Hooshangnejad Hamed, Miles Devin, Hill Colin, Narang Amol, Ding Kai, Han-Oh Sarah
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21287, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
Cancers (Basel). 2023 Aug 30;15(17):4332. doi: 10.3390/cancers15174332.
Pancreatic cancer is the fourth leading cause of cancer-related death, with nearly 60,000 cases each year and less than a 10% 5-year overall survival rate. Radiation therapy (RT) is highly beneficial as a local-regional anticancer treatment. As anatomical variation is of great concern, motion management techniques, such as DIBH, are commonly used to minimize OARs toxicities; however, the variability between DIBHs has not been well studied. Here, we present an unprecedented systematic analysis of patients' anatomical reproducibility over multiple DIBH motion-management technique uses for pancreatic cancer RT. We used data from 20 patients; four DIBH scans were available for each patient to design 80 SBRT plans. Our results demonstrated that (i) there is considerable variation in OAR geometry and dose between same-subject DIBH scans; (ii) the RT plan designed for one scan may not be directly applicable to another scan; (iii) the RT treatment designed using a DIBH simulation CT results in different dosimetry in the DIBH treatment delivery; and (iv) this confirms the importance of adaptive radiation therapy (ART), such as MR-Linacs, for pancreatic RT delivery. The ART treatment delivery technique can account for anatomical variation between referenced and scheduled plans, and thus avoid toxicities of OARs because of anatomical variations between DIBH patient setups.
胰腺癌是癌症相关死亡的第四大主要原因，每年有近60000例病例，5年总生存率不到10%。放射治疗（RT）作为一种局部区域抗癌治疗方法非常有益。由于解剖变异备受关注，通常使用如深吸气屏气（DIBH）等运动管理技术来尽量减少危及器官（OARs）的毒性；然而，不同DIBH之间的变异性尚未得到充分研究。在此，我们对胰腺癌放疗中多次使用DIBH运动管理技术时患者的解剖可重复性进行了前所未有的系统分析。我们使用了20名患者的数据；每位患者有4次DIBH扫描，用于设计80个立体定向体部放疗（SBRT）计划。我们的结果表明：（i）同一患者的DIBH扫描之间，OAR的几何形状和剂量存在相当大的差异；（ii）为一次扫描设计的放疗计划可能不适用于另一次扫描；（iii）使用DIBH模拟CT设计的放疗治疗在DIBH治疗实施中会导致不同的剂量测定结果；（iv）这证实了自适应放射治疗（ART），如磁共振直线加速器（MR-Linacs），在胰腺癌放疗中的重要性。ART治疗实施技术可以考虑参考计划和预定计划之间的解剖变异，从而避免由于DIBH患者摆位之间的解剖变异导致的OAR毒性。
