调强放射治疗（IMRT）与射波刀（CyberKnife）计划在局限性前列腺癌治疗中的剂量学和物理学比较
Dosimetric and physical comparison of IMRT and CyberKnife plans in the treatment of localized prostate cancer.
作者信息
Ceylan Cemile, Kucuk Nadir, Bas Ayata Hande, Guden Metin, Engin Kayihan
机构信息
Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
出版信息
Rep Pract Oncol Radiother. 2010 Nov 12;15(6):181-9. doi: 10.1016/j.rpor.2010.10.003. eCollection 2010.
AIM
The aim of our study was the dosimetric and physical evaluation of the CK and IMRT treatment plans for 16 patients with localized prostate cancer.
BACKGROUND
Intensity modulated radiation therapy (IMRT) is one of the recent technical advances in radiotherapy. The prostate is a well suited site to be treated with IMRT. The challenge of accurately delivering the IMRT needs to be supported by new advances such as image-guidance and four-dimensional computed conformal radiation therapy (4DCRT) tomography. CyberKnife (CK) provides real time orthogonal X-ray imaging of the patient during treatment course to follow gold fiducials installed into the prostate and to achieve motion correlation between online acquired X-ray imaging and digital reconstructed radiographs (DRRs) which are obtained from planning computed tomography images by translating and rotating the treatment table in five directions.
METHODS AND MATERIALS
Sixteen IMRT and CK plans were performed to be compared in terms of conformity (CI), heterogeneity indices (HI), percentage doses of 100% (V100), 66% (V66), 50% (V50), 33% (V33) and 10% (V10) volumes of the bladder and rectum. Dose-volume histograms for target and critical organs, (CI) and indices (HI) and isodose lines were analyzed to evaluate the treatment plans.
RESULTS
Statistically significant differences in the percentage rectal doses delivered to V10, V33, and V50 of the rectum were detected in favor of the CK plans (p values; <0.001, <0.001 and 0.019, respectively). The percentage doses for V66 and V100 of the rectum were larger in CK plans (13%, 2% in IMRT and 21%, 3% in CK plans, respectively). Percentage bladder doses for V10 and V33 were significantly lower in CK plans [96% in IMRT vs 48% in CK (p < 0.001) and 34% in IMRT vs 24% in CK (p = 0.047)]. Lower percentage doses were observed for V50, V66 of the bladder for the IMRT. They were 5.4% and 3.45% for IMRT and 13.4% and 8.05% for CK, respectively. Median CI of planning target volume (PTV) for IMRT and CK plans were 0.94 and 1.23, respectively (p < 0.001).
CONCLUSION
Both systems have a very good ability to create highly conformal volumetric dose distributions. Median HI of PTV for IMRT and CK plans were 1.08 and 1.33, respectively (p < 0.001).
目的
本研究旨在对16例局限性前列腺癌患者的射波刀（CK）和调强放疗（IMRT）治疗计划进行剂量学和物理学评估。
背景
调强放疗（IMRT）是放射治疗领域近期的技术进展之一。前列腺是适合采用IMRT治疗的部位。精确实施IMRT的挑战需要诸如图像引导和四维计算机适形放疗（4DCRT）断层扫描等新进展的支持。射波刀（CK）在治疗过程中为患者提供实时正交X线成像，以追踪植入前列腺的金标，并实现在线获取的X线成像与通过在五个方向平移和旋转治疗床从计划计算机断层扫描图像获得的数字重建射线照片（DRR）之间的运动相关性。
方法和材料
实施16个IMRT和CK计划，比较其适形度（CI）、不均匀性指数（HI）、膀胱和直肠100%（V100）、66%（V66）、50%（V50）、33%（V33）和10%（V10）体积的百分剂量。分析靶区和危及器官的剂量体积直方图、（CI）和指数（HI）以及等剂量线，以评估治疗计划。
结果
直肠V10、V33和V50所接受的直肠剂量百分比在统计学上有显著差异，射波刀（CK）计划更具优势（p值分别为<0.001、<0.001和0.019）。射波刀（CK）计划中直肠V66和V100的百分剂量更大（IMRT中分别为13%、2%，CK计划中分别为21%、3%）。射波刀（CK）计划中膀胱V10和V33的百分剂量显著更低[IMRT中为96%，CK中为48%（p<0.001）；IMRT中为34%，CK中为24%（p=0.047）]。IMRT中膀胱V50、V66的百分剂量更低。IMRT中分别为5.4%和3.45%，CK中分别为13.4%和8.05%。IMRT和射波刀（CK）计划的计划靶区（PTV）中位CI分别为0.94和1.23（p<0.001）。
结论
两种系统都有很强的能力创建高度适形的体积剂量分布。IMRT和射波刀（CK）计划的PTV中位HI分别为1.08和1.33（p<0.001）。
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