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碳纤维增强聚醚醚酮(CFR-PEEK)脊柱硬件在质子和光子计划中的综合评估。

Comprehensive Evaluation of Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) Spinal Hardware for Proton and Photon Planning.

机构信息

New York Proton Center, New York, NY, USA.

出版信息

Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221091700. doi: 10.1177/15330338221091700.

Abstract

To evaluate a novel spine implant, carbon-fiber-reinforced polyetheretherketone (CFR-PEEK), for proton and photon treatment planning. We compared target coverage and sparing of organs-at-risk (OARs) for a spinal phantom with 4 different spine configurations: (a) normal (no implant); (b) Titanium; (c) CFR-PEEK; and (d) hybrid (CFR-PEEK with Titanium tulip head). The spinal phantom was imaged via computed tomography (CT) scan, and the iterative Metal Artifact Reduction (iMAR) CT set was used for planning. A representative spinal chordoma target and associated OARs were contoured. The prescription dose was 50 Gy to the initial target volume, followed by a 24 Gy boost, for which multi-field optimization (MFO) proton plans were developed with a 3 mm setup and 3.5% range uncertainties. For photon planning, volumetric modulated arc therapy (VMAT) plans were developed for the initial and boost plans. OAR dose constraints were set according to our institutional guidelines. For the 4 spine configurations, the proton plans achieved similar nominal target coverage and OARs sparing. While evaluating coverage and OAR dose under uncertainty scenario analysis for initial clinical target volume (CTV) 50 Gy 95% and 90% coverage, higher means and the narrower band of doses variations were achieved for the normal and CFR-PEEK plans. Similarly, uncertainty analysis of spinal cord D showed tighter distribution for normal and CFR-PEEK plans. Overall plan quality showed no significant difference for photon planning when compared to normal spine versus other inserts. However, for proton planning, there is a larger difference for the normal spine insert scenario versus the Titanium insert scenario. For each insert scenario comparison between photon and proton plans, there was a larger difference for OARs: heart and spinal cord. The CFR-PEEK implant has similar clinical properties to a normal spine for proton planning, allowing us to pass protons through the material and achieve superior target coverage and OAR sparing under nominal and uncertainty conditions.

摘要

为了评估一种新型脊柱植入物——碳纤维增强聚醚醚酮(CFR-PEEK)在质子和光子治疗计划中的应用,我们比较了 4 种不同脊柱配置的脊柱模型的靶区覆盖和危及器官(OARs)保护:(a)正常(无植入物);(b)钛;(c)CFR-PEEK;和(d)混合(CFR-PEEK 加钛郁金香头)。脊柱模型通过计算机断层扫描(CT)成像,使用迭代金属伪影减少(iMAR)CT 集进行计划。代表性的脊柱脊索瘤靶区和相关的 OARs 被勾画。处方剂量为 50 Gy 至初始靶区体积,随后进行 24 Gy 推量,为其开发了多野优化(MFO)质子计划,设置为 3mm 和 3.5%的范围不确定性。对于光子计划,为初始和推量计划开发了容积调制弧形治疗(VMAT)计划。OAR 剂量限制根据我们的机构指南设定。对于 4 种脊柱配置,质子计划在达到相似的靶区覆盖和 OARs 保护的同时,实现了类似的标称靶区覆盖和 OARs 保护。在对初始临床靶区(CTV)50 Gy 95%和 90%覆盖范围的不确定性情景分析中评估覆盖范围和 OAR 剂量时,正常和 CFR-PEEK 计划的均值更高,剂量变化的带宽更窄。同样,脊髓 D 的不确定性分析显示,正常和 CFR-PEEK 计划的分布更为紧密。与正常脊柱相比,光子计划的总体计划质量没有显著差异,但与钛植入物相比,质子计划的差异更大。对于每个插入物情景,光子计划与质子计划之间的比较,OARs 的差异更大:心脏和脊髓。对于质子计划,CFR-PEEK 植入物与正常脊柱具有相似的临床特性,允许我们将质子穿过材料,在标称和不确定条件下实现更好的靶区覆盖和 OAR 保护。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4edd/9009152/6613cbb78a8a/10.1177_15330338221091700-fig1.jpg

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