用于放射性栓塞治疗计划的肺分流和肺剂量计算方法。
Lung shunt and lung dose calculation methods for radioembolization treatment planning.
作者信息
Kappadath S Cheenu, Lopez Benjamin P, Salem Riad, Lam Marnix G
机构信息
Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA -
Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Q J Nucl Med Mol Imaging. 2021 Mar;65(1):32-42. doi: 10.23736/S1824-4785.20.03287-2. Epub 2021 Jan 4.
Radioembolization, also known as selective internal radiation therapy (SIRT), is firmly established in the management of patients with unresectable liver cancers. Advances in normal and tumor liver dosimetry and new knowledge about tumor dose response relationships have helped promote the safe use of higher prescribed doses, consequently transitioning radioembolization from palliative to curative therapy. The lungs are considered a critical organ of risk for radioembolization treatment planning. Unfortunately, lung dosimetry has not achieved similar advances in dose calculation methodology as liver dosimetry. Current estimations of lung dose are dependent on a number of parameters associated with data acquisition and processing algorithms, leading to poor accuracy and precision. Therefore, the efficacy of curative radioembolization may be compromised in patients for whom the lung dose derived using currently available methods unnecessarily limits the desired administered activity to the liver. We present a systematic review of the various methods of determining the lung shunt fraction (LSF) and lung mean dose (LD). This review encompasses pretherapy estimations and post-therapy assessments of the LSF and LD using both 2D planar and 3D SPECT/CT based calculations. The advantages and limitations of each of these methods are deliberated with a focus on accuracy and practical considerations. We conclude the review by presenting a lexicon to precisely describe the methodology used for the estimation of LSF and LD; specifically, category, agent, modality, contour and algorithm, in order to aid in their interpretation and standardization in routine clinical practice.
放射性栓塞,也称为选择性内放射治疗(SIRT),在不可切除肝癌患者的治疗中已得到广泛应用。正常肝脏和肿瘤剂量学的进展以及关于肿瘤剂量反应关系的新知识,有助于推动更高处方剂量的安全使用,从而使放射性栓塞从姑息性治疗转变为根治性治疗。在放射性栓塞治疗计划中,肺部被视为一个关键的危险器官。不幸的是,肺部剂量学在剂量计算方法上尚未取得与肝脏剂量学类似的进展。目前对肺部剂量的估计依赖于许多与数据采集和处理算法相关的参数,导致准确性和精确性较差。因此,对于那些使用现有方法得出的肺部剂量不必要地限制了肝脏所需给药活度的患者,根治性放射性栓塞的疗效可能会受到影响。我们对确定肺分流分数(LSF)和肺平均剂量(LD)的各种方法进行了系统综述。本综述涵盖了使用二维平面和基于三维SPECT/CT的计算对LSF和LD进行治疗前估计和治疗后评估。对这些方法各自的优缺点进行了讨论,重点关注准确性和实际考虑因素。我们通过提供一个词汇表来精确描述用于估计LSF和LD的方法,从而结束本综述;具体来说,包括类别、试剂、模态、轮廓和算法,以帮助在常规临床实践中对它们进行解释和标准化。