碳离子放射治疗后的颞叶反应：局部效应模型 I 和 IV 预测的相对生物效应加权耐受剂量的比较。
Temporal lobe reactions after carbon ion radiation therapy: comparison of relative biological effectiveness-weighted tolerance doses predicted by local effect models I and IV.
机构信息
Department of Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany.
Department of Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany; Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Apr 1;88(5):1136-41. doi: 10.1016/j.ijrobp.2013.12.039.
PURPOSE
To compare the relative biological effectiveness (RBE)-weighted tolerance doses for temporal lobe reactions after carbon ion radiation therapy using 2 different versions of the local effect model (LEM I vs LEM IV) for the same patient collective under identical conditions.
METHODS AND MATERIALS
In a previous study, 59 patients were investigated, of whom 10 experienced temporal lobe reactions (TLR) after carbon ion radiation therapy for low-grade skull-base chordoma and chondrosarcoma at Helmholtzzentrum für Schwerionenforschung (GSI) in Darmstadt, Germany in 2002 and 2003. TLR were detected as visible contrast enhancements on T1-weighted MRI images within a median follow-up time of 2.5 years. Although the derived RBE-weighted temporal lobe doses were based on the clinically applied LEM I, we have now recalculated the RBE-weighted dose distributions using LEM IV and derived dose-response curves with Dmax,V-1 cm³ (the RBE-weighted maximum dose in the remaining temporal lobe volume, excluding the volume of 1 cm³ with the highest dose) as an independent dosimetric variable. The resulting RBE-weighted tolerance doses were compared with those of the previous study to assess the clinical impact of LEM IV relative to LEM I.
RESULTS
The dose-response curve of LEM IV is shifted toward higher values compared to that of LEM I. The RBE-weighted tolerance dose for a 5% complication probability (TD5) increases from 68.8 ± 3.3 to 78.3 ± 4.3 Gy (RBE) for LEM IV as compared to LEM I.
CONCLUSIONS
LEM IV predicts a clinically significant increase of the RBE-weighted tolerance doses for the temporal lobe as compared to the currently applied LEM I. The limited available photon data do not allow a final conclusion as to whether RBE predictions of LEM I or LEM IV better fit better clinical experience in photon therapy. The decision about a future clinical application of LEM IV therefore requires additional analysis of temporal lobe reactions in a comparable photon-treated collective using the same dosimetric variable as in the present study.
目的
比较在相同条件下，使用两种不同的局部效应模型版本（LEM I 与 LEM IV），对同一患者群体的颞叶反应进行相对生物学有效（RBE）加权耐受剂量。
方法和材料
在之前的一项研究中，对 1997 年至 2003 年在德国达姆施塔特重离子研究中心（GSI）接受碳离子放射治疗的 59 例低级别颅底脊索瘤和软骨肉瘤患者进行了研究，其中 10 例患者出现颞叶反应（TLR）。TLR 在中位随访时间为 2.5 年时，通过 T1 加权 MRI 图像上的可见对比增强来检测。尽管所得到的 RBE 加权颞叶剂量是基于临床应用的 LEM I，但我们现在已经使用 LEM IV 重新计算了 RBE 加权剂量分布，并使用 Dmax,V-1 cm³（剩余颞叶体积中 RBE 加权的最大剂量，排除了最高剂量的 1 cm³体积）作为独立的剂量学变量得出了剂量反应曲线。将得到的 RBE 加权耐受剂量与之前的研究进行比较，以评估 LEM IV 相对于 LEM I 的临床影响。
结果
LEM IV 的剂量反应曲线与 LEM I 相比向更高的值偏移。与 LEM I 相比，LEM IV 的 5%并发症概率（TD5）的 RBE 加权耐受剂量从 68.8 ± 3.3 增加到 78.3 ± 4.3 Gy（RBE）。
结论
与目前应用的 LEM I 相比，LEM IV 预测颞叶的 RBE 加权耐受剂量会有临床显著增加。有限的光子数据不允许最终确定 LEM I 或 LEM IV 的 RBE 预测是否更符合光子治疗的临床经验。因此，关于未来 LEM IV 的临床应用的决策需要使用本研究中相同的剂量学变量，在类似的光子治疗群体中分析颞叶反应，以做出进一步的分析。
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