Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Academy of Medical Sciences, 440 Jiyan Road, 250117, Jinan, China.
Strahlenther Onkol. 2012 Mar;188(3):262-8. doi: 10.1007/s00066-011-0044-5. Epub 2012 Feb 8.
The goal of this research was to investigate the feasibility of volumetric modulated arc therapy, RapidArc (RA), in association with the active breathing coordinator (ABC) for the treatment of hepatocellular carcinoma (HCC) with radiotherapy.
A total of 12 patients with HCC, after receiving transcatheter arterial chemoembolization (TACE) treatment, underwent three-dimensional computer tomography (3D-CT) scanning associated with ABC using end inspiration hold (EIH), end expiration hold (EEH), and free breathing (FB) techniques. The three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and RA plans (three 135° arcs) were designed on different CT images, respectively. The liver volume, gross tumor volume (GTV), and planning target volume (PTV) of the three breath status and the dosimetric differences of the different plans were compared.
There were no significant differences in the volumes of live and GTV between the three breathing techniques (p > 0.05); the PTV in FB was greater than in the EEH and EIH (p < 0.05). The overall conformality index (CI) and homogeneity index (HI) for RA (CI 0.92, HI 0.90) were better than IMRT (CI 0.90, HI 0.89) and 3D-CRT (CI 0.70, HI 0.84) for the three breathing techniques (p< 0.05). The RA and IMRT significantly reduced the mean dose, V(20), V(30), and V(40) of normal liver compared to 3D-CRT, while the V(5) and V(10) in RA were higher than in IMRT. The mean values in mean dose, V(10), V(20), V(30), and V(40) of the normal liver were reduced from 13.12 Gy, 46%, 24%, 13%, and 8% in RA(FB) to 10.23 Gy, 35%, 16%, 8%, and 5% in RA(EEH) and 9.23 Gy, 32%, 16%, 8%, and 5% in RA(EIH ), respectively. In addition, the treatment time of RA was equal to 3D-CRT, which was significantly shorter than IMRT.
RA in conjunction with ABC for the treatment of HCC with radiotherapy can achieve better dose delivery and ensure the accuracy of the target volume, which spares more organs at risk, uses fewer monitor units, and shortens treatment time.
本研究旨在探讨容积调强弧形治疗（RapidArc，RA）联合主动呼吸控制系统（ABC）治疗经肝动脉化疗栓塞（TACE）治疗后肝癌（HCC）的可行性。
对 12 例 HCC 患者在接受 TACE 治疗后，采用三维 CT（3D-CT）扫描，分别采用吸气末 hold（EIH）、呼气末 hold（EEH）和自由呼吸（FB）技术进行 ABC。在不同的 CT 图像上设计三维适形放疗（3D-CRT）、调强放疗（IMRT）和 RA 计划（三个 135° 弧）。比较三种呼吸状态下的肝脏体积、肿瘤体积（GTV）和计划靶区（PTV）的差异以及不同计划的剂量学差异。
三种呼吸技术的肝脏和 GTV 体积无显著差异（p＞0.05）；FB 时 PTV 大于 EEH 和 EIH（p＜0.05）。RA（CI 0.92，HI 0.90）的整体适形指数（CI）和均匀性指数（HI）优于 IMRT（CI 0.90，HI 0.89）和 3D-CRT（CI 0.70，HI 0.84），在三种呼吸技术中均有统计学意义（p＜0.05）。与 3D-CRT 相比，RA 和 IMRT 可显著降低正常肝脏的平均剂量、V（20）、V（30）、V（40），而 RA 中的 V（5）和 V（10）高于 IMRT。RA（FB）中正常肝脏的平均剂量、V（10）、V（20）、V（30）和 V（40）的平均值从 13.12Gy、46%、24%、13%和 8%分别降低至 RA（EEH）中的 10.23Gy、35%、16%、8%和 5%和 RA（EIH）中的 9.23Gy、32%、16%、8%和 5%。此外，RA 的治疗时间与 3D-CRT 相同，明显短于 IMRT。
RA 联合 ABC 治疗 HCC 放疗可实现更好的剂量传递，确保靶区的准确性，保护更多的危及器官，使用更少的监测单位，缩短治疗时间。
