基于图谱的主动骨髓保护调强放射治疗用于宫颈癌的可行性
Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer.
作者信息
Li Nan, Noticewala Sonal S, Williamson Casey W, Shen Hanjie, Sirak Igor, Tarnawski Rafal, Mahantshetty Umesh, Hoh Carl K, Moore Kevin L, Mell Loren K
机构信息
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States.
Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic.
出版信息
Radiother Oncol. 2017 May;123(2):325-330. doi: 10.1016/j.radonc.2017.02.017.
BACKGROUND
To test the hypothesis that atlas-based active bone marrow (ABM)-sparing intensity modulated radiation therapy (IMRT) yields similar dosimetric results compared to custom ABM-sparing IMRT for cervical cancer patients.
METHODS
We sampled 62 cervical cancer patients with pre-treatment FDG-PET/CT in training (n=32) or test (n=30) sets. ABM was defined as the subvolume of the pelvic bone marrow (PBM) with standardized uptake value (SUV) above the mean on the average FDG-PET image (ABM) vs. the individual's PET (ABM). Both were deformed to the planning CT. Overlap between the two subvolumes was measured using the Dice coefficient. Three IMRT plans designed to spare PBM, ABM, or ABM were compared for 30 test patients. Dosimetric parameters were used to evaluate plan quality.
RESULTS
ABM and ABM volumes were not significantly different (p=0.90), with a mean Dice coefficient of 0.75, indicating good agreement. Compared to IMRT plans designed to spare PBM and ABM, ABM-sparing IMRT plans achieved excellent target coverage and normal tissue sparing, without reducing dose to ABM (mean ABM dose 29.4Gy vs. 27.1Gyvs. 26.9Gy, respectively; p=0.10); however, PTV coverage and bowel sparing were slightly reduced.
CONCLUSIONS
Atlas-based ABM sparing IMRT is clinically feasible and may obviate the need for customized ABM-sparing as a strategy to reduce hematologic toxicity.
背景
为了验证基于图谱的主动骨髓（ABM） sparing调强放疗（IMRT）与针对宫颈癌患者定制的ABM sparing IMRT相比，是否能产生相似的剂量学结果这一假设。
方法
我们对62例宫颈癌患者进行了采样，这些患者在训练组（n = 32）或测试组（n = 30）中有治疗前的FDG-PET/CT。ABM被定义为盆腔骨髓（PBM）的子体积，其在平均FDG-PET图像上的标准化摄取值（SUV）高于平均值（ABM）与个体PET（ABM）相比。两者都被变形到计划CT上。使用Dice系数测量两个子体积之间的重叠。对30例测试患者比较了旨在保护PBM、ABM或ABM的三种IMRT计划。使用剂量学参数评估计划质量。
结果
ABM和ABM体积无显著差异（p = 0.90），平均Dice系数为0.75，表明一致性良好。与旨在保护PBM和ABM的IMRT计划相比，ABM sparing IMRT计划实现了出色的靶区覆盖和正常组织保护，且未降低对ABM的剂量（平均ABM剂量分别为29.4Gy、27.1Gy和26.9Gy；p = 0.10）；然而，计划靶区（PTV）覆盖和肠道保护略有降低。
结论
基于图谱的ABM sparing IMRT在临床上是可行的，可能无需定制ABM sparing作为降低血液学毒性的策略。
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