宫颈癌腹主动脉旁淋巴结转移静态调强放疗与容积旋转调强放疗的剂量学比较
|
摘要
目的:比较静态调强放疗(intensity modulated radiotherapy,IMRT)与容积旋转调强放疗(volumetric modulated arc therapy,VMAT)在宫颈癌伴腹主动脉旁淋巴结(para-aortic lymph node,PALN)转移患者放疗中的剂量学参数,为局部晚期宫颈癌放疗方式的选择提供参考依据。方法:对20例病理学证实经PET-CT检查诊断为宫颈鳞癌PALN转移接受放疗的患者,对同一CT图像分别进行IMRT和VMAT计划设计,比较两种放疗计划的靶区剂量和危及器官(organ at risk,OAR)的剂量学差异、靶区适形性指数(conformity index,CI)、均匀性指数(homogeneity index,HI)、加速器跳数(number of monitor units,MU)和治疗时间。结果:IMRT和VMAT组计划的靶区剂量均能够满足剂量学要求,在靶区CI和HI上,VMAT计划优于IMRT计划。OAR保护方面,VMAT计划中两侧肾脏平均剂量低于IMRT计划,直肠V40、直肠V50、小肠V40和膀胱V40的剂量均低于IMRT计划(P<0.05)。VMAT计划的MU(859.92±248.47)低于IMRT计划(1 649.50±167.44,t=11.836,P<0.001)。VMAT计划的治疗时间[(304.30±41.98)s]明显短于IMRT计划[(435.90±37.52)s,t=12.750,P<0.001]。结论:宫颈癌伴PALN转移患者,采取IMRT和VMAT技术均可达到临床靶区剂量要求和OAR的剂量保护,而VMAT计划在靶区CI和HI上优于IMRT计划,同时VMAT具有降低OAR剂量的优势,MU明显降低,照射时间缩短,提高了患者放疗的耐受性,提升了宫颈癌放射治疗的效率。
Objective:To compare dosimetric difference between the intensity modulated radiotherapy(IMRT)and volumetric modulated arc therapy(VMAT)of cervical cancer with para-aortic lymph node metastasis,and to provide the reference basis for selecting the reasonable radiotherapy approach of locally advanced cervical cancer patients. Methods:Twenty patients of cervical cancer with para-aortic lymph node(PALN)metastasis whom confirmed by PET-CT examination and diagnosis and received radiotherapy were selected,and the same CT image was designed by IMRT and VMAT respectively. Then,we compared the parameters of target,organ at risk(OAR),homogeneity index(HI),conformity index(CI),the number of monitor units(MU)and treatment times between two plans. Results:The target dose of IMRT plan and VMAT plan could meet the dosimetric requirement. The CI and HI of planning target volume(PTV)for VMAT plan were superior to IMRT plan(P<0.05). Compared with the IMRT plan,the mean dose of kidney for VMAT plan were lower(P<0.05). The V40 and V50 of the rectum,V40 of the small intestine and the bladder of VMAT plan were better than those of IMRT plan(P < 0.05). The number of MU for VMAT plan(859.92 ± 248.47)were lower than IMRT plan(1 649.50 ± 167.44)(t=11.836,P<0.001). The treatment time for VMAT plan[(304.30 ± 41.98)s]were shorter than IMRT plan[(435.90 ± 37.52)s,t=12.750,P<0.001]. Conclusion:Both of the IMRT and VMAT plans can achieve the clinical dosimetric demands and protect the OARs of cervical cancer with PALN. VMAT has the best performance on CI and HI,and protect the OARs better. VMAT plans have fewer MU and significantly improve the treatment efficiency. Thus it will improve the patient's radiotherapy tolerance,enhance the efficiency of radiotherapy.
