三种不同放疗技术用于胃窦部胃癌的剂量学比较
Dosimetric Comparison of Three Different Radiotherapy Techniques in Antrum-Located Stomach Cancer.
作者信息
Serarslan Alparslan, Ozbek Okumus Nilgun, Gursel Bilge, Meydan Deniz, Dastan Yalcin, Aksu Talat
机构信息
Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey. Email:
出版信息
Asian Pac J Cancer Prev. 2017 Mar 1;18(3):741-746. doi: 10.22034/APJCP.2017.18.3.741.
Background: The current optimal radiotherapy (RT) planning technique for stomach cancer is controversial. The design of RT for stomach cancer is difficult and differs according to tumor localization. Dosimetric and clinical studies have been performed in patients with different tumor localizations. This may be the main source of inconsistencies in study results. For this reason, we attempted to find the optimal RT technique for patients with stomach cancer in similar locations. Methods: This study was based on the computed tomography datasets of 20 patients with antrum-located stomach cancer. For each patient, treatments were designed using physical wedge-based conformal RT (WB-CRT), field-in-field intensity-modulated RT (FIF-IMRT), and dynamic intensity-modulated RT (IMRT). The techniques were compared in terms of expected target volume coverage and the dose to organs at risk (OAR) using a dose-volume histogram analysis. Results: FIF-IMRT was the most homogenous technique, with a better homogeneity index than WBCRT (p<0.001) or IMRT (p<0.001). However, IMRT had a better conformity index than WBCRT (p<0.001) or FIF-IMRT (p<0.001). Additionally, all OAR, including the kidneys, liver, and spinal cord, were better protected with IMRT than with WBCRT (p=0.023 to <0.001) or FIF-IMRT (p=0.028 to <0.001). Conclusions: In comparison to FIF-IMRT and WBCRT, IMRT appears to be the most appropriate technique for antrum-located stomach cancer. To establish whether IMRT is superior overall will require clinical studies, taking into account differences in both tumor localization (cardia, body, and antrum) and organ movement in patients with stomach cancer.
背景
目前用于胃癌的最佳放射治疗(RT)计划技术存在争议。胃癌的放射治疗设计困难,且因肿瘤定位不同而有所差异。针对不同肿瘤定位的患者进行了剂量学和临床研究。这可能是研究结果不一致的主要原因。因此,我们试图为肿瘤位置相似的胃癌患者找到最佳的RT技术。方法:本研究基于20例胃窦部胃癌患者的计算机断层扫描数据集。对于每位患者,分别采用基于物理楔形板的适形放疗(WB-CRT)、野中野调强放疗(FIF-IMRT)和动态调强放疗(IMRT)设计治疗方案。使用剂量体积直方图分析,从预期靶区覆盖情况和危及器官(OAR)的剂量方面对这些技术进行比较。结果:FIF-IMRT是最均匀的技术,其均匀性指数优于WB-CRT(p<0.001)或IMRT(p<0.001)。然而,IMRT的适形指数优于WB-CRT(p<0.001)或FIF-IMRT(p<0.001)。此外,与WB-CRT(p=0.023至<0.001)或FIF-IMRT(p=0.028至<0.001)相比,IMRT对包括肾脏、肝脏和脊髓在内的所有OAR的保护更好。结论:与FIF-IMRT和WB-CRT相比,IMRT似乎是胃窦部胃癌最合适的技术。要确定IMRT总体上是否更优,需要进行临床研究,同时考虑胃癌患者肿瘤定位(贲门、胃体和胃窦)和器官运动的差异。
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