全脑放射治疗海马区保护的剂量学研究
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摘要
目的:探讨容积调强技术在全脑放射治疗中对海马区保护的可行性,对比分析共面旋转调强计划与非共面旋转调强计划在海马区保护中的优缺点。方法:选取10例需进行全脑放射治疗的脑转移患者,分别对其进行共面旋转调强和非共面旋转调强的计划设计,对两组计划的机器跳数、靶区的均匀性指数和适形度指数以及危及器官的受量进行比较。结果:两组计划均能降低海马区的剂量,海马区D_(mean)分别为9.7、9.6 Gy。两组计划的海马区D_(100%)、D_(mean)、D_(40%)、D_(max)的均值相差不大;两组计划的靶区均匀性指数和适形度指数在统计学上均无差异。非共面计划的机器跳数比共面计划的大。两组计划的危及器官受量均在临床要求的范围内。结论:在海马保护的全脑放射治疗中,共面旋转调强计划与非共面旋转调强计划均可达到临床要求,且差异不明显。
Objective To discuss the feasible of volumetric modulated arc therapy(VMAT) for the protection of the hippocampus in whole brain radiotherapy(WBRT), and investigate the advantages and disadvantages of coplanar and non-coplanar VMAT plans for hippocampal-sparing WBRT. Methods Ten patients receiving WBRT for brain metastases were enrolled in this study.Two different plans, namely coplanar and non-coplanar VMAT plans, were designed for each patient. The monitor unit, the homogeneity index and conformity index of target areas, and the organs-at-risk dose were compared between two plans. Results Both the two plans reduced the dose of the hippocampus, and the D_(mean) of the hippocampus in coplanar and non-coplanar VMAT plans were 9.7 and 9.6 Gy, respectively. Moreover, the mean values of the D_(100%), D_(mean), D_(40%), and Dmaxof the hippocampus were similar in the two plans, and no statistical difference was found in the homogeneity index and conformity index of target areas.However, the monitor unit of non-coplanar VMAT plan was larger than that of coplanar VMAT plan. The organs-at-risk doses in the two plans met the clinical requirements. Conclusion Both coplanar and non-coplanar VMAT plans for hippocampal-sparing WBRT satisfy the clinical requirements, and the difference between the two plans is trivial.
Objective To discuss the feasible of volumetric modulated arc therapy(VMAT) for the protection of the hippocampus in whole brain radiotherapy(WBRT), and investigate the advantages and disadvantages of coplanar and non-coplanar VMAT plans for hippocampal-sparing WBRT. Methods Ten patients receiving WBRT for brain metastases were enrolled in this study.Two different plans, namely coplanar and non-coplanar VMAT plans, were designed for each patient. The monitor unit, the homogeneity index and conformity index of target areas, and the organs-at-risk dose were compared between two plans. Results Both the two plans reduced the dose of the hippocampus, and the D_(mean) of the hippocampus in coplanar and non-coplanar VMAT plans were 9.7 and 9.6 Gy, respectively. Moreover, the mean values of the D_(100%), D_(mean), D_(40%), and Dmaxof the hippocampus were similar in the two plans, and no statistical difference was found in the homogeneity index and conformity index of target areas.However, the monitor unit of non-coplanar VMAT plan was larger than that of coplanar VMAT plan. The organs-at-risk doses in the two plans met the clinical requirements. Conclusion Both coplanar and non-coplanar VMAT plans for hippocampal-sparing WBRT satisfy the clinical requirements, and the difference between the two plans is trivial.
引文
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[21]RONG Y,EVANS J,XU-WELLIVER M,et al.Dosimetric evaluation of intensity-modulated radiotherapy,volumetric modulated arc therapy,and helical tomotherapy for hippocampal-avoidance whole brain radiotherapy[J].PLoS One,2015,10(4):e0126222.
[2]STOKER J,VORA S,PATEL A,et al.Advantages of intensity modulated proton therapy during hippocampal avoidance whole brain radiation therapy[J].Phys Imaging Radiat Oncol,2018,8:28-32.
[3]ANDREWS D W,SCOTT C B,SPERDUTO P W,et al.Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases:phase III results of the RTOG 9508 randomised trial[J].Lancet,2004,363(9422):1665-1672.
