Yoshida Ken, Takenaka Tadashi, Akiyama Hironori, Yamazaki Hideya, Yoshida Mineo, Masui Koji, Kotsuma Tadayuki, Baek Sungjae, Uesugi Yasuo, Shimbo Taiju, Yoshikawa Nobuhiko, Arika Takumi, Koretsune Yukihiro, Yoshioka Yasuo, Narumi Yoshifumi, Tanaka Eiichi
Department of Radiology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
J Radiat Res. 2014 Jan 1;55(1):154-61. doi: 10.1093/jrr/rrt079. Epub 2013 Jun 3.
To investigate the influence of a 3D image-based treatment-planning method for high-dose-rate interstitial brachytherapy (HDR-ISBT) for mobile tongue cancer, we analyzed dose-volume histogram results for the clinical target volume (CTV) and the mandible. Between October 2010 and November 2011, one and four patients having T2 and T3 tumors, respectively, were treated with HDR-ISBT. Multiplane implantation using 9-15 treatment applicators was performed. Lugol's iodine staining, metal markers, ultrasonography, and magnetic resonance imaging were used to identify the contours of the gross tumor volume (defined as the CTV). The results of the image-based treatment plan were compared with those of the conventional simulated plan on the basis of a reference point 5 mm from the applicator position. The mean D90(CTV) and V100(CTV) were 112% of the prescribed dose (PD) and 98.1%PD, respectively, for the image-based plan, and 113%PD and 97.2%PD, respectively, for the conventional plan. The median CTVref/Vref was 0.23 for the image-based plan and 0.16 for the conventional plan (P = 0.01). The mean D0.1 cm(3) (mandible), D1 cm(3) (mandible), and D2 cm(3) (mandible) were 80.1%PD, 62.5%PD, and 55.7%PD, respectively, for the image-based plan, and 109.1%PD (P = 0.02), 82.4%PD (P = 0.005), and 74%PD (P = 0.004), respectively, for the conventional plan). Image-based treatment planning may achieve high-conformity radiotherapy for the CTV and decrease irradiated doses to the mandible.
为研究基于三维图像的高剂量率组织间近距离治疗（HDR-ISBT）对舌活动癌的影响，我们分析了临床靶区（CTV）和下颌骨的剂量体积直方图结果。在2010年10月至2011年11月期间，分别有1例T2期肿瘤患者和4例T3期肿瘤患者接受了HDR-ISBT治疗。采用9至15个治疗施源器进行多平面植入。使用卢戈氏碘染色、金属标记、超声检查和磁共振成像来确定大体肿瘤体积（定义为CTV）的轮廓。基于距施源器位置5毫米的参考点，将基于图像的治疗计划结果与传统模拟计划的结果进行比较。基于图像的计划中，CTV的平均D90和V100分别为处方剂量（PD）的112%和98.1%PD，传统计划中分别为113%PD和97.2%PD。基于图像的计划中CTVref/Vref的中位数为0.23，传统计划中为0.16（P = 0.01）。基于图像的计划中，下颌骨的平均D0.1 cm(3)、D1 cm(3)和D2 cm(3)分别为80.1%PD、62.5%PD和55.7%PD，传统计划中分别为109.1%PD（P = 0.02）、82.4%PD（P = 0.005）和74%PD（P = 0.004）。基于图像的治疗计划可能实现CTV的高适形放疗，并降低下颌骨的受照剂量。
