螺旋断层放疗、正向调强放疗和两阶段适形计划对头颈部鳞癌根治性放疗的剂量学和放射生物学比较。
Dosimetric and radiobiological comparison of helical tomotherapy, forward-planned intensity-modulated radiotherapy and two-phase conformal plans for radical radiotherapy treatment of head and neck squamous cell carcinomas.
机构信息
Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK.
出版信息
Br J Radiol. 2011 Dec;84(1008):1083-90. doi: 10.1259/bjr/53812025.
OBJECTIVES
The usual radical radiotherapy treatment prescribed for head and neck squamous cell carcinoma (HNSCC) is 70 Gy (in 2 Gy per fraction equivalent) administered to the high-risk target volume (TV). This can be planned using either a forward-planned photon-electron junction technique (2P) or a single-phase (1P) forward-planned technique developed in-house. Alternatively, intensity-modulated radiotherapy (IMRT) techniques, including helical tomotherapy (HT), allow image-guided inversely planned treatments. This study was designed to compare these three planning techniques with regards to TV coverage and the dose received by organs at risk.
METHODS
We compared the dose-volume histograms and conformity indices (CI) of the three planning processes in five patients with HNSCC. The tumour control probability (TCP), normal tissue complication probability (NTCP) and uncomplicated tumour control probability (UCP) were calculated for each of the 15 plans. In addition, we explored the radiobiological rationality of a dose-escalation strategy.
RESULTS
The CI for the high-risk clinical TV (CTV1) in the 5 patients were 0.78, 0.76, 0.82, 0.72 and 0.81 when HT was used; 0.58, 0.56, 0.47, 0.35 and 0.60 for the single-phase forward-planned technique and 0.46, 0.36, 0.29, 0.22 and 0.49 for the two-phase technique. The TCP for CTV1 with HT were 79.2%, 85.2%, 81.1%, 83.0% and 53.0%; for single-phase forward-planned technique, 76.5%, 86.9%, 73.4%, 81.8% and 31.8% and for the two-phase technique, 38.2%, 86.2%, 42.7%, 0.0% and 3.4%. Dose escalation using HT confirmed the radiobiological advantage in terms of TCP.
CONCLUSION
TCP for the single-phase plans was comparable to that of HT plans, whereas that for the two-phase technique was lower. Centres that cannot provide IMRT for the radical treatment of all patients could implement the single-phase technique as standard to attain comparable TCP. However, IMRT produced better UCP, thereby enabling the exploration of dose escalation.
目的
头颈部鳞状细胞癌（HNSCC）的常规根治性放射治疗方案为对高危靶区（TV）给予 70 Gy（2 Gy 等效剂量分次）。这可以使用正向规划的光子-电子结合技术（2P）或内部开发的单相（1P）正向规划技术来规划。或者，调强放疗（IMRT）技术，包括螺旋断层放疗（HT），允许进行图像引导的反向计划治疗。本研究旨在比较这三种计划技术在 TV 覆盖和危及器官剂量方面的差异。
方法
我们比较了五例 HNSCC 患者的三种计划过程的剂量-体积直方图和适形指数（CI）。计算了每种计划的肿瘤控制概率（TCP）、正常组织并发症概率（NTCP）和无并发症肿瘤控制概率（UCP）。此外，我们还探讨了剂量递增策略的放射生物学合理性。
结果
当使用 HT 时，五例患者的高危临床靶区（CTV1）的 CI 分别为 0.78、0.76、0.82、0.72 和 0.81；单相正向规划技术分别为 0.58、0.56、0.47、0.35 和 0.60；两阶段技术分别为 0.46、0.36、0.29、0.22 和 0.49。CTV1 用 HT 的 TCP 分别为 79.2%、85.2%、81.1%、83.0%和 53.0%；单相正向规划技术分别为 76.5%、86.9%、73.4%、81.8%和 31.8%；两阶段技术分别为 38.2%、86.2%、42.7%、0.0%和 3.4%。使用 HT 进行剂量递增证实了 TCP 方面的放射生物学优势。
结论
单相计划的 TCP 与 HT 计划相当，而两阶段技术的 TCP 较低。不能为所有患者的根治性治疗提供调强放疗的中心可以实施单相技术作为标准，以获得相当的 TCP。然而，IMRT 产生了更好的 UCP，从而能够探索剂量递增。
Zotero 插件