优化髓母细胞瘤的颅椎照射:两种VMAT规划方法的剂量学比较

IF 1.2 Q4 ONCOLOGY ecancermedicalscience Pub Date : 2024-05-08 DOI:10.3332/ecancer.2024.1700
Niketa Thakur, Nancy Bansal, Meena Sudan, Abhishek Sharma
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引用次数: 0

摘要

背景:颅脊柱照射(CSI)的靶体积复杂,因此规划过程极具挑战性。传统的三维适形 CSI 不能放过任何关键器官,从而导致患者中毒。在此,我们比较了使用部分弧形和避开扇形的容积调制弧形疗法(VMAT)在对接受 CSI 的成年患者进行规划时的剂量学优势,以开发一种既有效又高效的临床可行技术。患者和方法:回顾性地确定了八名接受 CSI 治疗的成年患者。共制定了 16 个计划。我们为每位患者生成了两个计划:1.使用部分弧线的 VMAT 计划,即 VMAT_pa。2.2. 使用回避扇区的 VMAT 计划,即 VMAT_as。处方剂量为 36 Gy,分 20 次进行。对计划目标体积(PTV)和危险器官(OAR)(晶状体、眼睛、心脏、甲状腺、肺、肝脏、性腺和肾脏)的剂量-体积直方图进行了分析和比较。评估了 PTV 的平均剂量、V 95% 和 V 107% 等剂量参数。结果显示PTV 的中位长度为 65.58 厘米(45.8-79.5)。两种方案中 PTV 接受 95% 剂量(V95%)的体积分别为 97.51%(VMAT_as)和 97.99%(VMAT_pa)(P = 0.121),而 VMAT_as 和 VMAT_pa 的 V107% 分别为 0.733 和 0.742(P = 0.969)。晶状体、眼睛、肝脏和性腺等 OAR 的剂量相当。VMAT_as 和 VMAT_pa 计划的平均心脏剂量分别为 10.4 Gy 和 9.0 Gy ( p = 0.005)。在使用回避扇区的 VMAT 计划中,甲状腺、肾脏和肺部受到的剂量明显较低。结论这项研究为 CSI 的治疗提供了一种实用的 VMAT 计划方法,并说明使用回避扇区的 VMAT 能够生成高度保形和均匀的 CSI 治疗计划,同时限制相关 OAR 的剂量。
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Optimising craniospinal irradiation for medulloblastoma: a dosimetric comparison of two VMAT planning methods
Background: Craniospinal irradiation (CSI) poses a challenging planning process because of the complex target volume. Traditional 3D conformal CSI does not spare any critical organs, resulting in toxicity in patients. Here the dosimetric advantages of volumetric-modulated arc therapy (VMAT) using partial arc and avoidance sectors are compared with each other in planning in adult patients undergoing CSI to develop a clinically feasible technique that is both effective and efficient. Patient and methods: Eight adult patients treated with CSI were retrospectively identified. In total 16 plans were made. We generated two plans for each patient: 1. VMAT plan using partial arc, namely VMAT_pa. 2. VMAT plan using avoidance sectors, namely VMAT_as. The dose prescribed was 36 Gy in 20 fractions. The dose-volume histogram for planning target volume (PTV) and organs at risk (OAR) (lens, eye, heart, thyroid, lungs, liver, gonads and kidneys) were analysed and compared. Dose parameters of mean dose, V 95% , and V 107% for the PTV were evaluated. Results: The median length of PTV is 65.58 cm (45.8–79.5). The volume of PTV receiving 95% of the dose (V95%) in both the plans are 97.51% (VMAT_as) and 97.99% (VMAT_pa) ( p = 0.121) while V107% are 0.733 and 0.742 for VMAT_as and VMAT_pa, respectively ( p = 0.969). The doses of OARs such as lens, eye, liver and gonads were comparable. The mean heart dose was 10.4 and 9.0 Gy in VMAT_as and VMAT_pa plans, respectively ( p = 0.005). Significant lower doses to the thyroid, kidneys and lungs were seen in VMAT plans using avoidance sectors. Conclusion: This study provides a practically useful VMAT planning method for the treat-ment of CSI and illustrates the ability of VMAT using avoidance sectors to generate highly conformal and homogeneous treatment plans for CSI, while limiting the dose to the relevant OARs.
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CiteScore
3.80
自引率
5.60%
发文量
138
审稿时长
27 weeks
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