Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
J Korean Med Sci. 2013 Aug;28(8):1233-7. doi: 10.3346/jkms.2013.28.8.1233. Epub 2013 Jul 31.
This study aimed to evaluate the effects of volume adapted re-planning for radiotherapy (RT) after gross total resection (GTR) for glioblastoma. Nineteen patients with glioblastoma who underwent GTR and postoperative RT were analyzed. The volumes of the surgical cavity on computed tomography (CT) obtained one day after GTR (CT0), the first RT simulation CT (sim-CT1), and the second simulation CT for the boost RT plan (sim-CT2) were compared. The boost RT plan was based on the surgical cavity observed on the sim-CT2 (boost RTP2) and was compared with that based on the surgical cavity observed on the sim-CT1 (boost RTP1). The volume reduction ratios were 14.4%-51.3% (median, 29.0%) between CT0 and sim-CT1 and -7.9%-71.9% (median, 34.9%) between sim-CT1 and sim-CT2 (P < 0.001). The normal brain volumes in boost RTP1 were significantly reduced in boost RTP2, especially at high dose levels. Target volume in sim-CT2 which was not covered with the boost RTP1, developed in five cases (26.3%). The surgical cavity volume was reduced following surgery in patients with glioblastoma who underwent GTR. The application of volume-adapted re-planning during RT could decrease the irradiated volume of normal brain and prevent a target miss for boost RT.
本研究旨在评估胶质母细胞瘤患者行全切除术后（GTR）容积自适应再计划放疗（RT）的效果。分析了 19 例接受 GTR 及术后 RT 的胶质母细胞瘤患者。比较了 GTR 后第 1 天获得的 CT（CT0）、首次 RT 模拟 CT（sim-CT1）和二次推量 RT 计划模拟 CT（sim-CT2）的手术腔体积。推量 RT 计划基于 sim-CT2 上观察到的手术腔（boost RTP2），并与基于 sim-CT1 上观察到的手术腔（boost RTP1）进行比较。CT0 与 sim-CT1 之间的体积减少率为 14.4%-51.3%（中位数为 29.0%），sim-CT1 与 sim-CT2 之间的体积减少率为-7.9%-71.9%（中位数为 34.9%）（P<0.001）。在 boost RTP2 中，boost RTP1 中正常脑体积明显减少，尤其是在高剂量水平。5 例（26.3%）患者在 sim-CT2 中出现 boost RTP1 未覆盖的靶区。胶质母细胞瘤患者行 GTR 后手术腔体积缩小。在 RT 中应用容积自适应再计划可以减少正常脑的照射体积，防止推量 RT 靶区遗漏。
