4种立体定向体部放射治疗技术治疗前列腺癌的剂量学比较与评估
Dosimetric Comparison and Evaluation of 4 Stereotactic Body Radiotherapy Techniques for the Treatment of Prostate Cancer.
作者信息
Seppälä Jan, Suilamo Sami, Tenhunen Mikko, Sailas Liisa, Virsunen Heli, Kaleva Erna, Keyriläinen Jani
机构信息
1 Radiotherapy Department, Cancer Center, Kuopio University Hospital, Kuopio, Finland.
2 Department of Medical Physics & Department of Radiotherapy and Oncology, Turku University Hospital, Turku, Finland.
出版信息
Technol Cancer Res Treat. 2017 Apr;16(2):238-245. doi: 10.1177/1533034616682156. Epub 2016 Dec 8.
PURPOSE
The aim of this study was to compare dosimetric characteristics, monitor unit, and delivery efficiency of 4 different stereotactic body radiotherapy techniques for the treatment of prostate cancer.
METHODS
This study included 8 patients with localized prostate cancer. Dosimetric assets of 4 delivery techniques for stereotactic body radiotherapy were evaluated: robotic CyberKnife, noncoplanar intensity-modulated radiotherapy, and 2 intensity-modulated arc therapy techniques (RapidArc and Elekta volumetric-modulated arc therapy). All the plans had equal treatment margins and a prescription dose of 35 Gy in 5 fractions.
RESULTS
Statistically significant differences were observed in homogeneity index and mean doses of bladder wall and penile bulb, all of which were highest with CyberKnife. No significant differences were observed in the mean doses of rectum, with values of 15.2 ± 2.6, 13.3 ± 2.6, 13.1 ± 2.8, and 13.8 ± 1.6 Gy with CyberKnife, RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy, respectively. The highest dose conformity was realized with RapidArc. The dose coverage of the planning target volume was lowest with noncoplanar intensity-modulated radiotherapy. Treatment times and number of monitor units were largest with CyberKnife (on average 34.0 ± 5.0 minutes and 8704 ± 1449 monitor units) and least with intensity-modulated arc therapy techniques (on average 5.1 ± 1.1 minutes and 2270 ± 497 monitor units).
CONCLUSION
Compared to CyberKnife, the RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy produced treatment plans with similar dosimetric quality, with RapidArc achieving the highest dose conformity. Overall, the dosimetric differences between the studied techniques were marginal, and thus, the choice of the technique should rather focus on the delivery accuracies and dose delivery times.
目的
本研究旨在比较4种不同的立体定向体部放射治疗技术治疗前列腺癌时的剂量学特征、监测单位和照射效率。
方法
本研究纳入8例局限性前列腺癌患者。评估了立体定向体部放射治疗4种照射技术的剂量学参数：机器人赛博刀、非共面调强放射治疗以及2种调强弧形治疗技术（容积旋转调强放疗和医科达容积旋转调强放疗）。所有计划的治疗边界相同，处方剂量为35 Gy，分5次照射。
结果
在均匀性指数以及膀胱壁和阴茎球部的平均剂量方面观察到有统计学意义的差异，所有这些指标在赛博刀治疗时最高。直肠的平均剂量未观察到显著差异，赛博刀、容积旋转调强放疗、医科达容积旋转调强放疗和非共面调强放射治疗时的直肠平均剂量分别为15.2±2.6、13.3±2.6、13.1±2.8和13.8±1.6 Gy。容积旋转调强放疗实现了最高的剂量适形度。非共面调强放射治疗时计划靶体积的剂量覆盖最低。赛博刀的治疗时间和监测单位数量最多（平均34.0±5.0分钟和8704±1449个监测单位），调强弧形治疗技术最少（平均5.1±1.1分钟和2270±497个监测单位）。
结论
与赛博刀相比，容积旋转调强放疗、医科达容积旋转调强放疗和非共面调强放射治疗产生的治疗计划具有相似的剂量学质量，容积旋转调强放疗实现了最高的剂量适形度。总体而言，所研究技术之间的剂量学差异很小，因此，技术的选择应更多地关注照射精度和剂量照射时间。
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