ABC辅助下RapidArc放疗原发性肝癌的可行性研究

doi:10.3760/cma.j.issn.1004-4221.2012.01.018

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的通过比较3种呼吸状态下三维适形放疗(3DCRT)、传统调强放疗(IMRT)、旋转调强放疗(瓦里安公司的为RapidArc,RA)计划,探讨主动呼吸控制(ABC)辅助RA放疗原发性肝癌(HCC)的可行性。方法选取12例HCC患者,依次完成ABC辅助下平静吸气末屏气(EIH)、平静呼气末屏气(EEH)、自由呼吸(FB)下CT模拟定位。对各呼吸状态下计划靶体积制定3DCRT、IMRT、RA (3个135°弧)计划,比较3种计划间、RA计划不同呼吸状态间的剂量学差异。结果 12例患者FB计划靶体积均大于EEH、EIH (160.8、89.5、83.1 cm³,F=6.63,P=0.004)。RA计划的适形指数和均匀性指数优于IMRT、3DCRT (0.92、0.90、0.77,F=72.55,P=0.000;0.90、0.89、0.84,F= 125.49,P=0.000)。3DCRT计划中正常肝V₂₀、V₃₀、V₄₀高于 IMRT、RA (24%、20%、19%,F=3.56,P=0.032;13%、10%、10%,F=5.74,P=0.004;8%、5%、6%,F=3.72,P=0.027)。FB RA计划的正常肝脏平均受量、V₁₀、V₂₀、V₃₀、V₄₀均高于EEH和EIH (13.46、10.25、9.48 Gy,F=3.63,P=0.038;46%、35%、32%,F=2.96,P=0.066;24%、16%、16%,F=3.69,P=0.036;13%、8%、8%,F=4.28,P=0.022;8%、5%、5%,F=2.39,P=0.108)。EEH下RA的十二指肠5 cm³体积所受剂量低于 FB 与 EIH (8.78、19.35 Gy与11.67 Gy,F=1.56,P=0.224)。3DCRT、IMRT、RA机器跳数平均为254.06、626.33、550.28 MU (F=147.35,P=0.000),治疗时间平均为135、540、130 s (F=62.83,P=0.000)。结论 ABC辅助下3个135°弧的RapidArc技术可在保证靶区准确基础上用较少治疗时间及机器跳数完成适形指数和均匀性优于IMRT计划的剂量传输,更好保护正常肝脏。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	巩贯忠
	尹勇
	刘同海
	宋金龙
	卢洁
	陈进琥
	马长升
	尚东平
	王若峥

关键词 ：放射疗法, 旋转调强, 放射疗法, 逆向调强, 放射疗法, 三维适形, 主动呼吸控制, 原发性肝癌

Abstract：Objective To study the feasibility of RapidArc (RA) associated with active breath coordinator (ABC) for hepatocelluar carcinoma (HCC) radiotherapy comparing of three-dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), RA treatment plans in different breath status. Methods 12 HCC cases were selected. Three series CT scanning were completed in Free Breathing (FB), End Inspiration Hold (EIH) and End Expiration Hold (EEH) associated with ABC device. 3DCRT, IMRT and RA (three 135° arcs) treatment plans were respectively designed on planning target volume (PTV) in different breath status. The dosimetric differences among 3DCRT, IMRT and RA, among RA plans under different breath status were compared. Results The PTV in FB was larger than in EEH and EIH (160.8 cm³, 89.5 cm³,83.1 cm³,F= 6.63,P=0.004). The conformity index and homogeneity index of RA plans were better than IMRT and 3DCRT (0.92,0.90,0.77,F=72.55,P=0.000;0.90,0.89,0.84,F=125.49,P=0.000);the V₂₀, V₃₀, V₄₀ of normal liver in 3DCRT were higher than IMRT and RA (24%,20%,19%,F=3.56,P=0.032;13%,10%,10%,F=5.74,P=0.004;8%, 5%,6%,F=3.72,P=0.027).The normal liver mean dose, V₁₀, V₂₀, V₃₀, V₄₀ of RA plans in FB were higher than in EEH and EIH (13.46 Gy,10.25 Gy,9.48 Gy,F=3.627,P=0.038;46%,35%,32%,F=2.96,P=0.066;24%,16%,16%,F=3.69,P=0.036;13%,8%,8%,F=4.28,P=0.022;8%,5%,5%,F=2.39,P=0.108).The duodenum D₅ cm³ of RA in EEH was lower than in FB and EIH (8.78 Gy,19.35 Gy and 11.67 Gy,F=1.56,P=0.224). The mean monitor units for 3DCRT,IMRT,RA was 254.06 MU,626.33 MU and 550.28 MU (F=147.35,P=0.000),while the mean treatment time was 135 s,540 s and 130 s respectively (F=62.83,P=0.000). Conclusions The RapidArc applying three 135°arcs with ABC in HCC radiotherapy can achieve better PTV coverage than IMRT with fewer monitor units, shorter treatment time and sparing more normal liver.

