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调强适形放疗（IMRT）与三维适形放疗（3DCRT）在局部进展期直肠癌（LARC）中的应用：剂量学比较和临床意义。

Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications.

机构信息

Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.

出版信息

Radiat Oncol. 2010 Feb 26;5:17. doi: 10.1186/1748-717X-5-17.

DOI:10.1186/1748-717X-5-17
PMID:20187944
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2845593/
Abstract

PURPOSE: To compare target dose distribution, comformality, normal tissue avoidance, and irradiated body volume (IBV) in 3DCRT using classic anatomical landmarks (c3DCRT), 3DCRT fitting the PTV (f3DCRT), and intensity-modulated radiation therapy (IMRT) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS: Fifteen patients with LARC underwent c3DCRT, f3DCRT, and IMRT planning. Target definition followed the recommendations of the ICRU reports No. 50 and 62. OAR (SB and bladder) constraints were D5 < or = 50 Gy and Dmax < 55 Gy. PTV dose prescription was defined as PTV95 > or = 45 Gy and PTVmin > or = 35 Gy. Target coverage was evaluated with the D95, Dmin, and Dmax. Target dose distribution and comformality was evaluated with the homogeneity indices (HI) and Conformity Index (CI). Normal tissue avoidance of OAR was evaluated with the D5 and V40. IBV at 5 Gy (V5), 10 Gy (V10), and 20 Gy (V20) were calculated. RESULTS: The mean GTV95, CTV95, and PTV95 doses were significantly lower for IMRT plans. Target dose distribution was more inhomogeneous after IMRT planning and 3DCRTplans had significantly lower CI. The V40 and D5 values for OAR were significantly reduced in the IMRT plans .V5 was greater for IMRT than for f3DCRT planning (p < 0.05) and V20 was smaller for IMRT plans(p < 0.05). CONCLUSIONS: IMRT planning improves target conformity and decreases irradiation of the OAR at the expense of increased target heterogeneity. IMRT planning increases the IBV at 5 Gy or less but decreases the IBV at 20 Gy or more.

摘要

目的：比较局部晚期直肠癌（LARC）患者使用经典解剖学标志（c3DCRT）、适形于 PTV（f3DCRT）的 3DCRT 和调强放疗（IMRT）的靶区剂量分布、适形度、正常组织回避和照射体积（IBV）。 材料与方法：15 例 LARC 患者接受 c3DCRT、f3DCRT 和 IMRT 计划。靶区定义遵循 ICRU 报告 No.50 和 62 的建议。OAR（SB 和膀胱）的限制为 D5≤50Gy 和 Dmax＜55Gy。PTV 剂量处方定义为 PTV95≥45Gy 和 PTVmin≥35Gy。使用 D95、Dmin 和 Dmax 评估靶区覆盖情况。使用均匀性指数（HI）和适形性指数（CI）评估靶区剂量分布和适形度。使用 D5 和 V40 评估 OAR 的正常组织回避。计算 5Gy（V5）、10Gy（V10）和 20Gy（V20）的 IBV。 结果：IMRT 计划的 GTV95、CTV95 和 PTV95 平均剂量明显较低。IMRT 计划和 3DCRT 计划的靶区剂量分布更加不均匀，且 CI 明显较低。OAR 的 V40 和 D5 值在 IMRT 计划中明显降低。IMRT 计划的 V5 大于 f3DCRT 计划（p＜0.05），而 V20 小于 f3DCRT 计划（p＜0.05）。 结论：IMRT 计划改善了靶区的适形度，降低了 OAR 的照射剂量，但增加了靶区的不均匀性。IMRT 计划增加了 5Gy 或以下的 IBV，但减少了 20Gy 或以上的 IBV。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/6a690b2f0e22/1748-717X-5-17-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/d809118b350d/1748-717X-5-17-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/9a169e49e41b/1748-717X-5-17-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/8acff402df3c/1748-717X-5-17-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/6a690b2f0e22/1748-717X-5-17-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/d809118b350d/1748-717X-5-17-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/9a169e49e41b/1748-717X-5-17-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/8acff402df3c/1748-717X-5-17-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab3/2845593/6a690b2f0e22/1748-717X-5-17-4.jpg

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本文引用的文献

[1]
Phase I-II trial of concurrent capecitabine and oxaliplatin with preoperative intensity-modulated radiotherapy in patients with locally advanced rectal cancer.

Int J Radiat Oncol Biol Phys. 2008-7-1

[2]
A new homogeneity index based on statistical analysis of the dose-volume histogram.

J Appl Clin Med Phys. 2007-3-20

[3]
Emptying the rectum before treatment delivery limits the variations of rectal dose - volume parameters during 3DCRT of prostate cancer.

Radiother Oncol. 2006-9

[4]
Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: investigating dose-volume relationships and role for inverse planning.

Int J Radiat Oncol Biol Phys. 2006-10-1

[5]
Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels.

Int J Radiat Oncol Biol Phys. 2006-7-1

[6]
Calculation of effective dose from measurements of secondary neutron spectra and scattered photon dose from dynamic MLC IMRT for 6 MV, 15 MV, and 18 MV beam energies.

Med Phys. 2006-2

[7]
Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy.

Int J Radiat Oncol Biol Phys. 2005-7-15

[8]
The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy.

Int J Radiat Oncol Biol Phys. 2005-7-15

[9]
Strategies to reduce the systematic error due to tumor and rectum motion in radiotherapy of prostate cancer.

Radiother Oncol. 2005-2

[10]
The influence of small bowel motion on both a conventional three-field and intensity modulated radiation therapy (IMRT) for rectal cancer.

Cancer Radiother. 2004-10

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