Exploration of the application of half-field intensity-modulated irradiation technique in the radiotherapy for esophageal cancer
Liu Yang1, Ding Danhong1, Wei Shengtao1, Wang Yingying2, Li Dingjie1
1Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou 450008, China; 2Department of Oncology, Zhengzhou Xinmi Hospital of Traditional Chinese Medicine, Zhengzhou 450000, China
Abstract：Objective To explore a new technique for lung dose reduction in esophageal cancer radiotherapy based on the dose distribution characteristics of the half-field combined with intensity-modulated radiotherapy (IMRT) technique. Methods A three-dimensional water tank was used to measure the dose distribution at the edge of the symmetrical field and half-field, which was then compared and analyzed. Twenty patients with the middle and lower thoracic esophageal cancer receiving radiotherapy with prescription doses of 50.4-60.0Gy were selected. Based on the Varian Vital beam linear accelerator and Eclipse planning system, flattening filter (FF) technique symmetrical field and half-field beam design and the flattening filter-free (FFF) technique symmetrical field and half-field design were adopted to compare and analyze various dose data and treatment MU numbers for the target area and the endangered organs. The field settings were chosen in the front 1 and back 4 mode. Results Compared with the symmetrical field plan, the half-field plan significantly improved the irradiated dose to the lung with a statistically significant difference (P<0.05), and the half-field FFF was slightly better than the half-field FF mode. Compared with the total lung V5Gy, V20Gy, V30Gy, and Dmean dosimetric parameters (Gy), the FF symmetric field and FFF half-field were (49.64±5.39)% vs.(42.70±5.53)%,(15.99±3.93)% vs.(13.32±3.06)%,(9.24±2.77)% vs.(8.50±2.62)%, and (10.45±1.76)% vs.(9.50±1.53)%, respectively. There was a significant reduction in the volume dose values for all structures of the lung (all P<0.05). For other comparative data, the irradiated dose for the heart of the symmetrical field was better than that of the half-field mode (P<0.05), and the differences in conformity index (CI) and homogeneity index (HI), number of treated MU, and spinal cord associated with the target area were not statistically significant (all P>0.05). Conclusions During radiotherapy for esophageal cancer, target area coverage and dose volume data of the lung are the main parameters affecting the efficacy and side effects. IMRT treatment based on the half-field mode can give full play to the advantages of half-field and IMRT, and significantly improve the irradiated dose to the lung, which can offer an additional clinical option.
Liu Yang,Ding Danhong,Wei Shengtao et al. Exploration of the application of half-field intensity-modulated irradiation technique in the radiotherapy for esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 65-70.
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