小细胞肺癌全脑预防性照射中腮腺限量降低正常组织并发症概率
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摘要
[目的]在小细胞肺癌患者全脑预防性照射(PCI)中通过限制腮腺的剂量来降低其正常组织并发症概率(NTCP),为全脑放疗中腮腺的保护提供依据。[方法]选择行PCI照射的SCLC患者24例,勾画腮腺轮廓作为危及器官(OAR),按照腮腺不同限量程度分别设计2D、2D_M和IMRT三种计划并评估其剂量体积和NTCP。[结果] 24例患者两侧腮腺体积平均为(36.04±4.41)cc。其中左侧腮腺(17.89±3.86)cc、右侧腮腺(18.15±4.41)cc;三种技术(2D、2D_M和IMRT)的T腮腺生物等效剂量(BETD)平均值分别为(1684±416)cGy、(1210±366)cGy和(839±128)cGy。在T2D技术腮腺不限量时有10例患者(41.67%)存在超量情况,其中左右两侧腮腺各有7个(29.17%)超过了2000cGy,并且各有2个(8.33%)超过了2500cGy。2D_M技术中仅有1例患者(4.16%)的单侧腮腺BED>2000cGy(2023cGy),而IMRT技术中则无超量腮腺T。三种技术的NTCP平均分别为(5.08±2.56)%、(3.12±1.42)%和(1.91±0.40)%,腮腺限量后其NTCP明显降低(P均<0.001)。[结论]在小细胞肺癌全脑预防性照射中不保护腮腺可能会导致其毒副反应的发生,在治疗计划设计中通过腮腺限量可以有效降低其正常组织并发症概率。
[Objective] To reduce the normal tissue complication probability(NTCP) in prophylactic cranial irradiation(PCI) for small cell lung cancer(SCLC),and to provide evidence for sparing of parotid in whole brain radiation therapy. [Methods] Twenty-four SCLC patients receiving PCI were recruited. Parotids were delineated and three plans named as 2D,2D_M and IMRT were designed according to different degree of dose limiting on parotid,subsequently the parotid dose volume and NTCP were evaluated. [Results] The mean total parotids volume was(36.04±4.41)cc,that of left and right parotid was(17.89±3.86)cc and(18.15±4.41)cc,respectively. The mean value of biological equivalent dose(BED) of parotids in plans 2D,2D_M and IMRT was(1684±416)cGy,(1210 ±366)cGy and(839 ±128)cGy,respectively. For 2D plans in which the parotids were not spared,the dose of parotids was excess in 10 patients(T41.67%T),including the dose of right and left parotid was >2000cGy in 7(29.17%) and >2500cGy in 2(8.33%); for 2D_M only 1 patients(4.16%) whose dose of unilateral parotid was >2000cGy; while there was no dose excess in IMRT.The average NTCP of the three plans were(5.08 ±2.56)%,(3.12±1.42)% and(1.91±0.40)%(P<0.05).[Conclusion] Normal tissue complication probability of parotid can be effectively reduced by limiting its dose in prophylactic cranial irradiation for patients with small cell lung cancer.
[Objective] To reduce the normal tissue complication probability(NTCP) in prophylactic cranial irradiation(PCI) for small cell lung cancer(SCLC),and to provide evidence for sparing of parotid in whole brain radiation therapy. [Methods] Twenty-four SCLC patients receiving PCI were recruited. Parotids were delineated and three plans named as 2D,2D_M and IMRT were designed according to different degree of dose limiting on parotid,subsequently the parotid dose volume and NTCP were evaluated. [Results] The mean total parotids volume was(36.04±4.41)cc,that of left and right parotid was(17.89±3.86)cc and(18.15±4.41)cc,respectively. The mean value of biological equivalent dose(BED) of parotids in plans 2D,2D_M and IMRT was(1684±416)cGy,(1210 ±366)cGy and(839 ±128)cGy,respectively. For 2D plans in which the parotids were not spared,the dose of parotids was excess in 10 patients(T41.67%T),including the dose of right and left parotid was >2000cGy in 7(29.17%) and >2500cGy in 2(8.33%); for 2D_M only 1 patients(4.16%) whose dose of unilateral parotid was >2000cGy; while there was no dose excess in IMRT.The average NTCP of the three plans were(5.08 ±2.56)%,(3.12±1.42)% and(1.91±0.40)%(P<0.05).[Conclusion] Normal tissue complication probability of parotid can be effectively reduced by limiting its dose in prophylactic cranial irradiation for patients with small cell lung cancer.
