直肠癌IMRT中小肠运动所致剂量体积以及NTCP评估的不确定性研究

doi:10.3760/cma.j.issn.1004-4221.2017.03.013

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Abstract Objective To evaluate the uncertainty of the small bowel dose-volume and the normal tissue complication probability (NTCP) during intensity-modulated radiotherapy (IMRT) for rectal cancer, and to provide a reference for the dose limit and protection of the small bowel during IMRT for rectal cancer. Methods A total of 20 patients with rectal cancer who received postoperative adjuvant radiotherapy from March 2014 to August 2015 were enrolled in this study, including 10 patients receiving CT scan in the supine position and 10 patients in the prone position. All patients received computed tomography (CT) scan before the treatment and at weeks 1, 2, 3, and 4 of treatment, and they were defined as Plan, 1W, 2W, 3W, and 4W CT groups, respectively. The small bowel loop (BL) and peritoneal space (PS) were delineated on the images. The IMRT plan based on the Plan CT was copied to the 1W, 2W, 3W, and 4W CT groups, and then the small bowel dose-volume and NTCP were assessed for all CT groups. The paired t-test was used for comparison between groups. The Pearson method was used to analyze the correlation between NTCP_C (chronic NTCP) and dose-volume. Results A total of 89 CT images of 20 patients were obtained. In all the patients, the volumes of BL and PS were 251.21 cm³ and 1324.16 cm³, respectively, and the shift% was 23.15% and 11.34%, respectively. The V₁₅ of BL and PS was 184.86 cm³ and 792.45 cm³, respectively, and the shift% was 31.69% and 3.70%, respectively. The V₃₀ of BL and PS was 88.01 cm³ and 645.73 cm³, respectively, and the shift% was 37.66% and 10.49%, respectively. The V₁₅ of BL in 35% of patients and V₁₅ of PS in 20% of patients, the D_max of BL in 50% of patients, and the NTCP of 15% of patients in the course of treatment exceeded the safety limits. The 1-4W CT groups had a significantly higher NTCP_C than the Plan CT group (4.02% vs. 3.20%, P=0.104), and their SD% was 41.68%. There was a significant correlation between NTCP_C and V₃₀-V₅₀ of BL (R>0.400, P=0.000). The NTCP_A (acute NTCP) and NTCP_C in the supine position were significantly higher than those in the prone position (62.30% vs. 56.74%, P=0.061;4.88% vs. 3.22%, P=0.145). Conclusions Small bowel motility leads to an uncertainty of the adverse event assessment during IMRT for rectal cancer. The change in BL is significantly larger than that in PS and the change in BL and PS in the supine position is significantly larger than that in the prone position. Using the prone position and minimizing V₁₅ and V₃₀ when designing the treatment plan can reduce the NTCP_A and NTCP_C in the small bowel.

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	Qian Jianjun
	Sun Yanze
	Yang Yongqiang
	Chen Liesong
	Tian Ye

Key words： Rectal neoplasms/intensity-modulated radiotherapy Small bowel Normal tissue complication probability

Received: 16 March 2016

Corresponding Authors: Chen Liesong,Email:liesongchen@163.com

Cite this article:

Qian Jianjun,Sun Yanze,Yang Yongqiang et al. Uncertainty of small bowel dose-volume and normal tissue complication probability assessment due to small bowel motility during intensity-modulated radiotherapy for rectal cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(3): 310-315.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.03.013 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I3/310

