Tian Wei, Du Yangfeng, Zhou Pixiao, Ren Huan, Wen Yu, Li Shiqiang, Dong Wen, Wang Hongming, Wu Zhijun, Wu Tao, Xiao Zemin
Department of Oncology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, China.
Medicine (Baltimore). 2025 Apr 25;104(17):e42280. doi: 10.1097/MD.0000000000042280.
This study evaluates the dosimetric benefits of off-line adaptive radiotherapy (ART) planning during radiotherapy for locally advanced cervical cancer. Forty-four patients in our hospital were included. The patients were monitored by cone-beam CT (CBCT), and the secondary CT scanning was performed timely. The ART2 planning was performed based on tumor regression and compared with the initial radiotherapy planning (ART1). The mean time of the secondary CT scanning was the thirteen fractions, and the mean gross tumor volume (GTV) decreased by 23.3%. The ART2 compared with the ART1 planning, significantly reduced the mean dose of PGTV (defined as the GTV with 5 mm expansion all directions)-D2%, V110, and PTV-V110 by 1.9 Gy, 9.2%, and 3.4%, whereas there was no significant difference in tumor target D98%, D50%, and V100 between the two groups. The HI of PGTV and planning target volume (PTV) was significantly lower in the ART2 planning. For the comparison of OARs dosimetric parameters, the ART2 planning was significantly decreased the mean dose of rectum-Dmean (2 Gy), D1cc (0.6 Gy), V30 (7.3%) and V40 (5.9%), bladder-D1cc (1.1 Gy), left femoral head-Dmean (1.2 Gy), V40 (1.3%) and right femoral head-Dmean (1.3 Gy), but significantly increased the small intestinal-V30 (2.5%). Other OARs dosimetric parameters were similar between two plannings. The Off-line ART planning can adapt for the changes in the target volume, and further decrease the target volume hotspot area/dose and OARs irradiation dose in locally advanced cervical cancer patients. And the clinical benefit of ART still needs to be verified in clinical trials.
本研究评估局部晚期宫颈癌放疗期间离线自适应放疗（ART）计划的剂量学益处。纳入我院44例患者。通过锥形束CT（CBCT）对患者进行监测，并及时进行二次CT扫描。基于肿瘤退缩情况进行ART2计划，并与初始放疗计划（ART1）进行比较。二次CT扫描的平均时间为第13次分割，平均肿瘤总体积（GTV）减少了23.3%。与ART1计划相比，ART2计划显著降低了计划靶区（PGTV，定义为向各个方向扩展5 mm的GTV）的平均剂量 - D2%、V110以及计划靶体积（PTV） - V110，分别降低了1.9 Gy、9.2%和3.4%，而两组之间肿瘤靶区的D98%、D50%和V100无显著差异。ART2计划中PGTV和计划靶体积（PTV）的均匀性指数（HI）显著更低。对于危及器官（OARs）剂量学参数的比较，ART2计划显著降低了直肠的平均剂量 - Dmean（2 Gy）、D1cc（0.6 Gy）、V30（7.3%）和V40（5.9%），膀胱的D1cc（1.1 Gy），左股骨头的平均剂量 - Dmean（1.2 Gy）、V40（1.3%）以及右股骨头的平均剂量 - Dmean（1.3 Gy），但显著增加了小肠的V30（2.5%）。两个计划之间其他OARs剂量学参数相似。离线ART计划可适应靶体积的变化，并进一步降低局部晚期宫颈癌患者靶体积的热点区域/剂量以及OARs的照射剂量。而ART的临床益处仍需在临床试验中得到验证。
