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一项针对II-III期非小细胞肺癌的等毒性计划比较研究:调强放射治疗是答案吗?

An isotoxic planning comparison study for stage II-III non-small cell lung cancer: is intensity-modulated radiotherapy the answer?

作者信息

Warren M, Webster G, Ryder D, Rowbottom C, Faivre-Finn C

机构信息

Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.

Medical Physics, University Hospitals Birmingham NHS Trust, Birmingham, UK.

出版信息

Clin Oncol (R Coll Radiol). 2014 Aug;26(8):461-7. doi: 10.1016/j.clon.2014.03.011. Epub 2014 May 3.

Abstract

AIMS

Recent clinical series suggest that treating patients with isotoxic twice-daily radiotherapy may be beneficial. This dosimetric planning study compared the use of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DRT) to deliver isotoxic treatment for non-small cell lung cancer (NSCLC) patients.

MATERIALS AND METHODS

Twenty patients with stage II/III NSCLC were selected. A dose-escalated plan was produced retrospectively for each using three different methods: (i) three to five beams 3DRT; (ii) seven beams inverse-planned conformal radiotherapy; (iii) seven beams IMRT. The starting point for dose escalation was 55.8 Gy in 1.8 Gy per fraction twice-daily. The number of fractions was then increased until one or more organ at risk tolerance dose was exceeded or a maximum dose of 79.2 Gy was reached.

RESULTS

The median escalated doses were 70.2, 66.6 and 64.8 Gy for IMRT, 3DRT and inverse-planned conformal radiotherapy, respectively. IMRT allowed a significant dose increase in comparison with the other two methods (P < 0.05), whereas no significant difference was found between 3DRT and inverse-planned conformal radiotherapy. IMRT was more successful at escalating dose in patients where the brachial plexus and spinal canal were close to the planning target volume. IMRT did not allow the escalation of dose beyond 70.2 Gy (82.8 Gy BED10, 69 Gy EQD2) due to the proximity of disease to the great vessels and the proximal bronchial tree.

CONCLUSIONS

IMRT allows increased dose escalation compared with conformal radiotherapy. However, there is limited opportunity to escalate the prescription dose beyond 70.2 Gy twice-daily in disease close to the central mediastinal structures.

摘要

目的

近期临床系列研究表明,对患者进行每日两次等剂量放疗可能有益。本剂量学规划研究比较了调强放疗(IMRT)和三维适形放疗(3DRT)用于非小细胞肺癌(NSCLC)患者进行等剂量治疗的情况。

材料与方法

选取20例II/III期NSCLC患者。回顾性地为每位患者使用三种不同方法制定剂量递增计划:(i)三至五野3DRT;(ii)七野逆向计划适形放疗;(iii)七野IMRT。剂量递增的起始点为每日两次,每次1.8 Gy,总量55.8 Gy。然后增加分次剂量,直至超过一个或多个危及器官的耐受剂量或达到最大剂量79.2 Gy。

结果

IMRT、3DRT和逆向计划适形放疗的中位递增剂量分别为70.2、66.6和64.8 Gy。与其他两种方法相比,IMRT可显著增加剂量(P < 0.05),而3DRT和逆向计划适形放疗之间未发现显著差异。在臂丛神经和椎管靠近计划靶区的患者中,IMRT在增加剂量方面更成功。由于病变靠近大血管和近端支气管树,IMRT无法将剂量递增至70.2 Gy以上(BED10为82.8 Gy,EQD2为69 Gy)。

结论

与适形放疗相比,IMRT可增加剂量递增。然而,对于靠近中央纵隔结构的病变,每日两次将处方剂量递增至70.2 Gy以上的机会有限。

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