[4]BáLENTOVáS,HNILICOVáP,KALENSKáD,et al.Effect of whole-brain irradiation on the specific brain regions in a rat model:metabolic and histopathological changes[J].Neurotoxicology,2017,60:70-81.
[5]MCTYRE E,SCOTT J,CHINNAIYAN P,et al.Whole brain radiotherapy for brain metastasis[J].Surg Neurol Int,2013,4(Suppl4):S236.
[6]DEANGELIS L M,DELATTRE J Y,POSNER J B.Radiation-induced dementia in patients cured of brain metastases[J].Neurology,1989,39(6):789-796.
[7]RABER J,ROLA R,LEFEVOUR A,et al.Radiation-induced cognitive impairments are associated with changes in indicators of hippocampal neurogenesis[J].Radiat Res,2004,162(1):39-47.
[8]AOYAMA H,SHIRATO H,TAGO M,et al.Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases:a randomized controlled trial[J].JAMA,2006,295(21):2483-2491.
[9]RUBIN R D,WATSON P D,DUFF M C,et al.The role of the hippocampus in flexible cognition and social behavior[J].Front Hum Neurosci,2014,8:742.
[10]GONDI V,PUGH S L,TOME WA,et al.Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases(RTOG 0933):a phase II multi-institutional trial[J].J Clin Oncol,2014,32(34):3810-3816.
[11]GONDI V,HERMANN B P,MEHTA M P,et al.Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors[J].Int J Radiat Oncol Biol Phys,2012,83(4):e487-e493.
[12]OEHLKE O,WUCHERPFENNIG D,FELS F,et al.Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases[J].Strahlenther Onkol,2015,191(6):461-469.
[13]HAUSWALD H,HABL G,KRUG D,et al.Whole brain helical tomotherapy with integrated boost for brain metastases in patients with malignant melanoma:a randomized trial[J].Radiat Oncol,2013,8(1):234.
[14]LI J,BENTZEN S M,RENSCHLER M,et al.Regression after wholebrain radiation therapy for brain metastases correlates with survival and improved neurocognitive function[J].J Clin Oncol,2007,25(10):1260-1266.
[15]MONJE M.Cranial radiation therapy and damage to hippocampal neurogenesis[J].Dev Disabil Res Rev,2008,14(3):238-242.
[16]RABER J,FAN Y,MATSUMORI Y,et al.Irradiation attenuates neurogenesis in the dentate gyrus and exacerbates ischemia-induced functional deficits[J].Ann Neurol,2004,55(3):381-389.
[17]HAN Y M,CAI G,CHAI W M,et al.Radiological distribution of brain metastases and its implication for the hippocampus avoidance in whole brain radiotherapy approach[J].Br J Radiol,2017,90(1079):20170099.
[18]MARSH J C,ZIEL G E,DIAZ A Z,et al.Integral dose delivered to normal brain with conventional intensity-modulated radiotherapy(IMRT)and helical tomotherapy IMRT during partial brain radiotherapy for high-grade gliomas with and without selective sparing of the hippocampus,limbic circuit and neural stem cell compartment[J].J Med Imaging Radiat Oncol,2013,57(3):378-383.
[19]BOEHLING N S,GROSSHANS D R,BLUETT J B,et al.Dosimetric comparison of three-dimensional conformal proton radiotherapy,intensity-modulated proton therapy,and intensity-modulated radiotherapy for treatment of pediatric craniopharyngiomas[J].Int JRadiat Oncol Biol Phys,2012,82(2):643-652.
[20]HARRABI S,BOUGATF N,MOHR A,et al.Dosimetric advantages of proton therapy over conventional radiotherapy with photons in young patients and adults with low-grade glioma[J].Strahlenther Onkol,2016,192(11):759-769.
[21]RONG Y,EVANS J,XU-WELLIVER M,et al.Dosimetric evaluation of intensity-modulated radiotherapy,volumetric modulated arc therapy,and helical tomotherapy for hippocampal-avoidance whole brain radiotherapy[J].PLoS One,2015,10(4):e0126222.