University of Colorado School of Medicine, Department of Radiation Oncology, Aurora, United States; St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, United States.
Memorial Hospital, Department of Radiation Oncology, Colorado Springs, United States.
Radiother Oncol. 2018 Dec;129(3):494-498. doi: 10.1016/j.radonc.2018.03.025. Epub 2018 Apr 5.
There are two significant challenges when implementing functional-guided radiotherapy using 4DCT-ventilation imaging: (1) lack of knowledge of realistic patient specific dosimetric goals for functional lung and (2) ensuring consistent plan quality across multiple planners. Knowledge-based planning (KBP) is positioned to address both concerns.
A KBP model was created from 30 previously planned functional-guided lung patients. Standard organs at risk (OAR) in lung radiotherapy and a ventilation contour delineating areas of high ventilation were included. Model validation compared dose-metrics to standard OARs and functional dose-metrics from 20 independent cases that were planned with and without KBP.
A significant improvement was observed for KBP optimized plans in V20Gy and mean dose to functional lung (p = 0.005 and 0.001, respectively), V20Gy and mean dose to total lung minus GTV (p = 0.002 and 0.01, respectively), and mean doses to esophagus (p = 0.005).
The current work developed a KBP model for functional-guided radiotherapy. Modest, but statistically significant, improvements were observed in functional lung and total lung doses.
使用 4DCT-通气成像实施功能引导放疗时存在两个重大挑战：（1）缺乏针对功能性肺的实际患者特异性剂量学目标的知识，（2）确保多个计划者之间的计划质量一致。基于知识的计划（KBP）有望解决这两个问题。
从 30 例先前计划的功能引导性肺患者中创建了 KBP 模型。标准的肺放疗危险器官（OAR）和通气描绘高通气区域的通气轮廓都包括在内。模型验证将剂量指标与 20 例独立病例的标准 OAR 和功能剂量指标进行了比较，这些病例是使用和不使用 KBP 进行计划的。
在 KBP 优化的计划中，V20Gy 和功能性肺的平均剂量（p=0.005 和 0.001）、V20Gy 和 GTV 减去总肺的平均剂量（p=0.002 和 0.01）以及食管的平均剂量（p=0.005）均有显著改善。
目前的工作为功能引导性放疗开发了 KBP 模型。在功能性肺和总肺剂量方面观察到了适度但具有统计学意义的改善。
