Department of Radiation and Medical Oncology, 89657Wenzhou Medical University 1st Affiliated Hospital, Wenzhou, China.
Department of Oncology, 117970The First Affiliated Hospital of Nanchang University, Nanchang, China.
Technol Cancer Res Treat. 2020 Jan-Dec;19:1533033820973283. doi: 10.1177/1533033820973283.
The purpose of the present study was first to apply the progressive optimization algorithm based automatic volumetric modulated arc therapy (POA-VMAT) technology to accelerate and improve the radiotherapy of cervicothoracic esophageal cancer (CTEC). We comprehensive analyze the feasibility, normal tissue complication probability (NTCP) and dosimetric results of POA-VMAT, manual based VMAT and step-shoot intensity-modulated radiation therapy (IMRT) plans in the treatment of CTEC.
Sixty patients with CTEC with or without concomitant chemotherapy at our institution between 2017 and 2019 were retrospectively identified. The manual 7field-IMRT (7f-IMRT), Single-arc-VMAT and Double-arc-VMAT (Single-Arc/Double-Arc) plans were generated in all cases. The POA-VMAT was designed using the automatic dual-arc VMAT technology of Pinnacle 9.10 planning system based on progressive optimization algorithm. Specially, it includes the selection of treatment techniques, the running of automated planning scripts, and the evaluation of the final radiotherapy regimen. Subsequently, quantitative evaluation of plans was performed by means of standard dose-volume histograms, homogeneity index (HI) and conformity index (CI).
Target dose conformity of the 7f-IMRT plan was inferior to all plans, whereas the Double-Arc plan was slightly inferior to the POA-VMAT but superior to the Single-Arc and 7f-IMRT plan. The HI for 7f-IMRT, Single-Arc, Double-Arc and POA-VMAT were 0.17 ± 0.08, 0.28 ± 0.06, 0.29 ± 0.06 and 0.28 ± 0.03, respectively. For the NTCP results, there was significant statistical difference among POA-VMAT, IMRT and VMAT plans. The total MU was reduced by 48.3% and 42.1% in Single-Arc and POA-VMAT plans compare to IMRT plans.
By comprehensive consideration, POA-VMAT efficiently generate acceptable treatment plans for CTEC without dose escalation to OARs and overall superior to manual planning which is a good option for treating CTEC.
本研究的目的首先是应用基于渐进式优化算法的自动容积调强弧形治疗（POA-VMAT）技术，加速并改善颈胸段食管癌（CTEC）的放射治疗。我们综合分析了 POA-VMAT、基于手动的 VMAT 和分步调强放射治疗（IMRT）计划在治疗 CTEC 中的可行性、正常组织并发症概率（NTCP）和剂量学结果。
回顾性分析了 2017 年至 2019 年在我院接受治疗的 60 例 CTEC 患者，这些患者或接受同步放化疗，或不接受。在所有患者中，均生成了手动 7 野 IMRT（7f-IMRT）、单弧 VMAT 和双弧 VMAT（Single-Arc/Double-Arc）计划。POA-VMAT 是基于渐进式优化算法的 Pinnacle 9.10 计划系统的自动双弧 VMAT 技术设计的。特别地，它包括治疗技术的选择、自动规划脚本的运行以及最终放射治疗方案的评估。随后，通过标准剂量-体积直方图、均匀性指数（HI）和适形性指数（CI）对计划进行定量评估。
7f-IMRT 计划的靶区剂量适形性劣于所有计划，而双弧计划略劣于 POA-VMAT，但优于单弧和 7f-IMRT 计划。7f-IMRT、单弧、双弧和 POA-VMAT 的 HI 分别为 0.17 ± 0.08、0.28 ± 0.06、0.29 ± 0.06 和 0.28 ± 0.03。对于 NTCP 结果，POA-VMAT、IMRT 和 VMAT 计划之间存在显著的统计学差异。与 IMRT 计划相比，单弧和 POA-VMAT 计划的总 MU 分别减少了 48.3%和 42.1%。
综合考虑，POA-VMAT 可有效地为 CTEC 生成可接受的治疗计划，而不会增加 OAR 剂量，并且总体优于手动计划，是治疗 CTEC 的一个很好的选择。
