基于体素的全骨盆调强光子与质子治疗前列腺癌术后管理的比较研究。
In silico comparison of whole pelvis intensity-modulated photon versus proton therapy for the postoperative management of prostate cancer.
机构信息
Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Acta Oncol. 2023 Jun;62(6):642-647. doi: 10.1080/0284186X.2023.2224925. Epub 2023 Jun 22.
BACKGROUND
Limited data exist comparing intensity-modulated photon (IMRT) and proton (IMPT) radiation therapy when treating the prostate bed and pelvic lymph nodes in the postoperative setting for prostate cancer. The aim of this study was to evaluate dosimetric differences between IMRT and IMPT when treating with whole pelvis radiation therapy (WPRT) postoperatively.
MATERIALS AND METHODS
IMRT and IMPT plans were generated for 10 post-prostatectomy patients treated between July and August 2020. The prescription was 50 Gy radiobiologic equivalent (GyE) (proton radiobiological effective dose 1.1) to the pelvis and 70 GyE to the prostate bed in 2 GyE per fraction. Paired 2-sided Wilcoxon signed-rank tests were used to compare clinical target volume (CTV) coverage and dose to organs at risk (OARs).
RESULTS
CTV coverage was met for all plans with 99% of CTVs receiving ≥99% of prescription doses. Dose to OARs was significantly higher with IMRT than IMPT for the following endpoints: bladder V5-V65; bowel V5-V45; sigmoid V5-V50; rectum V5-V70; femoral head V40 and maximum dose; bone V5-V65. Select endpoints with significant differences included bladder V30 (63.5 vs. 44.4%, < .001), bowel V15 (949 vs. 191 cc, = .001) and V30 (386 vs. 121 cc, < .001), rectum V40 (81.8 vs. 32.1%, < .001) and V50 (47.6 vs. 24.9%, < .001), femoral head maximum doses (46.4-47.1 vs. 38.3-38.6GyE, < .001), and bone V10 (93.3 vs. 85.4%, < . 001). Mean doses for all OARs were significantly higher with IMRT, including bladder (41.9 vs. 29.7GyE, < .001), bowel (21.2 vs. 5.5GyE, < .001), and rectum (50.8 vs. 27.3GyE, < .001). Integral dose to 'Body - CTV' was significantly higher with IMRT (32.8 vs. 18.4 J, < .001).
CONCLUSION
IMPT provides comparable target coverage to IMRT when treating prostate cancer with WPRT in the postoperative setting while significantly reducing dose to OARs. These data can inform the future clinical management and delivery of post-prostatectomy irradiation for prostate cancer.
背景
在前列腺癌术后治疗前列腺床和盆腔淋巴结时，调强光子（IMRT）和质子（IMPT）放疗的对比数据有限。本研究旨在评估术后全骨盆放疗（WPRT）时 IMRT 和 IMPT 之间的剂量学差异。
材料与方法
为 2020 年 7 月至 8 月期间治疗的 10 例前列腺切除术后患者生成了 IMRT 和 IMPT 计划。处方剂量为骨盆 50Gy 生物等效剂量（GyE）（质子生物等效有效剂量 1.1），前列腺床 70GyE，每次 2GyE。采用配对双侧 Wilcoxon 符号秩检验比较临床靶区（CTV）覆盖和危及器官（OARs）的剂量。
结果
所有计划均满足 CTV 覆盖要求，99%的 CTV 接受了≥99%的处方剂量。与 IMPT 相比，IMRT 对以下终点的 OAR 剂量明显更高：膀胱 V5-V65；肠 V5-V45；乙状结肠 V5-V50；直肠 V5-V70；股骨头 V40 和最大剂量；骨 V5-V65。具有显著差异的选择终点包括膀胱 V30（63.5%比 44.4%，<0.001）、肠 V15（949 比 191cc，=0.001）和 V30（386 比 121cc，<0.001）、直肠 V40（81.8%比 32.1%，<0.001）和 V50（47.6%比 24.9%，<0.001）、股骨头最大剂量（46.4-47.1 比 38.3-38.6GyE，<0.001）和骨 V10（93.3%比 85.4%，<0.001）。所有 OAR 的平均剂量均明显高于 IMRT，包括膀胱（41.9 比 29.7GyE，<0.001）、肠（21.2 比 5.5GyE，<0.001）和直肠（50.8 比 27.3GyE，<0.001）。“身体 -CTV”的积分剂量也明显高于 IMRT（32.8 比 18.4J，<0.001）。
结论
在前列腺癌术后使用 WPRT 治疗时，IMPT 提供了与 IMRT 相当的靶区覆盖，同时显著降低了 OAR 剂量。这些数据可以为前列腺癌术后的前列腺切除术照射的未来临床管理和实施提供信息。
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