使用TomoDirect计划治疗局部晚期非小细胞肺癌的疗效及其与TomoHelical计划相比的特点。

Treatment outcome for locally advanced non-small-cell lung cancer using TomoDirect plan and its characteristics compared to the TomoHelical plan.

作者信息

Mukai Yuki, Omura Motoko, Hashimoto Harumitu, Matsui Kengo, Hongo Hideyuki, Yamakabe Wataru, Yoshida Miwa, Hata Masaharu, Inoue Tomio

机构信息

Department of Radiology, Yokohama City University, Graduate School of Medicine, Yokohama, Kanagawa, Japan.

Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.

出版信息

J Med Radiat Sci. 2018 Mar;65(1):55-62. doi: 10.1002/jmrs.265. Epub 2018 Feb 2.

DOI:10.1002/jmrs.265

PMID:29393591

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5846024/

Abstract

INTRODUCTION

TomoDirect (TD) is an intensity-modulated radiotherapy system that uses a fixed gantry angle instead of the rotational beam delivery used in the TomoHelical (TH) system. This study was performed (1) to evaluate the treatment outcome of the TD plan for locally advanced non-small-cell lung cancer (NSCLC) and (2) to compare the characteristics of TD plans with those of TH plans.

METHODS

Twenty-one patients with NSCLC were treated using the TD system. The prescribed dose was 40 Gy/20 Fx for the initial planning target volume (PTV), which included the gross tumour volume (GTV) and lymph node regions. A boost plan of 20 Gy/10 Fx was then applied, focusing on the GTV. For the planning study, matched TH plans of 40 Gy for the initial PTV were created for each patient, to meet the same dosimetric constraints specified in the TD plans.

RESULTS

The 2-year overall survival, progression-free survival and local control rates were 47%, 45% and 74% respectively. Grade 2 treatment-related pneumonitis occurred in three (14%) patients. The planning study comparing TD and TH showed that dose distribution to GTV and PTV were not significantly different. The lung V5 Gy was lower in the TD plans than TH plans (46.4 ± 5.4 vs. 52.3 ± 8.5), while the V20 Gy was higher (26.2 ± 4 vs. 24 ± 4.3). The TD plans had a significantly shorter treatment time than TH plans (4.5 ± 1.3 min vs. 9.8 ± 1.5 min).

CONCLUSIONS

TD is a clinically acceptable treatment option for NSCSL. The quality of the TD and TH plans are comparable.

摘要

引言

TomoDirect（TD）是一种调强放射治疗系统，它使用固定的机架角度，而不是TomoHelical（TH）系统中使用的旋转束流传输方式。本研究旨在：（1）评估TD计划对局部晚期非小细胞肺癌（NSCLC）的治疗效果；（2）比较TD计划与TH计划的特点。

方法

21例NSCLC患者接受了TD系统治疗。初始计划靶体积（PTV）的处方剂量为40 Gy/20次分割，PTV包括大体肿瘤体积（GTV）和淋巴结区域。然后针对GTV实施20 Gy/10次分割的推量计划。对于计划研究，为每位患者创建了初始PTV为40 Gy的匹配TH计划，以满足TD计划中规定的相同剂量学约束。

结果

2年总生存率、无进展生存率和局部控制率分别为47%、45%和74%。3例（14%）患者发生2级治疗相关肺炎。比较TD和TH的计划研究表明，GTV和PTV的剂量分布无显著差异。TD计划中的肺V5 Gy低于TH计划（46.4±5.4 vs. 52.3±8.5），而V20 Gy更高（26.2±4 vs. 24±4.3）。TD计划的治疗时间明显短于TH计划（4.5±1.3分钟 vs. 9.8±1.5分钟）。