Cilla Savino, Deodato Francesco, Digesù Cinzia, Macchia Gabriella, Picardi Vincenzo, Ferro Marica, Sallustio Giuseppina, De Spirito Marco, Piermattei Angelo, Morganti Alessio G
Medical Physics Unit, Fondazione di ricerca e cura "Giovanni Paolo II," Università Cattolica del Sacro Cuore, Campobasso, Italy.
Radiation Oncology Unit, Fondazione di ricerca e cura "Giovanni Paolo II," Università Cattolica del Sacro Cuore, Campobasso, Italy.
Med Dosim. 2014 Spring;39(1):108-16. doi: 10.1016/j.meddos.2013.11.001. Epub 2013 Dec 15.
Intensity-modulated radiotherapy (IMRT) allowed the simultaneous delivery of different doses to different target volumes within a single fraction, an approach called simultaneous integrated boost (SIB). As consequence, the fraction dose to the boost volume can be increased while keeping low doses to the elective volumes, and the number of fractions and overall treatment time will be reduced, translating into better radiobiological effectiveness. In recent years, volumetric-modulated arc therapy (VMAT) has been shown to provide similar plan quality with respect to fixed-field IMRT but with large reduction in treatment time and monitor units (MUs) number. However, the feasibility of VMAT when used with SIB strategy has few investigations to date. We explored the potential of VMAT in a SIB strategy for complex cancer sites. A total of 15 patients were selected, including 5 head-and-neck, 5 high-risk prostate, and 5 rectal cancer cases. Both a double-arc VMAT and a 7-field IMRT plan were generated for each case using Oncentra MasterPlan treatment planning system for an Elekta Precise linac. Dosimetric indexes for targets and organs at risk (OARs) were compared based on dose-volume histograms. Conformity index, homogeneity index, and dose-contrast index were used for target analyses. The equivalent uniform doses and the normal tissue complication probabilities were calculated for main OARs. MUs number and treatment time were analyzed to score treatment efficiency. Pretreatment dosimetry was performed using 2-dimensional (2D)-array dosimeter. SIB-VMAT plans showed a high level of fluence modulation needed for SIB treatments, high conformal dose distribution, similar target coverage, and a tendency to improve OARs sparing compared with the benchmark SIB-IMRT plans. The median treatment times reduced from 13 to 20 minutes to approximately 5 minutes for all cases with SIB-VMAT, with a MUs reduction up to 22.5%. The 2D-array ion-chambers' measurements reported an agreement of more than 95% for a criterion of 3% to 3mm. SIB-VMAT was able to combine the advantages of conventional SIB-IMRT with its highly conformal dose distribution and OARs sparing and the advantages of 3D-conformal radiotherapy with its fast delivery.
调强放射治疗(IMRT)能够在单次分割照射中同时向不同靶区给予不同剂量,这种方法称为同步整合加量(SIB)。因此,在保持对选择性靶区低剂量的同时,可以提高对加量靶区的分割剂量,并且分割次数和总治疗时间将减少,从而转化为更好的放射生物学效能。近年来,容积调强弧形治疗(VMAT)已被证明与固定野IMRT相比能提供相似的计划质量,但治疗时间和监测单位(MU)数量大幅减少。然而,VMAT与SIB策略联合使用时的可行性迄今鲜有研究。我们探讨了VMAT在复杂癌灶SIB策略中的潜力。共选取了15例患者,包括5例头颈部癌、5例高危前列腺癌和5例直肠癌病例。使用Oncentra MasterPlan治疗计划系统为Elekta Precise直线加速器针对每个病例生成双弧VMAT和7野IMRT计划。基于剂量体积直方图比较靶区和危及器官(OAR)的剂量学指标。使用适形指数、均匀性指数和剂量对比指数进行靶区分析。计算主要OAR的等效均匀剂量和正常组织并发症概率。分析MU数量和治疗时间以评估治疗效率。使用二维(2D)阵列剂量仪进行治疗前剂量测定。与基准SIB-IMRT计划相比,SIB-VMAT计划显示出SIB治疗所需的高剂量率调制水平、高适形剂量分布、相似的靶区覆盖,并且有改善对OAR保护的趋势。所有SIB-VMAT病例的中位治疗时间从13至20分钟减少至约5分钟,MU减少高达22.5%。2D阵列电离室测量结果表明,在3%至3mm标准下一致性超过95%。SIB-VMAT能够将传统SIB-IMRT的高度适形剂量分布和对OAR的保护优势与三维适形放疗的快速照射优势相结合。