Kisiván Katalin, Erdélyesi Dóra, Gutyina Dávid, Sajti Péter, Gugyerás Dániel, Farkas Andrea, Glavák Csaba, László Zoltán, Somogyiné Ezer Éva, Máhr Károly, Szabó Zsolt, Szabó Helga, Cselik Zsolt, Gulybán Ákos, Petőné Csima Melinda, Káposztás Zsolt, Lakosi Ferenc
Dr. Baka József Központ, Somogy Megyei Kaposi Mór Oktató Kórház, Onkoradiológia, Kaposvár, Hungary.
Klinikai Onkológiai Osztály, Somogy Megyei Kaposi Mór Oktató Kórház, Kaposvár, Hungary.
Magy Onkol. 2021 Mar 17;65(1):6-13. Epub 2021 Jan 25.
Our aim was to present different treatment strategies (non-gated [NG], respiratory-gated [RG] and deep inspiration breath-hold [DIBH] technique) of linac-based stereotaxic ablative radiotherapy (SABR) for pancreatic cancer in terms of use of marker, abdominal compression, image quality, and time efficiency. From October 2016 to October 2020 14 patients were treated with VMAT-based SABR (NG: 6/14, 8/14 RG RT including 3/8 DIBH SABR). Treatment verification consisted of 3D/4D CBCTs. For intrafractional tumor visualization (11/14) different type of fiducials were used. The average treatment time was the shortest with NG RT, followed by DIBH and RG RT. However, the best image quality was achieved with DIBH technique. The Krippendorff's agreement test among three independent RTTs showed that DIBH CBCT (Cone Beam CT) can produce sufficient image quality for OARs and can be used to reliably determine OARs position related to safety zone (PRV). Overall, marker-based DIBH SABR with intrafractional tumor visualization appears to be the best technique on linac at present.
我们的目的是从标志物的使用、腹部压迫、图像质量和时间效率方面，介绍基于直线加速器的立体定向消融放疗（SABR）治疗胰腺癌的不同治疗策略（非门控[NG]、呼吸门控[RG]和深吸气屏气[DIBH]技术）。2016年10月至2020年10月，14例患者接受了基于容积调强弧形放疗（VMAT）的SABR治疗（NG：6/14，8/14为RG放疗，其中3/8为DIBH SABR）。治疗验证包括三维/四维锥形束CT（CBCT）。对于分次治疗期间的肿瘤可视化（11/14），使用了不同类型的基准标记。NG放疗的平均治疗时间最短，其次是DIBH和RG放疗。然而，DIBH技术获得的图像质量最佳。三位独立放疗技师之间的Krippendorff一致性检验表明，DIBH CBCT（锥形束CT）可为危及器官（OAR）产生足够的图像质量，并可用于可靠地确定OAR与安全区（计划靶区[PTV]）相关的位置。总体而言，基于标志物的DIBH SABR及分次治疗期间的肿瘤可视化似乎是目前直线加速器上最佳的技术。
