Department of Radiooncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Strahlenther Onkol. 2013 Jan;189(1):54-61. doi: 10.1007/s00066-012-0235-8. Epub 2012 Nov 18.
To explore a new positron emission tomography (PET)-based target concept for pediatric Hodgkin's lymphoma (PHL).
For 10 patients, the planning target volume PTV1 was based on initial CT tumor extension and PTV2 on anatomy-related PET-positive lymph node levels after chemotherapy. The treatment techniques investigated (prescribed dose 19.8 Gy) comprised opposed-field (2F), intensity-modulated photon (IMXT), and single-field (PS) proton techniques. Treatment concepts were compared concerning dose-volume histogram (DVH) parameters and organ-equivalent doses (OED).
The median PTV1 and PTV2 were 902 ± 555 cm(3) and 281 ± 228 cm(3). When using PTV2 instead of PTV1 for all techniques, the D(2%) of the heart was reduced from 14 to 9 Gy and the D(mean) of the thyroid from 16.6 to 2.7 Gy. Low- (20%), median- (50%), and high-dose volumes (80%) were reduced by 60% for the heart and bones using PTV2. PS reduced the high-dose volume of the lungs and the heart by up to 60%. IMXT increased the low-dose volumes and OED. PTV2 reduced OED by 54 ± 10% for all organs at risk.
PTV2 has a high impact on the treated volume and on sparing of organs at risk. The combination of an adaptive target volume definition with protons could contribute to future PHL treatment concepts.
探索一种新的正电子发射断层扫描（PET）为基础的儿童霍奇金淋巴瘤（PHL）的靶区概念。
10 例患者，计划靶区（PTV1）基于初始 CT 肿瘤的延伸和化疗后与解剖相关的 PET 阳性淋巴结水平的 PTV2。研究的治疗技术（规定剂量 19.8 Gy）包括对置野（2F）、强度调制光子（IMXT）和单野（PS）质子技术。比较了这些治疗概念在剂量体积直方图（DVH）参数和器官等效剂量（OED）方面的差异。
PTV1 和 PTV2 的中位数分别为 902±555 cm(3)和 281±228 cm(3)。当所有技术都使用 PTV2 代替 PTV1 时，心脏的 D（2%）从 14 减少到 9 Gy，甲状腺的 D（mean）从 16.6 减少到 2.7 Gy。使用 PTV2 后，心脏和骨骼的低（20%）、中（50%）和高剂量体积（80%）分别减少了 60%。PS 可将肺部和心脏的高剂量体积减少高达 60%。IMXT 增加了低剂量体积和 OED。PTV2 使所有危险器官的 OED 降低了 54±10%。
PTV2 对治疗体积和保护危险器官有很大的影响。自适应靶区定义与质子治疗的结合可能有助于未来的 PHL 治疗概念。
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