Kutcher G J, Kestler C, Greenblatt D, Brenner H, Hilaris B S, Nori D
Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, NY, NY 10021.
Int J Radiat Oncol Biol Phys. 1987 Nov;13(11):1747-52. doi: 10.1016/0360-3016(87)90173-8.
A combined photon-electron beam treatment for diffuse pleural mesothelioma is discussed in this paper. The technique consists of parallel opposed 10 MV X rays prescribed to 4250 cGy using customized blocks to shield the lung. The pleura is then boosted with electrons to a dose of 3600 cGy. The combination yields a TDF of 74 ret to the pleura. As discussed in an earlier paper, this treatment method when combined with subtotal pleurectomy and I-125 implantation leads to improved survivals with minimal complications. The details of this 3-dimensional radiation treatment method were not described in detail. To improve target coverage and local control, the technique has been modified. CT is now used along with simulation plane films to define the entire pleural surface. The target volume has also been extended from the dome to the base of this diaphragm. These changes have led to improved pleural dose distributions; by blocking the liver or stomach, and boosting the crus of the diaphragm with electrons, there is little added morbidity. As is demonstrated by dose volume histograms, we have been able to deliver 4250 cGy +/- 10% to most of the pleura with 1/3 of the lung parenchyma receiving less than 2100 cGy.
本文讨论了一种用于弥漫性胸膜间皮瘤的光子 - 电子束联合治疗方法。该技术包括使用定制挡块屏蔽肺部，对平行相对的10 MV X射线规定剂量为4250 cGy。然后用电子束对胸膜进行增敏，剂量为3600 cGy。这种联合治疗使胸膜的总剂量因子（TDF）达到74 ret。如早期一篇论文中所讨论的，这种治疗方法与胸膜次全切除术和碘 - 125植入相结合，可提高生存率且并发症最少。这种三维放射治疗方法的细节未详细描述。为了提高靶区覆盖范围和局部控制效果，该技术已进行了改进。现在使用CT以及模拟平面片来确定整个胸膜表面。靶区体积也已从膈肌穹窿扩展至膈肌底部。这些改变改善了胸膜剂量分布；通过遮挡肝脏或胃，并对膈肌脚进行电子束增敏，几乎不会增加发病率。如剂量体积直方图所示，我们已能够向大部分胸膜输送4250 cGy±10%的剂量，且1/3的肺实质接受的剂量低于2100 cGy。
