Mitra Devarati, Pei Yaguang, Buzurovic Ivan, Devlin Phillip M, Thornton Katherine, Raut Chandrajit P, Baldini Elizabeth H, Lam Miranda B
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.
Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Sarcoma. 2020 Aug 25;2020:7615248. doi: 10.1155/2020/7615248. eCollection 2020.
Angiosarcoma of the face and scalp is a rare disease with high rates of recurrence. The optimal treatment approach is not well defined. This study presents a dosimetric comparison of high-dose-rate surface applicator (HDR-SA) brachytherapy to volumetric-modulated arc therapy (VMAT).
Between 2011 and 2018, 12 patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy using CT-based planning at our institution. For comparison, deliverable VMAT plans for each patient were generated, and dose distribution was compared to the delivered HDR-SA brachytherapy plans.
Both VMAT and HDR-SA brachytherapy plans delivered good coverage of the clinical target. However, the dose distribution of VMAT was significantly different from HDR-SA brachytherapy across a variety of parameters. Mean doses to the lacrimal gland, orbit, lens, and cochlea were significantly higher with HDR-SA brachytherapy vs. VMAT. Brain Dmax, V80%, and V50% were also significantly higher with HDR-SA brachytherapy.
There may be dosimetric advantages to VMAT over HDR-SA brachytherapy for many patients. However, individual tumor location, patient anatomy, and treatment reproducibility may result in HDR-SA brachytherapy being the preferred technique in a subset of patients. Ultimately, a personalized approach is likely to be the optimal treatment plan.
面部和头皮血管肉瘤是一种罕见疾病，复发率高。最佳治疗方法尚未明确。本研究对高剂量率表面敷贴器（HDR-SA）近距离放射治疗与容积调强弧形治疗（VMAT）进行了剂量学比较。
2011年至2018年间，在我们机构对12例面部或头皮原发性或复发性血管肉瘤患者采用基于CT的计划进行HDR-SA近距离放射治疗。为作比较，为每位患者生成了可实施的VMAT计划，并将剂量分布与实施的HDR-SA近距离放射治疗计划进行比较。
VMAT和HDR-SA近距离放射治疗计划均能很好地覆盖临床靶区。然而，VMAT的剂量分布在各种参数上与HDR-SA近距离放射治疗有显著差异。与VMAT相比，HDR-SA近距离放射治疗时泪腺、眼眶、晶状体和耳蜗的平均剂量显著更高。HDR-SA近距离放射治疗时脑Dmax、V80%和V50%也显著更高。
对于许多患者，VMAT在剂量学上可能优于HDR-SA近距离放射治疗。然而，个体肿瘤位置、患者解剖结构和治疗可重复性可能导致HDR-SA近距离放射治疗成为部分患者的首选技术。最终，个性化方法可能是最佳治疗方案。
