[Dosimetric comparison between intensity-modulated radiotherapy and conformal radiotherapy for upper thoracic esophageal carcinoma].

Wu-Zhe Zhang, Zhi-Jian Chen, De-Rui Li, Zhi-Xiong Lin, Dong-Sheng Li, Chuang-Zhen Chen
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引用次数: 9

Abstract

Background and objective: Treatment planning for radiotherapy of upper thoracic esophageal carcinoma is challenging due to the anatomical features. The difficulty may be resolved by intensity-modulated radiotherapy (IMRT). This study was to compare the dosimetric advantages of IMRT to that of conformal radiotherapy (CRT) for upper thoracic esophageal carcinoma, and to explore the clinical application of IMRT.

Methods: Eleven patients with upper thoracic esophageal carcinoma were enrolled. In addition to the actually used CRT plan, a five-field IMRT plan was generated for each case. The parameters of dose volume histogram for targets and organs at risk were compared between two techniques.

Results: For the planning target volume (PTV) of tumor and para-tumor tissues, the mean dose, maximal dose, doses covering 99% and 95% volume were similar in IMRT and CRT plans (P>0.05). However, IMRT plan had a higher conformity index than CRT plan (0.68+/-0.04 vs. 0.46+/-0.11, P<0.01). For the PTV of supraclavicular region, IMRT plan showed a better dose heterogeneity index than CRT plan (1.17+/-0.05 vs. 1.33+/-0.15, P=0.01). IMRT plan had lower maximal dose to the planning risk volume of the spinal cord (44.4 Gy vs. 52.5 Gy, P<0.05) and lower lung volume received dose of 10 Gy or higher [(32+/-6)% vs. (35+/-9)%, P<0.05] than CRT plan.

Conclusion: For the upper thoracic esophageal carcinoma, IMRT has more conformal distribution of dose and better spinal cord sparing than CRT, and can reduce the volume of lung that received dose of 10 Gy or higher.

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[调强放疗与适形放疗治疗上胸食管癌的剂量学比较]。
背景与目的:由于上胸食管癌的解剖特点,放疗治疗方案具有挑战性。这个困难可以通过调强放疗(IMRT)来解决。本研究旨在比较IMRT与适形放疗(CRT)治疗上胸食管癌的剂量学优势,探讨IMRT的临床应用。方法:选取11例上胸段食管癌患者。除了实际使用的CRT计划外,还为每个病例生成了一个五域IMRT计划。比较两种方法的靶器官和危险器官的剂量-体积直方图参数。结果:在肿瘤及肿瘤旁组织的规划靶体积(PTV)方面,IMRT与CRT方案的平均剂量、最大剂量、覆盖99%、95%体积的剂量相似(P>0.05)。但IMRT计划的符合性指数高于CRT计划(0.68+/-0.04 vs. 0.46+/-0.11)。结论:对于上胸段食管癌,IMRT比CRT具有更适形的剂量分布和更好的脊髓保留,并且在剂量为10 Gy及以上时可减少肺体积。
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