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Study on dosimetric changes between initial and second treatment plans in IMRT for large volume NSCLC
Ren Jianxin1, Yin Yong2, Gong Guanzhong2, Yao Xinsen3, Han Zhujun1, Su Ming3, Quan Hong1
1School of Physics and Technology, Wuhan University, Wuhan 430072, China; 2Department of Radiation Oncology,Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences; 3School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
AbstractObjective To evaluate the cumulative dose of the target volume and organs at risk (OARs) in intensity-modulated radiation therapy (IMRT) for large volume non-small cell lung cancer (NSCLC) based on rigid and deformation registration methods. The dosimetric changes between the initial and second treatment plans were compared. Methods Thirty patients treated with IMRT for large volume NSCLC with twice 4DCT scans acquired before radiotherapy and after 20 fractions of radiotherapy were recruited. The initial treatment plan (Plan1) based on the average density projection CT (CT1-avg) of the first 4DCT images and the second treatment plan (Plan2) based on the average density projection CT (CT2-avg) of the second 4DCT images were calculated. Then, the dose distributions of Plan1 and Plan2 were accumulated based on rigid and deformation registration methods to obtain Planrig and Plandef, respectively. Finally, the volume changes of gross tumor volume (GTV) and OARs between two CT scans were compared. The dose-volume parameters between Plan1 and other plans (including Plan2, Planrig and Plandef) were also statistically compared. Results Compared with the initial CT scan, the mean volume of GTV and heart on the second CT was decreased by 44.2% and 5.5%, respectively, while the mean volume of ipsilateral lung, contralateral lung and total lung was increased by 5.2%, 6.2% and 5.8%, respectively (all P<0.05). Compared with Plan1, the D95%, D98% and V100% of target volume IGTV (GTV fusion of 10 4DCT phases) and PTV in Plan2 did not significantly change (all P>0.05), and those in Planrig and Plandef were decreased (all P<0.05). The dose-volume parameters of spinal-cord, heart, ipsilateral lung and total lung in Plan2, Planrig and Plandef were significantly lower than those in Plan1(all P<0.05). Among them, the V30Gy and Dmean of heart were decreased by 27.3%, 16.5%, 15.3% and 15.2%, 6.6%, 5.6%, respectively. The V20Gy and Dmean of total lung were decreased by 15.6%, 4.5%, 3.7% and 15.7%, 6.2%, 5.1%, respectively. Some dose-volume parameters (including D95% and D98% of target volume, V40Gy of heart, V20Gy and Dmean of the ipsilateral lung and the total lung) of Plandef were higher than those in Planrig (all P<0.05). The Dice similarity coefficients (DSCs) of OARs after deformation registration were significantly higher than those after rigid registration (P<0.05). Conclusions The dose-volume parameters of OARs significantly differ between Plan1 and Plan2. Hence, all these parameters have a large degree of deviation in predicting radiation-induced injury of OARs. Nevertheless, the dose-volume parameters obtained by deformation registration can enhance the prediction accuracy.
Ren Jianxin,Yin Yong,Gong Guanzhong et al. Study on dosimetric changes between initial and second treatment plans in IMRT for large volume NSCLC[J]. Chinese Journal of Radiation Oncology, 2020, 29(10): 872-876.
Ren Jianxin,Yin Yong,Gong Guanzhong et al. Study on dosimetric changes between initial and second treatment plans in IMRT for large volume NSCLC[J]. Chinese Journal of Radiation Oncology, 2020, 29(10): 872-876.
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2020, Vol. 29 
