旋转误差对宫颈癌VMAT计划阳性淋巴结剂量影响及应对策略

doi:10.3760/cma.j.cn113030-20211018-00415

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Abstract Objective To evaluate the effect of rotational errors (antero-posterior) on dosimetric parameters of positive lymph nodes in the long target volumetric modulated arc therapy (VMAT) plan for advanced cervical cancer and investigate its coping strategies. Methods Clinical data of patients with cervical cancer complicated with para-aortic or inguinal lymph node metastasis admitted to Affiliated Hospital of North Sichuan Medical College were randomly selected and retrospectively analyzed. The target areas of the lymph nodes at different distances from the center of the plan were outlined according to the requirements. After designing the VMAT plan on the CT images of each case, the rotational errors (antero-posterior) were introduced by changing the parameters of the treatment couch, and the dose distribution was reconstructed by dose calculation with other parameters unchanged. Then, the external boundary of the original lymph node target was added according to d=2πr(α/360) (r is the distance from the center of the lymph node to the plan center), re-planned, and the changes of dosimetric parameters in the target area of the original lymph node were analyzed after the corresponding rotational errors were introduced. Results When the distance between the lymph node target area and the plan center was 6 cm with an error of 3°, the distance was 9 cm and 12 cm with an error of 2.5°, the distance was 15 cm with an error of 2°, and the distance was 18 cm with an error of 1.5°, the mean change of D_95% was more than 5%. When the rotational errors were ≤1°, the mean change of D_95% in lymph node target area was less than 5%, and when the lymph node was 18 cm away from the treatment plan center, the mean change was more than 3%, reaching 3.75%. When the rotational errors were 0.5° and the distance from the plan center was 18 cm (0.5°, 18 cm), the dose change of lymph node target was more than 5%, reaching 5.58%. At (1°, 15 cm), the V_100% change reached 8.96%, and at (1°, 18 cm), the V_100% change was 14.5%. The D_95% and V_100% parameters of the original lymph node target were changed by less than 1% after adding the external boundary of the original lymph node target and introducing corresponding rotational errors. Conclusions In the long target area radiotherapy of cervical cancer, the variation of dosimetric parameters of lymph node target was increased with the increase of rotational errors and with the increase of distance from the plan center. It is recommended to increase the efferent boundary of lymph nodes in different positions to avoid underdose by d=2πr(α/360).

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	Xu Peng
	Cao Lu
	Deng Qiao
	Peng Bigeng
	Li Suping
	Li Xianfu

Key words： Uterine cervical neoplasms Radiotherapy, volumetric modulated arc Rotational error Dosimetric parameter Positive lymph node

Received: 18 October 2021

Fund:Foundation of Sichuan Provincial Health Commission (19PJ037); Cooperative Scientific Research Project of Nanchong City and School (18SXHZ0398)

Corresponding Authors: Li Xianfu, Email: lixianfu13@163.com

Cite this article:

Xu Peng,Cao Lu,Deng Qiao et al. Effect of rotational errors on dose of positive lymph nodes in cervical cancer VMAT plan and its coping strategies[J]. Chinese Journal of Radiation Oncology, 2023, 32(1): 36-41.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20211018-00415 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2023/V32/I1/36

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