Department of Medical Physics, Institute for Cancer Research and Treatment (IRCCS) at Candiolo, Turin, Italy.
Radiat Oncol. 2013 Oct 25;8:247. doi: 10.1186/1748-717X-8-247.
The aim of this work was to determine the technical feasibility and safety of extended-field radiotherapy (EF), performed by Helical TomoTherapy, in patients with positive pelvic and/or para-aortic nodes. Dosimetric data were collected and acute and sub-acute toxicities of the upper abdominal organs at risk (OAR) were evaluated.
Twenty-nine patients suitable for EF irradiation for local disease and/or nodal disease in the pelvic or para-aortic area were treated. The prescription dose was 50.4/54 Gy (1.7-1.8 Gy/fraction) for prophylactic lymph nodes (N-) and 60-70.5 Gy (2-2.35 Gy/fraction) for clinically evident gross disease (N+). Modulation factor (MF), pitch and field width (FW) were chosen to optimize dose distribution and treatment duration. Dose values of PTVs and OAR were analysed. The length of the treatment field, the N + and N- volumes, and treatment duration were reported. To evaluate the safety of treatment, haematological, hepatic, renal and pancreatic functions were assessed before, during and after treatment. The median follow-up time was 17.6 months (range: 6-22 months).
The treatment was well tolerated and all patients but one completed treatment without interruption. Four of the 29 patients experienced G3 haematological acute toxicity (13.8%), but no patient experienced sub-acute grade G3 toxicity. Ten patients experienced G1 and three G2 acute gastrointestinal toxicity (nausea). No sub-acute gastrointestinal or renal toxicity was observed. Only one (3.7%) patient had a persistent slight increase of pancreatic enzymes and two (7.4%) patients a slight increase of hepatic enzymes six months after radiotherapy (G1 toxicity).
With our treatment design and dose regimen, we found that EF treatment by TomoTherapy could be safely and effectively delivered with minimal acute and sub-acute toxicities in the upper abdomen area.
本研究旨在探讨螺旋断层放疗（TomoTherapy）扩展野放疗（EF）在盆腔和/或腹主动脉旁阳性淋巴结患者中的技术可行性和安全性。我们收集了剂量学数据，并评估了高危上腹部器官（OAR）的急性和亚急性毒性。
共 29 例局部疾病和/或盆腔或腹主动脉区淋巴结疾病患者适合接受 EF 照射。预防性淋巴结（N-）处方剂量为 50.4/54 Gy（1.7-1.8 Gy/分次），临床明显大体疾病（N+）为 60-70.5 Gy（2-2.35 Gy/分次）。调制因子（MF）、螺距和射野宽度（FW）的选择旨在优化剂量分布和治疗时间。分析了 PTV 和 OAR 的剂量值。报告了治疗野长度、N+和 N-体积以及治疗时间。为了评估治疗的安全性，在治疗前后评估了血液学、肝、肾功能和胰腺功能。中位随访时间为 17.6 个月（范围：6-22 个月）。
治疗耐受性良好，除 1 例患者外，所有患者均未中断治疗完成治疗。29 例患者中有 4 例（13.8%）发生 3 级血液学急性毒性，但无 1 例发生 3 级亚急性毒性。10 例患者出现 1 级和 3 例 2 级急性胃肠道毒性（恶心）。未观察到亚急性胃肠道或肾脏毒性。仅有 1 例（3.7%）患者胰腺酶持续轻微升高，2 例（7.4%）患者放疗后 6 个月肝脏酶轻微升高（1 级毒性）。
采用我们的治疗设计和剂量方案，我们发现 TomoTherapy 的 EF 治疗可安全有效地在上腹部区域进行，急性和亚急性毒性最小。
