静脉注射碘化造影剂对中央型肺癌放疗剂量计算及放射生物学效应预测的影响。

The impact of intravenous iodinated contrast agents on radiotherapy dose calculation and radiobiological effect predictions in central lung cancer.

作者信息

Yang Defu, Shang Feng, Xu Ying, Yan Ying

机构信息

Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, China.

出版信息

Front Oncol. 2025 Aug 11;15:1563919. doi: 10.3389/fonc.2025.1563919. eCollection 2025.

DOI:10.3389/fonc.2025.1563919

PMID:40860830

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12375641/

Abstract

BACKGROUND

Accurate dose calculation algorithms are critical for optimizing radiotherapy outcomes. This study evaluates and compares dosimetric differences and predictions of Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) between the Analytic Anisotropic Algorithm (AAA) and Acuros XB (AXB) algorithm in lung cancer radiotherapy, under both contrast-enhanced and non-contrast enhanced CT conditions.

METHODS

Twenty patients with centralized lung cancer treated with intensity-modulated radiation therapy (IMRT) technique, including two patients with small cell lung cancer and 18 with non-small cell lung cancer, were selected to undergo CT scanning with and without contrast. Multiple dosimetric parameters were calculated for both algorithms under enhanced and non-contrast enhanced CT conditions. TCP and NTCP were assessed for critical organs such as the lungs, heart, and esophagus.

RESULTS

Significant differences were observed in dosimetric values between the AAA and AXB algorithms. For the minimum dose (PTV_Min), the AAA algorithm yielded higher values under enhanced CT conditions (4427 cGy) compared to non-contrast enhanced CT (3872 cGy), whereas AXB showed 4248 cGy (enhanced CT) and 3762 cGy (non-contrast enhanced CT). For maximum dose(PTV_Max), The AAA algorithm showed 6430 cGy (enhanced CT) compared to AXB's 6541 cGy (p< 0.0001). The mean dose (PTV_Mean) was 5674 cGy for AAA vs. 5640 cGy for AXB (p = 0.0042). TCP analysis showed that AAA predicted higher TCP values across both imaging conditions, with a 0.69% difference between AXB_C_Dm and AXB_C_Dw under enhanced CT (p = 0.0011). NTCP for lung radiofibrosis was 20.42% higher with the AAA algorithm, suggesting increased risk.

CONCLUSION

The AAA algorithm tends to overestimate both tumor control and normal tissue complications, while the AXB algorithm provides more conservative estimates. These findings highlight the importance of algorithm choice in optimizing treatment planning and minimizing adverse effects in radiation therapy.

摘要

背景

精确的剂量计算算法对于优化放射治疗结果至关重要。本研究评估并比较了在增强CT和非增强CT条件下，解析各向异性算法（AAA）和Acuros XB（AXB）算法在肺癌放射治疗中的剂量差异以及肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）的预测情况。

方法

选取20例接受调强放射治疗（IMRT）技术的中央型肺癌患者，其中包括2例小细胞肺癌患者和18例非小细胞肺癌患者，分别进行增强CT扫描和非增强CT扫描。在增强CT和非增强CT条件下，计算两种算法的多个剂量学参数。评估肺、心脏和食管等关键器官的TCP和NTCP。

结果

AAA算法和AXB算法的剂量学值存在显著差异。对于最小剂量（PTV_Min），在增强CT条件下AAA算法的值（4427 cGy）高于非增强CT（3872 cGy），而AXB算法在增强CT时为4248 cGy，非增强CT时为3762 cGy。对于最大剂量（PTV_Max），AAA算法为6430 cGy（增强CT），而AXB算法为6541 cGy（p < 0.0001）。AAA算法的平均剂量（PTV_Mean）为5674 cGy，AXB算法为5640 cGy（p = 0.0042）。TCP分析表明，在两种成像条件下AAA算法预测的TCP值更高，在增强CT时AXB_C_Dm和AXB_C_Dw之间相差0.69%（p = 0.0011）。AAA算法的肺放射性纤维化NTCP高20.42%，提示风险增加。