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两种脊柱立体定向体部放疗治疗计划系统的剂量学比较

Dosimetric comparison of two treatment planning systems for spine SBRT.

作者信息

Lee Young Kyung, Munawar Iram, Mashouf Shahram, Sahgal Arjun, Ruschin Mark

机构信息

Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada.

Department of Medical Physics, Trillium Health Partners, the Credit Valley Hospital, Mississauga, Canada.

出版信息

Med Dosim. 2020;45(1):77-84. doi: 10.1016/j.meddos.2019.07.001. Epub 2019 Aug 1.

Abstract

Two commonly used treatment planning systems (TPS) are compared for the planning of spine stereotactic body radiotherapy (SBRT). The main purpose is to highlight relative advantages and disadvantages of each system and propose a methodologic approach for comparisons. Twenty clinical plans were inversely planned with step-and-shoot intensity-modulated radiotherapy (IMRT) each using 9 to 11 beams, referred to as IMRT_P. The prescription dose was 24 Gy in 2 fractions, and the plans were generated following our institutional protocol using the Pinnacle v9.2. Each case was replanned using a 2-arc volumetric modulated arc therapy (VMAT) approach, referred as VMAT_P. CT and structure sets were DICOM exported to Monaco v5.10 and planned in 2 different ways: IMRT (IMRT_M) and VMAT (VMAT_M) using the same prescription dose. Dose volume histograms (DVH) and other dose statistics of planning target volumes (PTV) and organ-at-risk (OAR) were analyzed and compared between plans. The gradient index (GI = ratio of 50% isodose volume to prescribed isodose volume) was used to measure dose fall-off outside of the PTV. Another metric - Gradient Index Inner (GI = the rate (in Gy/mm) - at which the dose changes from the level of the spinal cord/thecal sac toward the prescription dose) was developed and compared. All plans were considered clinically acceptable by institutional guidelines and achieved all of the OAR dose constraints. VMAT_M and IMRT_M showed comparable dose statistics for the PTV when compared to VMAT_P and IMRT_P, respectively. For IMRT plans, the median GI was 1.88 Gy/mm vs 1.52 Gy/mm for IMRT_M and IMRT_P respectively (p< 0.001). All other IMRT metrics were statistically similar except for the PTV maximum dose (D), which was higher for IMRT_M than IMRT_P (median 30.7 Gy vs 29.0 Gy, p< 0.001). For VMAT plans, only PTV D showed a statistical different between VMAT_M and VMAT_P of median 12.7 Gy vs 9.7 Gy (p< 0.001). In terms of beam sequencing parameters, the number of monitor units was statistically higher for VMAT_P compared to VMAT_M (median = 6764 vs 5376) whereas the number of segments for IMRT_M was statistically greater than IMRT_P (median = 155 vs 73). We were able to generate clinically acceptable plans for different types of spine SBRT using 2 different TPS. We used an evaluation strategy involving coverage, conformity, and dose gradient that can compared between TPS.

摘要

对两种常用的治疗计划系统(TPS)进行比较,以用于脊柱立体定向体部放射治疗(SBRT)的计划制定。主要目的是突出每种系统的相对优缺点,并提出一种比较的方法学途径。二十个临床计划采用静态调强放射治疗(IMRT)进行逆向计划,每种计划使用9至11个射野,称为IMRT_P。处方剂量为24 Gy,分2次给予,计划按照我们机构的方案,使用Pinnacle v9.2生成。每个病例采用双弧容积调强弧形治疗(VMAT)方法重新计划,称为VMAT_P。CT和结构集以DICOM格式导出到Monaco v5.10,并以两种不同方式进行计划:IMRT(IMRT_M)和VMAT(VMAT_M),使用相同的处方剂量。分析并比较计划靶区(PTV)和危及器官(OAR)的剂量体积直方图(DVH)及其他剂量统计数据。梯度指数(GI = 50%等剂量体积与处方等剂量体积之比)用于测量PTV外的剂量下降情况。还开发并比较了另一个指标——梯度指数内部(GI = 剂量从脊髓/硬膜囊水平向处方剂量变化的速率(Gy/mm))。根据机构指南,所有计划均被认为在临床上可接受,并满足所有OAR剂量限制。与VMAT_P和IMRT_P相比,VMAT_M和IMRT_M分别在PTV方面显示出可比的剂量统计数据。对于IMRT计划,IMRT_M和IMRT_P的GI中位数分别为1.88 Gy/mm和1.52 Gy/mm(p < 0.001)。除PTV最大剂量(D)外,所有其他IMRT指标在统计学上相似,IMRT_M的PTV最大剂量高于IMRT_P(中位数30.7 Gy对29.0 Gy,p < 0.001)。对于VMAT计划,仅PTV D在VMAT_M和VMAT_P之间显示出统计学差异,中位数分别为12.7 Gy和9.7 Gy(p < 0.001)。在射野排序参数方面,VMAT_P的监测单位数量在统计学上高于VMAT_M(中位数 = 6764对5376),而IMRT_M的子野数量在统计学上大于IMRT_P(中位数 = 155对73)。我们能够使用两种不同的TPS为不同类型的脊柱SBRT生成临床上可接受的计划。我们采用了一种涉及覆盖、适形性和剂量梯度的评估策略,可在TPS之间进行比较。

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