Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Radiation Oncology, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China.
J Appl Clin Med Phys. 2021 Oct;22(10):178-189. doi: 10.1002/acm2.13416. Epub 2021 Sep 10.
To assist in the selection of a suitable combination of an irradiation technique and jaw condition in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) for lung cancer treatment plans.
Thirty patients with lung cancer who underwent radiotherapy were enrolled retrospectively. They were categorized as having central lung cancer, peripheral lung cancer with mediastinal lymph node metastasis (peripheral E lung cancer), and peripheral lung cancer without mediastinal lymph node metastasis (peripheral N lung cancer). Four treatment plans were designed for each patient: fixed jaw and adaptive jaw IMRT technique (FJ-IMRT and JA-IMRT), and fixed jaw and jaw tracking VMAT technique (FJ-VMAT and JT-VMAT). The dose parameters of the four group plans were compared and analyzed.
Compared to FJ-IMRT, JA-IMRT significantly reduced the mean dose (D ) and volume percentage of 5 Gy (V ) of the total lung in central and peripheral N lung cancer. Similarly, compared to FJ-VMAT, JT-VMAT provided better protection to most organs at risk (OARs), particularly for total lung and heart. In comparison with IMRT, VMAT significantly improved the conformity index (CI) of the planning target volume for the three lung cancer classifications, and it reduced the dose of almost all OARs except V and D of the total lung. Moreover, the mean monitor units of the VMAT groups were far lower than the IMRT groups.
Based on the dosimetric findings and considering clinical data published on lung and heart side effects, we propose recommendations on the preferred treatment technique based on tumor location and pulmonary function. For central lung cancer with normal pulmonary function, we advise JT-VMAT techniques. Conversely, for central lung cancer with poor pulmonary function, we recommend JA-IMRT techniques. We advocate JA-IMRT for peripheral E lung cancer. For peripheral N lung cancer, JT-VMAT techniques are strongly recommended.
在肺癌调强放疗（IMRT）和容积旋转调强放疗（VMAT）计划中，协助选择合适的照射技术和颌骨条件组合。
回顾性纳入 30 例接受放疗的肺癌患者。将他们分为中央型肺癌、纵隔淋巴结转移的周围型肺癌（外周 E 型肺癌）和无纵隔淋巴结转移的周围型肺癌（外周 N 型肺癌）。为每位患者设计了 4 种治疗计划：固定颌骨和自适应颌骨 IMRT 技术（FJ-IMRT 和 JA-IMRT），以及固定颌骨和颌骨跟踪 VMAT 技术（FJ-VMAT 和 JT-VMAT）。比较和分析了四组计划的剂量参数。
与 FJ-IMRT 相比，JA-IMRT 显著降低了中央型和外周 N 型肺癌中全肺的平均剂量（D）和 5Gy 体积百分比（V）。同样，与 FJ-VMAT 相比，JT-VMAT 为大多数危及器官（OARs）提供了更好的保护，特别是全肺和心脏。与 IMRT 相比，VMAT 显著提高了三种肺癌分类的计划靶区适形指数（CI），并降低了除全肺 V 和 D 之外的几乎所有 OARs 的剂量。此外，VMAT 组的平均监测器单位远低于 IMRT 组。
基于剂量学发现，并考虑到已发表的关于肺和心脏副作用的临床数据，我们根据肿瘤位置和肺功能提出了基于治疗技术的建议。对于功能正常的中央型肺癌，我们建议使用 JT-VMAT 技术。相反，对于功能不佳的中央型肺癌，我们建议使用 JA-IMRT 技术。我们建议 JA-IMRT 用于外周 E 型肺癌。对于外周 N 型肺癌，强烈推荐使用 JT-VMAT 技术。