Objective:To compare dosimetric difference between the intensity modulated radiotherapy(IMRT)and volumetric modulated arc therapy(VMAT)of cervical cancer with para-aortic lymph node metastasis,and to provide the reference basis for selecting the reasonable radiotherapy approach of locally advanced cervical cancer patients. Methods:Twenty patients of cervical cancer with para-aortic lymph node(PALN)metastasis whom confirmed by PET-CT examination and diagnosis and received radiotherapy were selected,and the same CT image was designed by IMRT and VMAT respectively. Then,we compared the parameters of target,organ at risk(OAR),homogeneity index(HI),conformity index(CI),the number of monitor units(MU)and treatment times between two plans. Results:The target dose of IMRT plan and VMAT plan could meet the dosimetric requirement. The CI and HI of planning target volume(PTV)for VMAT plan were superior to IMRT plan(P<0.05). Compared with the IMRT plan,the mean dose of kidney for VMAT plan were lower(P<0.05). The V40 and V50 of the rectum,V40 of the small intestine and the bladder of VMAT plan were better than those of IMRT plan(P < 0.05). The number of MU for VMAT plan(859.92 ± 248.47)were lower than IMRT plan(1 649.50 ± 167.44)(t=11.836,P<0.001). The treatment time for VMAT plan[(304.30 ± 41.98)s]were shorter than IMRT plan[(435.90 ± 37.52)s,t=12.750,P<0.001]. Conclusion:Both of the IMRT and VMAT plans can achieve the clinical dosimetric demands and protect the OARs of cervical cancer with PALN. VMAT has the best performance on CI and HI,and protect the OARs better. VMAT plans have fewer MU and significantly improve the treatment efficiency. Thus it will improve the patient's radiotherapy tolerance,enhance the efficiency of radiotherapy.
引文
[1]Global Burden of Disease Cancer Collaboration,Fitzmau-rice C,Dicker D,et al.The global burden of cancer 2013[J].JAMA Oncol,2015,1(4):505-527
[2]Mcmahon CJ,Rofsky NM,Pedrosa I.Lymphatic metasta-ses from pelvic tumors:anatomic classification,character-ization,and staging[J].Radiology,2010,254(1):31-46
[3]Whitney CW,Sause W,Bundy BN,et al.Randomizedcomparison of fluorouracil plus cisplatin versus hydroxy-urea as an adjunct to radiation therapy in stageⅡB-ⅣAcarcinoma of the cervix with negative para-aortic lymph nodes:a Gynecologic Oncology Group and Southwest Oncol-ogy Group study[J].J Clin Oncol,1999,17(5):1339-1348
[4]Song S,Kim JY,Kim YJ,et al.The size of the metastaticlymph node is an independent prognostic factor for the pa-tients with cervical cancer treated by definitive radiothera-py[J].Radiother Oncol,2013,108(1):168-173
[5]Oh J,Seol KH,Lee HJ,et al.Prophylactic extended-fieldirradiation with concurrent chemotherapy for pelviclymph node-positive cervical cancer[J].Radiat Oncol J,2017,35(4):349-358
[6]Wu Z,Xie C,Hu M,et al.Dosimetric benefits of IMRTand VMAT in the treatment of middle thoracic esophagealcancer:is the conformal radiotherapy still an alternativeoption?[J].J Appl Clin Med Phys,2014,15(3):93-101
[7]Yu CX,Tang G.Intensity-modulated arc therapy:princi-ples,technologies and clinical implementation[J].PhysMed Biol,2011,56(5):R31-R54
[8]Otto K.Volumetric modulated arc therapy:IMRT in a sin-gle gantry arc[J].Med Phys,2008,35(1):310-317
[9]Zhao H,He M,Cheng G,et al.A comparative dosimetricstudy of left sided breast cancer after breast-conservingsurgery treated with VMAT and IMRT[J].Radiat Oncol,2015,10:231
[10]Small W,Mell LK,Anderson P,et al.Consensus guide-lines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatmentof endometrial and cervical cancer[J].Int J Radiat OncolBiol Phys,2008,71(2):428-434
