The 1st Affiliated Hospital of Wenzhou Medical College.
J Appl Clin Med Phys. 2013 Sep 6;14(5):153-61. doi: 10.1120/jacmp.v14i5.4325.
The purpose of this study is to investigate the potential benefits of conformal radiotherapy (CRT) combined with a sequential volumetric-modulated arc therapy (VMAT) boost in the treatment of upper thoracic esophageal cancer. Ten patients with upper thoracic esophageal cancer previously treated with CRT plus a sequential VMAT boost plan were replanned with CRT plus an off-cord CRT boost plan and a full course of VMAT plan. Dosimetric parameters were compared. Results indicated that CRT plus off-cord CRT boost was inferior in planning target volume (PTV) coverage, as indicated by the volume covered by 93% (p = 0.05) and 95% (p = 0.02) of the prescription dose. The full course VMAT plan was superior in conformal index (CI) and conformation number (CN), and produced the highest protection for the spinal cord. CRT plus a VMAT boost demonstrated significant advantages in decreasing the volume of the lung irradiated by a dose of 10 Gy (V10, p = 0.007), 13 Gy (V13, p = 0.003), and 20 Gy (V20, p = 0.001). The full course VMAT plan demonstrated the lowest volume of lung receiving a dose of 30 Gy. CRT plus a VMAT boost for upper thoracic esophageal cancer can improve the target coverage and reduce the volume of lung irradiated by an intermediate dose. This combination may be a promising treatment technique for patients with upper thoracic esophageal cancer.
本研究旨在探讨适形放疗（CRT）联合序贯容积旋转调强放疗（VMAT）推量在治疗胸上段食管癌中的潜在获益。对 10 例接受 CRT 联合序贯 VMAT 推量治疗的胸上段食管癌患者，采用 CRT 联合离轴 CRT 推量计划和全程 VMAT 计划进行再计划，并比较剂量学参数。结果表明，CRT 联合离轴 CRT 推量在计划靶区（PTV）覆盖方面较差，93%（p=0.05）和 95%（p=0.02）处方剂量的 PTV 体积覆盖率较低。全程 VMAT 计划在适形指数（CI）和形态指数（CN）方面具有优势，对脊髓的保护作用最强。CRT 联合 VMAT 推量在降低 10 Gy（V10，p=0.007）、13 Gy（V13，p=0.003）和 20 Gy（V20，p=0.001）剂量照射的肺体积方面具有显著优势。全程 VMAT 计划显示出接受 30 Gy 剂量照射的肺体积最小。CRT 联合 VMAT 推量治疗胸上段食管癌可提高靶区覆盖率，降低中剂量照射的肺体积。这种联合治疗可能是胸上段食管癌患者的一种有前途的治疗技术。