引文
[1]Aupérin A,Arriagada R,Pignon JP,et al.Prophylactic cranial irradiation for atients with small-cell lung cancer in complete remission.Prophylactic Cranial rradiation Overview Collaborative Group[J].N Engl J Med,1999,34(1):476-484.
[2]Zhang W,Jiang W,Luan L,et al.Prophylactic cranial irradiation in small cell lung cancer:a systematic review of the literature with meta-analysis[J].BMC Cancer,2014,14:793.
[3]Arriagada R,Le Chevalier T,Borie F,et al.Prophylactic cranial irradiation for atients with small-cell lung cancer in complete remission[J].J Natl Cancer Inst,1995,87(3):183-190.
[4]Slotman B,Faivre-Finn C,Kramer G,et al.Prophylactic cranial irradiation in extensive small-cell lung cancer[J].N Engl J Med,2007,357(7):664-672.
[5]Sood S,Pokhrel D,Mcclinton C,et al.Volumetric-modulated arc therapy(VMAT)for whole brain radiotherapy:not only for hippocampal sparing,but also for reduction of dose to organs at risk[J].Medical Dosimetry,2017,(17):30070-30075.
[6]Ta VDW,Bijl HP,Westerlaan HE,et al.Delineation guidelines for organs at risk involved in radiation-induced salivary dysfunction and xerostomia[J].Radiother Oncol,2009,93(3):545-552.
[7]Stieler F,Wolff D,Schmid H,et al.A comparison of several modulated radiotherapy techniques for head and neck cancer and dosimetric validation of VMAT[J].Radiother Oncol,2011,101(3):388-393.
[8]Fiorentino A,Chiumento C,Caivano R,et al.Whole brain radiotherapy:are parotid glands organs at risk?[J].Radiother Oncol,2012,103(1):130-131.
[9]Webb S,Nahum AE.A model for calculating tumor control probability in radiotherapy including the effects of inhomogeneous disributions of dose and clonogenic cell density[J].Phys Med Biol,1993,38(6):653-666.
[10]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.
[11]Lyman JT,Wolbarst AB.Optimization of radiation therapyⅢ:a method of assessing complication probabilities from dose volume histograms[J].Int J Radiat Oncol Biol Phys,1987,13(1):103-109.
[12]Castelli J,Simon A,Louvel G,et al.Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia[J].Radia Oncol,2015,10(1):1-10.
[13]Blanco AI,Chao KS,El Naqa I,et al.Dose-volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy[J].Int J Radiat Oncol Biol Phys,2005,62(4):1055-1069.
[14]Deasy JO,Moiseenko V,Marks L,et al.Radiotherapy dose-volume effects on salivary gland function[J].Int JRadiat Oncol Biol Phys,2010,76(3 Suppl):S58-S63.
[15]Roesink JM,Moerland MA,Battermann JJ,et al.Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region[J].Int J Radiat Oncol Biol Phys,2001,51(4):938-946.
[16]Manegold C,Bülzebruck H,Drings P,et al.Prognostic factors in small cell bronchial cancer[J].Onkologie,1989,12(5):240-245.
[17]Burlage FR,Coppes RP,Meertens H,et al.Parotid and submandibular/sublingual salivary flow during high dose radiotherapy[J].Radiother Oncol,2001,61(3):271-274.
[18]Péchoux CL,Dunant A,Senan S,et al.Standard-dose versus higher-dose prophylactic cranial irradiation(PCI)in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy(PCI 99-01,EORTC 22003-08004,RTOG 0212,and IFCT 99-01):a randomised clinical trial[J].Lancet Oncol,2009,10(5):467-474.
[19]Yu JB,Shiao SL,Knisely JP.A dosimetric evaluation of conventional helmet field irradiation versus two-field intensity-modulated radiotherapy technique[J].Int J Radiat Oncol Biol Phys,2007,68(2):621-631.
[20]Goyal S,Yue NJ,Millevoi R,et al.Improvement in dose homogeneity with electronic tissue compensation over IM-RT and conventional RT in whole brain radiotherapy[J].Radiother Oncol,2008,88(2):196-201.
[21]Gondi V,Pugh SL,Tome WA,et al.Preservation of memory with conformal avoidance of the hippocampal neural stemcell compartment during whole-brain radiotherapy for brain metastases(RTOG 0933):a phaseⅡmulti-institutional trial[J].J Clin Oncol,2014,32(34):3810-3816.
[22]Redmond KJ,Hales RK,Anderson-Keightly H,et al.Prospective study of hippocampal-sparing prophylactic cranial irradiation in limited-stage small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2017,98(3):603-611.
[23]SimóM,Vaquero L,Ripollés P,et al.Brain damage following prophylactic cranial irradiation in lung cancer survivors[J].Brain Imaging Behav,2016,10(1):283-295.
