Arcelli Alessandra, Bertini Federica, Strolin Silvia, Macchia Gabriella, Deodato Francesco, Cilla Savino, Parisi Salvatore, Sainato Aldo, Fiore Michele, Gabriele Pietro, Genovesi Domenico, Cellini Francesco, Guido Alessandra, Cammelli Silvia, Buwenge Milly, Loi Emiliano, Bisello Silvia, Renzulli Matteo, Golfieri Rita, Morganti Alessio G, Strigari Lidia
Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, Bologna University, 40138 Bologna, Italy.
Cancers (Basel). 2021 Jun 18;13(12):3051. doi: 10.3390/cancers13123051.
The study aimed to generate a local failure (LF) risk map in resected pancreatic cancer (PC) and validate the results of previous studies, proposing new guidelines for PC postoperative radiotherapy clinical target volume (CTV) delineation. Follow-up computer tomography (CT) of resected PC was retrospectively reviewed by two radiologists identifying LFs and plotting them on a representative patient CT scan. The percentages of LF points randomly extracted based on CTV following the RTOG guidelines and based on the LF database were 70% and 30%, respectively. According to the Kernel density estimation, an LF 3D distribution map was generated and compared with the results of previous studies using a Dice index. Among the 64 resected patients, 59.4% underwent adjuvant treatment. LFs closer to the root of the celiac axis (CA) or the superior mesenteric artery (SMA) were reported in 32.8% and 67.2% cases, respectively. The mean (± standard deviation) distances of LF points to CA and SMA were 21.5 ± 17.9 mm and 21.6 ± 12.1 mm, respectively. The Dice values comparing our iso-level risk maps corresponding to 80% and 90% of the LF probabilistic density and the CTVs-80 and CTVs-90 of previous publications were 0.45-0.53 and 0.58-0.60, respectively. According to the Kernel density approach, a validated LF map was proposed, modeling a new adjuvant CTV based on a PC pattern of failure.
该研究旨在生成切除术后胰腺癌（PC）的局部复发（LF）风险图，并验证先前研究的结果，为PC术后放疗临床靶区（CTV）勾画提出新的指南。两名放射科医生对切除术后PC的随访计算机断层扫描（CT）进行了回顾性分析，确定LF并将其标注在代表性患者的CT扫描上。根据RTOG指南基于CTV随机提取的LF点百分比和基于LF数据库的分别为70%和30%。根据核密度估计，生成了LF三维分布图，并使用Dice指数与先前研究的结果进行比较。在64例切除患者中，59.4%接受了辅助治疗。分别有32.8%和67.2%的病例报告LF更靠近腹腔干（CA）根部或肠系膜上动脉（SMA）。LF点到CA和SMA的平均（±标准差）距离分别为21.5±17.9mm和21.6±12.1mm。将我们对应于LF概率密度80%和90%的等水平风险图与先前出版物的CTVs - 80和CTVs - 90进行比较的Dice值分别为0.45 - 0.53和0.58 - 0.60。根据核密度方法，提出了一个经过验证的LF图，基于PC复发模式建立了一个新的辅助CTV模型。
