调强放疗、容积弧形调强放疗和螺旋断层放疗治疗高级别胶质瘤的剂量学增益比较。
Comparison of Dosimetric Gains Provided by Intensity-Modulated Radiotherapy, Volume-Modulated Arc Therapy, and Helical Tomotherapy for High-Grade Glioma.
机构信息
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008.
出版信息
Biomed Res Int. 2020 Mar 18;2020:4258989. doi: 10.1155/2020/4258989. eCollection 2020.
PURPOSE
Because of the poor prognosis for high-grade glioma (HGG) patients, it is important to increase the dose of the tumor to improve the efficacy while minimizing the dose of organs at risk (OARs). Thus, we evaluated the potential dosimetric gains of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) or volume-modulated arc therapy (VMAT) for high-grade glioma (HGG).
METHODS
A total of 42 HGG patients were retrospectively selected who had undergone helical tomotherapy; then, IMRT and VMAT plans were generated and optimized for comparison after contouring crucial neuronal structures for neurogenesis and neurocognitive function. IMRT and VMAT were optimized with the Eclipse treatment planning system (TPS) (Version 11.0.31) and HT using TomoTherapy Hi-Art Software (Version 2.0.7) (Accuray, Madison, WI, USA). All three techniques were optimized for simultaneously delivering 60 Gy to planning target volume (PTV) 1 and 50-54 Gy to PTV2. We also analyzed the homogeneity index (HI) and conformity index (CI) of PTVs and organ at risk (OAR) sparing.
RESULTS
There was no significant difference in the PTV coverage among IMRT, VMAT, or HT. As for the HI, HT plans (PTV1 HI: 0.09 ± 0.03, PTV2 HI: 0.17 ± 0.05) had the best homogeneity when compared to IMRT plans (PTV1 HI: 0.10 ± 0.04, PTV2 HI: 0.18 ± 0.04) and VMAT plans (PTV1 HI: 0.11 ± 0.03, PTV2 HI: 0.20 ± 0.03). The CI value of HT (PTV1 CI: 0.98 ± 0.03, PTV2: 0.98 ± 0.05) was closest to the optimal value. Except for the IMRT and VMAT groups, there were statistically significant differences between the other two groups of the CI values in both PTV1 and PTV2. The other comparison values were statistically significant except for the optic nerve, and VMAT had the best sparing of the optic chiasm. The mean and max doses of OARs declined significantly in HT.
CONCLUSIONS
For high-grade glioma patients, HT had superior outcomes in terms of PTV coverage and OAR sparing as compared with IMRT/VMAT.
目的
由于高级别神经胶质瘤（HGG）患者的预后较差，因此增加肿瘤剂量以提高疗效，同时使危及器官（OAR）的剂量最小化非常重要。因此，我们评估了螺旋断层放疗（HT）与强度调制放疗（IMRT）或容积调强弧形治疗（VMAT）治疗高级别神经胶质瘤（HGG）的潜在剂量学增益。
方法
回顾性选择了 42 名接受螺旋断层放疗的 HGG 患者，然后对关键神经元结构进行轮廓勾画，以促进神经发生和神经认知功能，生成并优化 IMRT 和 VMAT 计划进行比较。IMRT 和 VMAT 采用 Eclipse 治疗计划系统（TPS）（版本 11.0.31）进行优化，HT 采用 TomoTherapy Hi-Art 软件（版本 2.0.7）（Accuray，Madison，WI，USA）进行优化。三种技术均优化为同时向计划靶区（PTV）1 给予 60Gy，向 PTV2 给予 50-54Gy。我们还分析了 PTV 和危及器官（OAR）的均匀性指数（HI）和适形性指数（CI）。
结果
IMRT、VMAT 或 HT 之间 PTV 覆盖率无显著差异。对于 HI，与 IMRT 计划（PTV1 HI：0.10 ± 0.04，PTV2 HI：0.18 ± 0.04）和 VMAT 计划（PTV1 HI：0.11 ± 0.03，PTV2 HI：0.20 ± 0.03）相比，HT 计划（PTV1 HI：0.09 ± 0.03，PTV2 HI：0.17 ± 0.05）具有更好的均匀性。HT 的 CI 值（PTV1 CI：0.98 ± 0.03，PTV2：0.98 ± 0.05）最接近最佳值。除 IMRT 和 VMAT 组外，其他两组 PTV1 和 PTV2 的 CI 值差异均有统计学意义。除视神经外，其他比较值均有统计学意义，VMAT 对视神经交叉的保护效果最好。OAR 的平均和最大剂量在 HT 中显著下降。
结论
与 IMRT/VMAT 相比，HT 治疗高级别神经胶质瘤患者时，在 PTV 覆盖范围和 OAR 保护方面具有更好的结果。
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