI spine = 1.21, 1.17; CI lung = 1.20, 1.07, respectively) in comparison with standard palliative anteroposterior/posteroanterior (AP/PA) treatment plans (CI spine = 7.01, CI lung = 7.30), with better sparing of heart, esophagus, and spinal cord. For palliative whole-brain radiotherapy, STAT RT and tomotherapy reduced maximum and mean doses to the orbits and lens (maximum/mean lens dose: STAT RT = 2.94/2.65 Gy, tomotherapy = 3.13/2.80 Gy, Lateral opposed fields = 7.02/3.65 Gy), with an increased dose to the scalp (mean scalp dose: STAT RT = 16.19 Gy, tomotherapy = 15.61 Gy, lateral opposed fields = 14.01 Gy). For bony metastatic hip lesions, conformality with both tomotherapy techniques (CI = 1.01 each) is superior to AP/PA treatments (CI = 1.21), as expected. Helical tomotherapy-based STAT RT treatment planning provides clinically acceptable dosimetry, with conformality and homogeneity that is superior to standard linac-based 3D conformal planning and is only slightly inferior to standard helical tomotherapy IMRT dosimetry. STAT RT facilitates rapid treatment planning and delivery for palliative radiation of patients with metastatic disease, with relative sparing of adjacent OARs compared with standard 3D conformal plans.
基于螺旋断层放疗的STAT放射治疗（RT）使用一种高效的软件算法进行快速调强治疗计划，能够在兆伏级计算机断层扫描（MVCT）上生成适形放射治疗计划，以便在一次扫描中完成CT模拟、治疗计划制定和治疗实施。我们将基于螺旋断层放疗的STAT RT剂量测定法与基于标准直线加速器的三维适形计划以及基于标准螺旋断层放疗的调强放射治疗（IMRT）剂量测定法进行了比较，用于全脑、中央阻塞性肺肿块、多级脊柱疾病和髋部转移瘤的姑息治疗。具体而言，作为STAT RT快速放射姑息治疗计划临床实施的第一步，我们比较了每个计划的适形性、均匀性以及与区域危及器官（OARs）的剂量。在肺部、脊柱、大脑和髋部的人体模型上勾勒出假设的计划靶体积（PTV）。使用三种计划技术创建治疗计划：Pinnacle³上的三维适形、螺旋断层放疗以及基于螺旋断层放疗的STAT RT。分析并比较了计划的均匀性、适形性以及对OARs的剂量。与标准姑息前后（AP/PA）治疗计划（脊柱CI = 7.01，肺部CI = 7.30）相比，STAT RT和断层放疗改善了脊柱和肺部计划的适形指数（脊柱CI分别为1.21、1.17；肺部CI分别为1.20、1.07），对心脏、食管和脊髓的保护更好。对于姑息性全脑放疗，STAT RT和断层放疗降低了眼眶和晶状体的最大和平均剂量（晶状体最大/平均剂量：STAT RT = 2.94/2.65 Gy，断层放疗 = 3.13/2.80 Gy，侧野对穿 = 7.02/3.65 Gy），头皮剂量增加（头皮平均剂量：STAT RT = 16.19 Gy，断层放疗 = 15.61 Gy，侧野对穿 = 14.01 Gy）。对于髋部骨转移瘤，两种断层放疗技术的适形性（CI均为1.01）均优于AP/PA治疗（CI = 1.21），正如预期。基于螺旋断层放疗的STAT RT治疗计划提供了临床上可接受的剂量测定，其适形性和均匀性优于基于标准直线加速器三维适形计划，仅略逊于标准螺旋断层放疗IMRT剂量测定法。STAT RT有助于为转移性疾病患者的姑息性放疗快速制定治疗计划并实施，与标准三维适形计划相比，对相邻OARs有相对保护作用。
Zotero 插件