Li Yazhou, Ma Yuanyuan, Wu Jieyan, Zhang Hui, Cai Hongyi, Liu Xinguo, Li Qiang
Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China.
Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.
J Appl Clin Med Phys. 2025 Apr;26(4):e14609. doi: 10.1002/acm2.14609. Epub 2024 Dec 20.
Tumor hypoxia significantly impacts the efficacy of radiotherapy. Recent developments in the technique of dose painting by numbers (DPBN) promise to improve the tumor control probability (TCP) in conventional radiotherapy for hypoxic cancer. The study initially combined the DPBN method with hypoxia-guided dose distribution optimization to overcome hypoxia for lung cancers and evaluated the effectiveness and appropriateness for clinical use of the DPBN plans. F-FMISO PET-CT scans from 13 lung cancer patients were retrospectively employed in our study to make hypoxia-guided radiotherapy. In the clinic, TCP and normal tissue complication probability (NTCP) derived from the DPBN plans in comparison to conventional intensity modulated radiation therapy (IMRT) plans were evaluated. Additionally, in order to investigate the improved clinical suitability, the robustness of DPBN plans in response to potential patient positioning errors and radiation resistance variations throughout the treatment course was assessed. The DPBN approach, employing voxelized prescription doses, led to an average increase of 24.47% in TCP, alongside a reduction of 1.83% in NTCP, compared to the conventional radiotherapy treatment plans. Regarding the robustness of the DPBN plans, it was observed that positional uncertainties were limited to 2 mm and radiosensitivity deviations were within 4%. The lung NTCP showed a 0.05% increase when the isocenter was moved by 3 mm in any direction, suggesting that the DPBN plan meets clinical acceptability criteria. Our study has shown that the DPBN technique has significant potential as an innovative approach to enhance the efficacy of radiotherapy for lung cancer with hypoxic regions.
肿瘤缺氧显著影响放射治疗的疗效。数字绘画剂量技术（DPBN）的最新进展有望提高缺氧癌症常规放射治疗中的肿瘤控制概率（TCP）。该研究最初将DPBN方法与缺氧引导的剂量分布优化相结合，以克服肺癌的缺氧问题，并评估DPBN计划临床应用的有效性和适用性。本研究回顾性采用了13例肺癌患者的F-FMISO PET-CT扫描图像进行缺氧引导放疗。在临床中，评估了DPBN计划与传统调强放射治疗（IMRT）计划相比的TCP和正常组织并发症概率（NTCP）。此外，为了研究临床适用性的提高，评估了DPBN计划在整个治疗过程中对潜在患者定位误差和放射抗性变化的鲁棒性。与传统放射治疗计划相比，采用体素化处方剂量的DPBN方法使TCP平均提高了24.47%，同时NTCP降低了1.83%。关于DPBN计划的鲁棒性，观察到位置不确定性限制在2毫米以内，放射敏感性偏差在4%以内。当等中心在任何方向移动3毫米时，肺部NTCP增加了0.05%，这表明DPBN计划符合临床可接受标准。我们的研究表明，DPBN技术作为一种创新方法，在提高对有缺氧区域肺癌的放射治疗疗效方面具有巨大潜力。
