Foroudi Farshad, Pham Daniel, Rolfo Aldo, Bressel Mathias, Tang Colin I, Tan Alex, Turner Sandra, Hruby George, Williams Stephen, Hayne Dickon, Lehman Margot, Skala Marketa, Jose Chakiath C, Gogna Kumar, Kron Tomas
Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
Peter MacCallum Cancer Centre, Melbourne, Australia.
Radiother Oncol. 2014 May;111(2):316-20. doi: 10.1016/j.radonc.2014.02.015. Epub 2014 Apr 17.
To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology.
A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three "plan of the day", was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department.
54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a 'standard' CTV to PTV margin of 1.5cm was used for one or more fractions where the pre-treatment bladder CTV was larger than any of the three adaptive plans. The bladder CTV extended beyond the PTV on post treatment imaging in 9 (18%) of the 49 patients.
From a technical perspective an online adaptive radiotherapy technique can be instituted in a multi-centre setting. However, without further bladder filling control or imaging, a CTV to PTV margin of 7mm is insufficient.
评估使用不同成像、放疗实施和记录技术的多个放射肿瘤学科室开展膀胱癌在线自适应放疗是否可行。
在12个科室开展了一项多中心在线自适应放疗可行性研究，采用三种“当日计划”中的一种。纳入肌层浸润性膀胱癌患者。若参与初步研究或在进行机构资质考察后，科室即可开展研究。对每个科室的前两例病例进行实时评估。
共招募54例患者，其中50例接受放疗。男性43例，女性7例，平均年龄78岁。治疗的肿瘤分期包括T1期（1例）、T2期（35例）、T3期（10例）和T4期（4例）。1例患者在放疗期间死于无关原因。所有病例均在第10次分割前制定了三种自适应计划。8例（16%）患者在治疗前膀胱临床靶体积（CTV）大于三种自适应计划中的任何一种时，有一个或多个分割采用了“标准”CTV至计划靶体积（PTV）边缘为1.5cm的传统计划。49例患者中有9例（18%）在治疗后成像时膀胱CTV超出PTV。
从技术角度来看，在线自适应放疗技术可在多中心环境中开展。然而，若不进一步控制膀胱充盈或进行成像，CTV至PTV边缘7mm是不够的。
