Dipartimento di Diagnostica per Immagini, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Dipartimento di Diagnostica per Immagini, UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
J Appl Clin Med Phys. 2019 Jun;20(6):194-198. doi: 10.1002/acm2.12575. Epub 2019 May 4.
The case of a 50-year-old man affected by a rhabdomiosarcoma metastatic lesion in the left flank Is reported. The patient was addressed to 50.4 Gy radiotherapy with concomitant chemotherapy in order to locally control the lesion. A Tri-60-Co magnetic resonance hybrid radiotherapy unit was used for treatment delivery and a respiratory gating protocol was applied for the different breathing phases (Free Breathing, Deep Inspiration Breath Hold and Final Expiration Breath Hold). Three intensity modulated radiation therapy (IMRT) plans were calculated and Final Expiration Breath Hold plan was finally selected due to the absence of PTV coverage differences and better organs at risk sparing (i.e. kidneys). This case report suggests that organs at risk avoidance with MRI-guided respiratory-gated Radiotherapy is feasible and particularly advantageous whenever sparing the organs at risk is of utmost dosimetric or clinical importance.
本文报告了一例 50 岁男性患者，其左侧腰部有横纹肌肉瘤转移病灶。为了局部控制病变，对该患者采用了 50.4 Gy 的放射治疗，并同时进行了化疗。治疗采用 Tri-60-Co 磁共振混合放射治疗单元，并应用呼吸门控协议进行不同呼吸阶段（自由呼吸、深吸气屏气和末次呼气屏气）的治疗。计算了三个调强放射治疗（IMRT）计划，最终选择了末次呼气屏气计划，因为它没有出现 PTV 覆盖差异，并且对重要器官（如肾脏）的保护更好。本病例报告表明，在需要最大限度地保护器官免受剂量或临床影响时，使用 MRI 引导的呼吸门控放射治疗来避免危及器官是可行的，并且具有特别的优势。