[11]Erpolat OP,Alco G,Caglar HB,et al.Comparison of he-matologic toxicity between 3DCRT and IMRT planning incervical cancer patients after concurrent chemoradiothera-py:a national multi-center study[J].Eur J Gynaecol On-col,2014,35(1):62-66
[12]Jamie LL,Coreen F,Sushil B,et al.Upfront treatment oflocally advanced cervical cancer with intensity modulatedradiation therapy compared to four field radiation therapy:a cost-effectiveness analysis[J].Gynecol Oncol,2013,129:574-579
[13]Li J,Tang XB,Wang BH,et al.Comparison between dualarc VMAT and 7F-IMRT in the protection of hippocam-pus for patients during whole brain radiotherapy[J].J Xray Sci Technol,2016,24(3):457-466
[14]Jin X,Yi J,Zhou Y,et al.Comparison of whole-field simultaneous integrated boost VMAT and IMRT in the treatment of nasopharyngeal cancer[J].Med Dosim,2013,38(4):418-423
[15]Chen H,Wang H,Gu H,et al.Study for reducing lung dose of upper thoracic esophageal cancer radiotherapy by auto-planning:volumetric-modulated arc therapy vs.intensity-modulated radiation therapy[J].Med Dosim,2017(17):30103-30106
[16]Regnier A,Ulbrich J,Münch S,et al.Comparative analysis of efficacy,toxicity,and patient-reported outcomes in rectal cancer patients undergoing preoperative 3D conformal radiotherapy or VMAT[J].Front Oncol,2017,7:225
[17]Guy JB,Falk AT,Auberdiac P,et al.Dosimetric study of volumetric arc modulation with rapid arc and intensitymodulated radiotherapy in patients with cervical cancer and comparison with 3-dimensional conformal technique for definitive radiotherapy in patients with cervical cancer[J].Med Dosim,2016,41(1):9-14
[18]Huang B,Fang Z,Huang Y,et al.dosimetric analysis of volumetric-modulated arc radiotherapy with jaw width restriction vs.7 field intensity-modulated radiotherapy for definitive treatment of cervical cancer[J].Br J Radiol,2014,87(1039):20140183
[19]Onal C,Arslan G,Parlak C,et al.Comparison of IMRT and VMAT plans with different energy levels using MonteCarlo algorithm for prostate cancer[J].Jpn J Radiol,2014,32(4):224-232
[20]Atri M,Zhang Z,Dehdashti F,et al.Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer:Results of ACRIN6671/GOG0233trial[J].Gynecol Oncol,2016,142(3):413-419
[21]Si LE,Catalano O,Dehdashti F.Evaluation of gynecologic cancer with MR imaging,18F-FDG PET/CT,and PET/MR imaging[J].J Nucl Med,2015,56(3):436-443
[22]Small W Jr,Winter K,Levenback C,et al.Extended-field irradiation and intracavitary brachytherapy combined with cisplatin and amifostine for cervical cancer with positive para-aortic or high common iliac lymph nodes:results of armⅡof Radiation Therapy Oncology Group(RTOG)0116[J].Int J Gynecol Cancer,2011,21(7):1266-1275
[23]Lan ML,Yu X,Xiao H,et al.Clinical outcomes and toxicity of postoperative intensity-modulated versus three-dimensional conformal radiation therapy in patients with cervical cancer[J].Asia Pac J Clin Oncol,2016,12(4):430-436
[2]Mcmahon CJ,Rofsky NM,Pedrosa I.Lymphatic metasta-ses from pelvic tumors:anatomic classification,character-ization,and staging[J].Radiology,2010,254(1):31-46
[3]Whitney CW,Sause W,Bundy BN,et al.Randomizedcomparison of fluorouracil plus cisplatin versus hydroxy-urea as an adjunct to radiation therapy in stageⅡB-ⅣAcarcinoma of the cervix with negative para-aortic lymph nodes:a Gynecologic Oncology Group and Southwest Oncol-ogy Group study[J].J Clin Oncol,1999,17(5):1339-1348
[4]Song S,Kim JY,Kim YJ,et al.The size of the metastaticlymph node is an independent prognostic factor for the pa-tients with cervical cancer treated by definitive radiothera-py[J].Radiother Oncol,2013,108(1):168-173
[5]Oh J,Seol KH,Lee HJ,et al.Prophylactic extended-fieldirradiation with concurrent chemotherapy for pelviclymph node-positive cervical cancer[J].Radiat Oncol J,2017,35(4):349-358