[1] Braendengen M,Tveit KM,Berglund A,et al. Randomized phase Ⅲ study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer[J].J Clin Oncol,2008,26(22):3687-3694.DOI:10.1200/JCO.2007.15.3858.
[2] Bosset JF,Collette L,Calais G,et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J].N Engl J Med,2006,355(11):1114-1123.DOI:10.1056/NEJMoa060829.
[3] Gandhi AK,Sharma DN,Rath GK,et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma:a prospective randomized study[J].Int J Radiat Oncol Biol Phys,2013,87(3):542-548.DOI:10.1016/j.ijrobp.2013.06.2059.
[4] Gunnlaugsson A,Kjellén E,Nilsson P,et al. Dose-volume relationships between enteritis and irradiated bowel volumes during 5-fluorouracil and oxaliplatin based chemoradiotherapy in locally advanced rectal cancer[J].Acta Oncol,2007,46(7):937-944.DOI:10.1080/02841860701317873.
[5] Robertson JM,Lockman D,Yan D,et al. The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys,2008,70(2):413-418.DOI:10.1016/j.ijrobp.2007.06.066.
[6] Gay HA,Barthold HJ,O’Meara E,et al. Pelvic normal tissue contouring guidelines for radiation therapy:a radiation therapy oncology group consensus panel atlas[J].Int J Radiat Oncol Biol Phys,2012,83(3):e353-e362.DOI:10.1016/j.ijrobp.2012.01.023.
[7] Banerjee R,Chakraborty S,Nygren I,et al. Small bowel dose parameters predicting grade ≥3 acute toxicity in rectal cancer patients treated with neoadjuvant chemoradiation:an independent validation study comparing peritoneal space versus small bowel loop contouring techniques[J].Int J Radiat Oncol Biol Phys,2013,85(5):1225-1231.DOI:10.1016/j.ijrobp.2012.09.036.
[8] Myerson RJ,Garofalo MC,El Naqa I,et al. Elective clinical target volumes for conformal therapy in anorectal cancer:a radiation therapy oncology group consensus panel contouring atlas[J].Int J Radiat Oncol Biol Phys,2009,74(3):824-830.DOI:10.1016/j.ijrobp.2008.08.070.
[9] Reyngold M,Niland J,ter Veer A,et al. Neoadjuvant radiotherapy use in locally advanced rectal cancer at NCCN member institutions[J].J Natl Compr Canc Netw,2014,12(2):235-243.
[10] Nuyttens JJ,Robertson JM,Yan D,et al. The influence of small bowel motion on both a conventional three-field and intensity modulated radiation therapy (IMRT) for rectal cancer[J].Cancer Radiothérapie,2004,8(5):297-304.DOI:10.1016/j.canrad.2004.08.001.
[11] Webb S,Nahum AE.A model for calculating tumour control probability in radiotherapy including the effects of inhomogeneous distributions of dose and clonogenic cell density[J].Phys Med Biol,1993,38(6):653-666.DOI:10.1088/0031-9155/38/6/001.
[12] Burman C,Kutcher GJ,Emami B,et al. Fitting of normal tissue tolerance data to an analytic function[J].Int J Radiat Oncol Biol Phys,1991,21(1):123-135.DOI:10.1016/0360-3016(91)90172-Z.
[13] Lyman JT,Wolbarst AB.Optimization of radiation therapy,Ⅲ:a method of assessing complication probabilities from dose-volume histograms[J].Int J Radiat Oncol Biol Phys,1987,13(1):103-109.DOI:10.1016/0360-3016(87)90266-5.
[14] Tho LM,Glegg M,Paterson J,et al. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer:investigating dose-volume relationships and role for inverse planning[J].Int J Radiat Oncol Biol Phys,2006,66(2):505-513.DOI:10.1016/j.ijrobp.2006.05.005.
[15] 姚泰.生理学[M].北京:人民卫生出版社,2005:284-287.
Yao T.Physiology[M].Beijing:People′s medical publishing house,2005:284-287.
[16] Chi A,Nguyen NP,Xu J,et al. Correlation of three different approaches of small bowel delineation and acute lower gastrointestinal toxicity in adjuvant pelvic intensity-modulated radiation therapy for endometrial cancer[J].Technol Cancer Res Treat,2012,11(4):353-359.
[17] 孙彦泽,周钢,钱建军,等.宫颈癌放疗计划中小肠3种勾画方法比较[J].中华放射肿瘤学杂志,2016,25(1):67-70.DOI:10.3760/cma.j.issn.1004-4221.2016.01.017.
Sun YZ,Zhou G,Qian JJ,et al. The comparison of three bowel delineation strategies in the radiation therapy of cervical cancer[J].Chin J Radiat Oncol,2016,25(1):67-70.DOI:10.3760/cma.j.issn.1004-4221.2016.01.017.
[18] Kvinnsland Y,Muren LP.The impact of organ motion on intestine doses and complication probabilities in radiotherapy of bladder cancer[J].Radiother Oncol,2005,76(1):43-47.DOI:10.1016/j.radonc.2005.06.007.
[19] Singh AK,Tierney RM,Low DA,et al. A prospective study of differences in duodenum compared to remaining small bowel motion between radiation treatments:Implications for radiation dose escalation in carcinoma of the pancreas[J].Radiat Oncol,2006,1:33.DOI:10.1186/1748-717X-1-33.
[20] Sanguineti G,Little M,Endres EJ,et al. Comparison of three strategies to delineate the bowel for whole pelvis IMRT of prostate cancer[J].Radiother Oncol,2008,88(1):95-101.DOI:10.1016/j.radonc.2008.01.015.
[21] Stromberger C,Kom Y,Kawgan-Kagan M,et al. Intensity-modulated radiotherapy in patients with cervical cancer. An intra-individual comparison of prone and supine positioning[J].Radiat Oncol,2010,5:63.DOI:10.1186/1748-717X-5-63.
[22] Kavanagh BD,Pan CC,Dawson LA,et al. Radiation dose-volume effects in the stomach and small bowel[J].Int J Radiat Oncol Biol Phys,2010,76(3):S101-S107.DOI:10.1016/j.ijrobp.2009.05.071.
[23] Perna L,Alongi F,Fiorino C,et al. Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy[J].Radiother Oncol,2010,97(1):71-75.DOI:10.1016/j.radonc.2010.02.025.