Key words： Radiotherapy, RapidArc Radiotherapy, intensity-modulated Radiotherapy, three-dimensional conformal Active breath coordinator Hepatocellular carcinoma

收稿日期: 2010-12-06

基金资助:山东省自然科学基金项目(ZR2010HM071)

通讯作者: 尹勇 E-mail: yinyongsd@yahoo.com.cn

引用本文:

巩贯忠,尹勇,刘同海等. ABC辅助下RapidArc放疗原发性肝癌的可行性研究[J]. 中华放射肿瘤学杂志, 2012, 21(1): 63-67.

GONG Guan-zhong^*,YIN Yong,LIU Tong-hai et al. Study the feasibility in the application of RapidArc associated with active breath coordinator for radiotherapy of hepatocelluar carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(1): 63-67.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2012.01.018 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2012/V21/I1/63

[1] Whang-Peng J, Cheng AL, Hsu C, et al. Clinical development and future direction for the treatment of hepatocellular carcinoma. J Exp Clin Med,2010,2:93-103.
[2] Merle P, Mornex F, Trepo C, et al. Innovative therapy for hepatocelluar carcinoma:three-dimensional high-dose photon radiotherapy. Cancer Letters,2009,286:129-133.
[3] Palma DA, Verbakel WFAR, Otto K, et al. New developments in arc radiation therapy:a review. Cancer Treatment Reviews,2010,36:393-399.
[4] Eccles C, Brock K, Bissonnette J, et al. Reproducibility of liver position using active breathing coordinator for liver cancer radiotherapy. Int J Radiat Oncol Biol Phys,2006,64:751-759.
[5] Wong JW, Sharpe MB, Jaffray DA, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys,1999,44:911-919.
[6] 杜世锁,曾昭冲,吴铮,等.主动呼吸控制系统在肝癌三维适形放疗中的应用研究.中华放射肿瘤学杂志,2006,15:368-370.
[7] 岳金波,于金明,刘菁,等. 图像引导自主呼吸控制下肝脏肿瘤计划靶区外放研究. 中华放射肿瘤学杂志,2007,16:368-370.
[8] Seong J, Park HC, Han KH, et al. Clinical results and prognosticfactors in radiotherapy for unresectable hepatocellular carcinoma a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys,2003,55:329-336.
[9] 梁世雄,蒋国梁,朱小东,等. 原发性肝癌三维适形放疗后放射性肝病的影响因素. 中华放射肿瘤学杂志,2005,14:284-288.
[10] Wu QW, Mohan R, Morris M, et al. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. Ⅰ:dosimetric results. Int J Radiat Oncol Biol Phys,2003,56:573-585.
[11] Kavanagh BD, Pan CC, Dawson LA, et al. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys,2010,76 Suppl:101-107.
[12] 刘同海,尹勇,陈进琥,等. 鼻咽癌旋转调强与固定野调强同步加量计划比较研究. 中华放射肿瘤学杂志,2010,19:486-490.
[13] Shaffer R, Nichol AM, Vollans E, et al. A comparison of volumetric modulated arc therapy and conventional Intensity-modulated radiotherapy for frontal and temporal high-Grade gliomas. Int J Radiat Oncol Biol Phys,2010,76:1177-1184.
[14] 陈进琥,尹勇,刘同海,等.颈段食管癌固定野调强与旋转调强放疗计划比较研究. 中华放射肿瘤学杂志,2010,19:429-433.
[15] Popescu CC, Olivotto IA, Beckham WA, et al. Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional Intensity-Modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys, 2010,76:287-295.
[16] 马长升,尹勇,刘同海,等.旋转调强与固定野调强治疗肝癌的剂量学比较.中华放射医学与防护杂志,2010,30:581-584.
[17] Stromberg JS, Sharpe MB, Kim LH, et al. Active breathing control (ABC) for Hodgkin′s disease reduction in normal tissue irradiation with deep inspiration and implications for treatment. Int J Radiat Oncol Biol Phys,2000,48:797-806.
[18] Pan CC, Kavanagh BD, Dawson LA, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys,2010,76 Suppl:94-100.
[19] Dawson LA, Brock KK, Kazanjian S, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys, 2001,51:1410-1421.