[6]Wu Z,Xie C,Hu M,et al.Dosimetric benefits of IMRTand VMAT in the treatment of middle thoracic esophagealcancer:is the conformal radiotherapy still an alternativeoption?[J].J Appl Clin Med Phys,2014,15(3):93-101
[7]Yu CX,Tang G.Intensity-modulated arc therapy:princi-ples,technologies and clinical implementation[J].PhysMed Biol,2011,56(5):R31-R54
[8]Otto K.Volumetric modulated arc therapy:IMRT in a sin-gle gantry arc[J].Med Phys,2008,35(1):310-317
[9]Zhao H,He M,Cheng G,et al.A comparative dosimetricstudy of left sided breast cancer after breast-conservingsurgery treated with VMAT and IMRT[J].Radiat Oncol,2015,10:231
[10]Small W,Mell LK,Anderson P,et al.Consensus guide-lines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatmentof endometrial and cervical cancer[J].Int J Radiat OncolBiol Phys,2008,71(2):428-434
[11]Erpolat OP,Alco G,Caglar HB,et al.Comparison of he-matologic toxicity between 3DCRT and IMRT planning incervical cancer patients after concurrent chemoradiothera-py:a national multi-center study[J].Eur J Gynaecol On-col,2014,35(1):62-66
[12]Jamie LL,Coreen F,Sushil B,et al.Upfront treatment oflocally advanced cervical cancer with intensity modulatedradiation therapy compared to four field radiation therapy:a cost-effectiveness analysis[J].Gynecol Oncol,2013,129:574-579
[13]Li J,Tang XB,Wang BH,et al.Comparison between dualarc VMAT and 7F-IMRT in the protection of hippocam-pus for patients during whole brain radiotherapy[J].J Xray Sci Technol,2016,24(3):457-466
[14]Jin X,Yi J,Zhou Y,et al.Comparison of whole-field simultaneous integrated boost VMAT and IMRT in the treatment of nasopharyngeal cancer[J].Med Dosim,2013,38(4):418-423
[15]Chen H,Wang H,Gu H,et al.Study for reducing lung dose of upper thoracic esophageal cancer radiotherapy by auto-planning:volumetric-modulated arc therapy vs.intensity-modulated radiation therapy[J].Med Dosim,2017(17):30103-30106
[16]Regnier A,Ulbrich J,Münch S,et al.Comparative analysis of efficacy,toxicity,and patient-reported outcomes in rectal cancer patients undergoing preoperative 3D conformal radiotherapy or VMAT[J].Front Oncol,2017,7:225
[17]Guy JB,Falk AT,Auberdiac P,et al.Dosimetric study of volumetric arc modulation with rapid arc and intensitymodulated radiotherapy in patients with cervical cancer and comparison with 3-dimensional conformal technique for definitive radiotherapy in patients with cervical cancer[J].Med Dosim,2016,41(1):9-14
[18]Huang B,Fang Z,Huang Y,et al.dosimetric analysis of volumetric-modulated arc radiotherapy with jaw width restriction vs.7 field intensity-modulated radiotherapy for definitive treatment of cervical cancer[J].Br J Radiol,2014,87(1039):20140183
[19]Onal C,Arslan G,Parlak C,et al.Comparison of IMRT and VMAT plans with different energy levels using MonteCarlo algorithm for prostate cancer[J].Jpn J Radiol,2014,32(4):224-232
[20]Atri M,Zhang Z,Dehdashti F,et al.Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer:Results of ACRIN6671/GOG0233trial[J].Gynecol Oncol,2016,142(3):413-419
[21]Si LE,Catalano O,Dehdashti F.Evaluation of gynecologic cancer with MR imaging,18F-FDG PET/CT,and PET/MR imaging[J].J Nucl Med,2015,56(3):436-443
[22]Small W Jr,Winter K,Levenback C,et al.Extended-field irradiation and intracavitary brachytherapy combined with cisplatin and amifostine for cervical cancer with positive para-aortic or high common iliac lymph nodes:results of armⅡof Radiation Therapy Oncology Group(RTOG)0116[J].Int J Gynecol Cancer,2011,21(7):1266-1275
[23]Lan ML,Yu X,Xiao H,et al.Clinical outcomes and toxicity of postoperative intensity-modulated versus three-dimensional conformal radiation therapy in patients with cervical cancer[J].Asia Pac J Clin Oncol,2016,12(4):430-436