[2]Zhang W,Jiang W,Luan L,et al.Prophylactic cranial irradiation in small cell lung cancer:a systematic review of the literature with meta-analysis[J].BMC Cancer,2014,14:793.
[3]Arriagada R,Le Chevalier T,Borie F,et al.Prophylactic cranial irradiation for atients with small-cell lung cancer in complete remission[J].J Natl Cancer Inst,1995,87(3):183-190.
[4]Slotman B,Faivre-Finn C,Kramer G,et al.Prophylactic cranial irradiation in extensive small-cell lung cancer[J].N Engl J Med,2007,357(7):664-672.
[5]Sood S,Pokhrel D,Mcclinton C,et al.Volumetric-modulated arc therapy(VMAT)for whole brain radiotherapy:not only for hippocampal sparing,but also for reduction of dose to organs at risk[J].Medical Dosimetry,2017,(17):30070-30075.
[6]Ta VDW,Bijl HP,Westerlaan HE,et al.Delineation guidelines for organs at risk involved in radiation-induced salivary dysfunction and xerostomia[J].Radiother Oncol,2009,93(3):545-552.
[7]Stieler F,Wolff D,Schmid H,et al.A comparison of several modulated radiotherapy techniques for head and neck cancer and dosimetric validation of VMAT[J].Radiother Oncol,2011,101(3):388-393.
[8]Fiorentino A,Chiumento C,Caivano R,et al.Whole brain radiotherapy:are parotid glands organs at risk?[J].Radiother Oncol,2012,103(1):130-131.
[9]Webb S,Nahum AE.A model for calculating tumor control probability in radiotherapy including the effects of inhomogeneous disributions of dose and clonogenic cell density[J].Phys Med Biol,1993,38(6):653-666.
[10]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.
[11]Lyman JT,Wolbarst AB.Optimization of radiation therapyⅢ:a method of assessing complication probabilities from dose volume histograms[J].Int J Radiat Oncol Biol Phys,1987,13(1):103-109.
[12]Castelli J,Simon A,Louvel G,et al.Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia[J].Radia Oncol,2015,10(1):1-10.
[13]Blanco AI,Chao KS,El Naqa I,et al.Dose-volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy[J].Int J Radiat Oncol Biol Phys,2005,62(4):1055-1069.
[14]Deasy JO,Moiseenko V,Marks L,et al.Radiotherapy dose-volume effects on salivary gland function[J].Int JRadiat Oncol Biol Phys,2010,76(3 Suppl):S58-S63.
[15]Roesink JM,Moerland MA,Battermann JJ,et al.Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region[J].Int J Radiat Oncol Biol Phys,2001,51(4):938-946.
[16]Manegold C,Bülzebruck H,Drings P,et al.Prognostic factors in small cell bronchial cancer[J].Onkologie,1989,12(5):240-245.
[17]Burlage FR,Coppes RP,Meertens H,et al.Parotid and submandibular/sublingual salivary flow during high dose radiotherapy[J].Radiother Oncol,2001,61(3):271-274.
[18]Péchoux CL,Dunant A,Senan S,et al.Standard-dose versus higher-dose prophylactic cranial irradiation(PCI)in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy(PCI 99-01,EORTC 22003-08004,RTOG 0212,and IFCT 99-01):a randomised clinical trial[J].Lancet Oncol,2009,10(5):467-474.
[19]Yu JB,Shiao SL,Knisely JP.A dosimetric evaluation of conventional helmet field irradiation versus two-field intensity-modulated radiotherapy technique[J].Int J Radiat Oncol Biol Phys,2007,68(2):621-631.
[20]Goyal S,Yue NJ,Millevoi R,et al.Improvement in dose homogeneity with electronic tissue compensation over IM-RT and conventional RT in whole brain radiotherapy[J].Radiother Oncol,2008,88(2):196-201.
[21]Gondi V,Pugh SL,Tome WA,et al.Preservation of memory with conformal avoidance of the hippocampal neural stemcell compartment during whole-brain radiotherapy for brain metastases(RTOG 0933):a phaseⅡmulti-institutional trial[J].J Clin Oncol,2014,32(34):3810-3816.
[22]Redmond KJ,Hales RK,Anderson-Keightly H,et al.Prospective study of hippocampal-sparing prophylactic cranial irradiation in limited-stage small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2017,98(3):603-611.
[23]SimóM,Vaquero L,Ripollés P,et al.Brain damage following prophylactic cranial irradiation in lung cancer survivors[J].Brain Imaging Behav,2016,10(1):283-295.