Ju Zhuojun, Sakai Makoto, Meng Xiangdi, Kubo Nobuteru, Kawamura Hidemasa, Ohno Tatsuya
Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 3718511, Japan.
Gunma University Heavy Ion Medical Center, Maebashi 3718511, Japan.
Cancers (Basel). 2025 Aug 20;17(16):2709. doi: 10.3390/cancers17162709.
: This study aimed to assess the precision of dose delivery to the target in adaptive carbon ion radiotherapy (CIRT) for locally advanced non-small cell lung cancer (LA-NSCLC) in cumulative dosimetry. Forty-six patients who received CIRT were included (64 Gy[relative biological effectiveness, RBE] in 16 fractions) with treatment plan computed tomography (CT) and weekly CT scans. Offline adaptive radiotherapy (ART) was administered if the dose distribution significantly worsened. Daily doses were calculated from weekly CTs and integrated into plan CT scans using deformable image registration. The dosimetry parameters were compared between the as-scheduled plan and adaptive replan in patients receiving ART. Survival outcomes and toxicity were compared between the ART and non-ART groups. ART was implemented for 27 patients in whom adaptive replans significantly increased the median V of the clinical tumor volume from 96.5% to 98.1% and D from 60.5 to 62.7 Gy(RBE) compared with the as-scheduled plans ( < 0.001). The conformity and uniformity of the dose distribution improved ( < 0.001), with no significant differences in the doses to normal tissues (lungs, heart, esophagus, and spinal cord) from the as-scheduled plans ( > 0.05). The ART and non-ART groups demonstrated comparable local control, progression-free survival, and overall survival ( > 0.05). No grade 3 or higher radiation-related toxicities were observed. ART enhanced target dose coverage while maintaining acceptable normal tissue exposure, supporting weekly CT monitoring integration during CIRT for the timely intervention for anatomical variations, ensuring precise dose delivery in LA-NSCLC.
本研究旨在评估在累积剂量测定中，自适应碳离子放射治疗（CIRT）用于局部晚期非小细胞肺癌（LA-NSCLC）时向靶区输送剂量的精确性。纳入了46例接受CIRT的患者（16次分割，总剂量64 Gy[相对生物效应，RBE]），进行了治疗计划计算机断层扫描（CT）和每周一次的CT扫描。如果剂量分布明显恶化，则进行离线自适应放射治疗（ART）。根据每周的CT计算每日剂量，并使用可变形图像配准将其整合到计划CT扫描中。比较接受ART的患者中预定计划和自适应重新计划之间的剂量测定参数。比较ART组和非ART组的生存结果和毒性。27例患者实施了ART，与预定计划相比，自适应重新计划使临床肿瘤体积的中位V从96.5%显著增加到98.1%，D从60.5 Gy(RBE)增加到62.7 Gy(RBE)（<0.001）。剂量分布的适形性和均匀性得到改善（<0.001），与预定计划相比，正常组织（肺、心脏、食管和脊髓）的剂量无显著差异（>0.05）。ART组和非ART组在局部控制、无进展生存期和总生存期方面表现相当（>0.05）。未观察到3级或更高等级的放射相关毒性。ART提高了靶区剂量覆盖，同时保持了可接受的正常组织照射，支持在CIRT期间进行每周CT监测，以便及时干预解剖学变化，确保LA-NSCLC的精确剂量输送。
