Department of Radiation Oncology and Department of Head & Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Department of Radiation Oncology, Seidman Cancer Center, University Hospitals and Case Western Reserve University, Cleveland, OH 44106, United States.
Oral Oncol. 2018 May;80:74-81. doi: 10.1016/j.oraloncology.2018.03.020. Epub 2018 Apr 4.
To evaluate the benefit of intensity-modulated radiation therapy (IMRT) with multi-criteria optimization (MCO) in patients with oropharyngeal cancer (OPC) and compare the dose difference between the MCO plans navigated by physicians and dosimetrists.
The conventional IMRT plans (nonMCO) and MCO IMRT plans navigated by physicians and dosimetrists (MCOp and MCOd) were created for 30patients with OPC. All the plans were reviewed, and the planning time and dose-volume parameters were compared.
The difference of D among three kinds of plans was not significant (p > 0.05). The maximum dose and D of spinal cord, brain stem, the mean dose of bilateral parotids, cochlea, oral cavity and glottic larynx were lower in MCO plans than those in nonMCO plans (p < 0.017). Furthermore, MCOp showed better bilateral parotids, oral cavity and glottic larynx sparing compared to MCOd (p < 0.017), in which the magnitude was related to the overlapping volume of the corresponding organ at risk (OAR) and targets. The active planning time was reduced by a median of 94.3 min (MCOd vs. nonMCO) or 91.6 min (MCOp vs. nonMCO).
MCO IMRT plans significantly reduced the dose of OARs and the active planning time, without compromising the target coverage in OPC patients; navigations by physicians could be beneficial to the dose sparing of the OARs with high complication rate and those overlapping with targets; the constraints could be the predominant factor affecting the results of optimization in the MCO IMRT planning.
评估多标准优化（MCO）调强放疗（IMRT）在口咽癌（OPC）患者中的获益，并比较医生和剂量师导航的 MCO 计划之间的剂量差异。
为 30 例 OPC 患者创建了常规调强放疗计划（非 MCO）和由医生和剂量师导航的 MCO 调强放疗计划（MCOp 和 MCOd）。对所有计划进行了评估，并比较了计划时间和剂量体积参数。
三种计划之间的 D 差异无统计学意义（p>0.05）。脊髓、脑干、双侧腮腺、耳蜗、口腔和声门的最大剂量和 D 值，以及双侧腮腺、口腔和声门的平均剂量均低于非 MCO 计划（p<0.017）。此外，与 MCOd 相比，MCOp 显示出更好的双侧腮腺、口腔和声门保护（p<0.017），其程度与相应危及器官（OAR）和靶区的重叠体积有关。主动计划时间中位数减少了 94.3 分钟（MCOd 与非 MCO）或 91.6 分钟（MCOp 与非 MCO）。
MCO IMRT 计划可显著降低 OAR 剂量和主动计划时间，同时不影响 OPC 患者的靶区覆盖；医生导航有利于高并发症风险和与靶区重叠的 OAR 剂量保护；约束条件可能是 MCO IMRT 计划优化结果的主要影响因素。
