Department of Radiation Oncology, University of Michigan and Ann Arbor Veteran Affairs Medical System, Ann Arbor, MI 48109, USA.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1442-57. doi: 10.1016/j.ijrobp.2010.07.1977. Epub 2010 Oct 8.
To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus.
The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy and 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists.
Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed.
We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.
回顾胸部放射治疗（RT）中危及器官（OARs）的剂量限制，并对其进行三维（3D）放射学定义标准化，包括肺、近端支气管树、食管、脊髓、肋骨和臂丛。
本研究由放射治疗肿瘤学组、欧洲癌症研究与治疗组织以及西南肿瘤组肺癌委员会的代表进行。回顾了 3D 适形 RT 和立体定向体部 RT 主要多中心试验的剂量学限制，并描述了这些 OARs 3D 勾画的挑战。利用对人体解剖结构和 3D 放射学相关性的了解，由美国的一位放射肿瘤学家、医学物理学家、剂量师和放射科医生生成了草案图谱，并由一位来自欧洲的放射肿瘤学家和医学物理学家进行了审查。然后，由另外 10 位放射肿瘤学家对图谱进行了严格审查、讨论和编辑。
呈现了肺、近端支气管树、食管、脊髓、肋骨和臂丛的 3D 描述。开发了两个 CT 图谱：一个用于中下段胸部 OARs（心脏除外），另一个聚焦于仰卧位患者手臂抬起进行胸部 RT 时的臂丛。讨论了关键 OARs 的剂量学限制。
我们相信这些图谱将使我们能够以更少的变异性定义 OARs，并以更一致的方式生成剂量学数据。这有助于我们研究辐射对这些 OARs 的影响，并指导 3D 适形 RT 和立体定向体部 RT 中的高质量临床试验和个体化实践。
