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子宫切除术后妇科癌症患者铅笔束扫描质子治疗的初步报告。

Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer.

机构信息

Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

出版信息

Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):181-189. doi: 10.1016/j.ijrobp.2015.07.2205. Epub 2015 Jul 11.

Abstract

PURPOSE

To report the acute toxicities associated with pencil beam scanning proton beam radiation therapy (PBS) for whole pelvis radiation therapy in women with gynecologic cancers and the results of a dosimetric comparison of PBS versus intensity modulated radiation therapy (IMRT) plans.

METHODS AND MATERIALS

Eleven patients with posthysterectomy gynecologic cancer received PBS to the whole pelvis. The patients received a dose of 45 to 50.4 Gy relative biological effectiveness (RBE) in 1.8 Gy (RBE) daily fractions. Acute toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 4. A dosimetric comparison between a 2-field posterior oblique beam PBS and an IMRT plan was conducted. The Wilcoxon signed rank test was used to assess the potential dosimetric differences between the 2 plans and PBS target coverage robustness relative to setup uncertainties.

RESULTS

The median patient age was 55 years (range 23-76). The primary site was cervical in 7, vaginal in 1, and endometrial in 3. Of the 11 patients, 7 received concurrent cisplatin, 1 each received sandwich carboplatin and paclitaxel chemotherapy, both sandwich and concurrent chemotherapy, and concurrent and adjuvant chemotherapy, and 1 received no chemotherapy. All patients completed treatment. Of the 9 patients who received concurrent chemotherapy, the rate of grade 2 and 3 hematologic toxicities was 33% and 11%, respectively. One patient (9%) developed grade 3 acute gastrointestinal toxicity; no patient developed grade ≥3 genitourinary toxicity. The volume of pelvic bone marrow, bladder, and small bowel receiving 10 to 30 Gy was significantly lower with PBS than with intensity modulated radiation therapy (P<.001). The target coverage for all PBS plans was robust relative to the setup uncertainties (P>.05) with the clinical target volume mean dose percentage received by 95% and 98% of the target volume coverage changes within 2% for the individual plans.

CONCLUSIONS

Our results have demonstrated the clinical feasibility of PBS and the dosimetric advantages, especially for the low-dose sparing of normal tissues in the pelvis with the target robustness maintained relative to the setup uncertainties. Future studies with larger patient numbers are planned to further validate our preliminary findings.

摘要

目的

报道铅笔束扫描质子束放射治疗(PBS)在妇科癌症患者全骨盆放疗中的急性毒性,并对 PBS 与调强放射治疗(IMRT)计划进行剂量学比较。

方法和材料

11 例子宫切除术后妇科癌症患者接受 PBS 全骨盆照射。患者接受 45 至 50.4 Gy 相对生物学有效剂量(RBE),每日 1.8 Gy(RBE)分次照射。根据通用不良事件术语标准,第 4 版对急性毒性进行评分。对 2 野后斜束 PBS 与 IMRT 计划进行了剂量学比较。采用 Wilcoxon 符号秩检验评估 2 种计划之间的潜在剂量学差异以及 PBS 靶区覆盖率对摆位不确定性的稳健性。

结果

中位患者年龄为 55 岁(范围 23-76 岁)。原发部位为宫颈 7 例,阴道 1 例,子宫内膜 3 例。11 例患者中,7 例接受同期顺铂治疗,1 例接受夹心卡铂和紫杉醇化疗,1 例接受夹心和顺铂化疗,1 例接受同期和辅助化疗,1 例未接受化疗。所有患者均完成治疗。9 例接受同期化疗的患者中,2 级和 3 级血液学毒性发生率分别为 33%和 11%。1 例(9%)患者发生 3 级急性胃肠道毒性;无患者发生≥3 级泌尿生殖系统毒性。与 IMRT 相比,PBS 组骨盆骨髓、膀胱和小肠接受 10 至 30 Gy 的体积明显减少(P<.001)。所有 PBS 计划的靶区覆盖率均对摆位不确定性具有稳健性(P>.05),各计划的 95%和 98%靶区覆盖率的临床靶区体积平均剂量百分比变化均在 2%以内。

结论

我们的结果表明 PBS 的临床可行性,以及剂量学优势,特别是在保持靶区稳健性的同时,对骨盆内低剂量正常组织的保护。未来计划进行更大样本量的研究,以进一步验证我们的初步发现。

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