Dosimetric advantages of a "butterfly" technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin's lymphoma.
Dosimetric advantages of a "butterfly" technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin's lymphoma.
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DOI：
10.1186/1748-717x-9-94
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发表时间：
2014-04-15
期刊：
影响因子：
--
通讯作者：
Dabaja BS
中科院分区：
文献类型：
--
作者：
Voong KR;McSpadden K;Pinnix CC;Shihadeh F;Reed V;Salehpour MR;Arzu I;Wang H;Hodgson D;Garcia J;Aristophanous M;Dabaja BS
霍奇金淋巴瘤的高治愈率必须与长期治疗相关的毒性相平衡。在这里，我们报告了一种强度调节放射治疗（IMRT）技术，该技术在最大限度地减少高剂量和低剂量暴露于关键器官的同时，对纵隔疾病实现了足够的靶覆盖。对9例纵隔霍奇金淋巴瘤女性患者，采用倾斜体位、每日屏气和CT-on-rails验证，制定了IMRT和常规前后前（AP-PA）技术的治疗方案，其计划靶体积（PTV）覆盖率相当。我们的“蝶形”IMRT光束布置包括300°- 30°的前梁和160°- 210°的后梁。将左右乳房、全肺、心脏、左右心室、左冠状动脉前降支（LAD）和脊髓接受30 Gy （V30）、20 Gy （V20）和5 Gy （V5）正常结构的百分比制成表格。计算两种技术之间各变量、符合性指数、均匀性指数和V107%的差异（IMRT减去常规）。使用IMRT通常会使V30和V20降至关键结构：右乳降至- 1.4%和+0.1%，左乳降至- 1.7%和- 0.9%，全肺降至- 14.6%和- 7.7%，心脏降至- 12.2%和- 10.5%，左心室降至- 2.4%和- 14.2%，右心室降至- 16.4%和- 8.4%，LAD降至- 7.0%和- 14.2%，脊髓降至- 52.2%和- 13.4%。V5差异为右乳+6.2%，左乳+2.8%，全肺+12.9%，心脏+ 3.5%，左心室- 8.2%，右心室- 1.5%,LAD +0.1%，脊髓- 0.1%。IMRT的使用显著减少了接受107%剂量的组织体积（平均减少754 cm3）。这种用于IMRT的蝴蝶技术避免了心脏、乳房、肺和脊髓过度暴露于30或20 Gy的剂量；轻度增加乳房的V5；降低V107%。
High cure rates for Hodgkin’s lymphoma must be balanced with long-term treatment-related toxicity. Here we report an intensity-modulated radiation therapy (IMRT) technique that achieves adequate target coverage for mediastinal disease while minimizing high- and low-dose exposure of critical organs. Treatment plans for IMRT and conventional anteroposterior-posteroanterior (AP-PA) techniques, with comparable coverage of the planning target volume (PTV), were generated for 9 female patients with mediastinal Hodgkin’s lymphoma assuming use of inclined positioning, daily breath-hold, and CT-on-rails verification. Our “butterfly” IMRT beam arrangement involved anterior beams of 300°−30° and posterior beams of 160°−210°. Percentages of normal structures receiving 30 Gy (V30), 20 Gy (V20), and 5 Gy (V5) were tabulated for the right and left breasts, total lung, heart, left and right ventricles, left anterior descending coronary artery (LAD), and spinal cord. Differences in each variable, conformity index, homogeneity index, and V107% between the two techniques were calculated (IMRT minus conventional). Use of IMRT generally reduced the V30 and V20 to critical structures: −1.4% and +0.1% to the right breast, −1.7% and −0.9% to the left breast, −14.6% and −7.7% to the total lung, −12.2% and −10.5% to the heart, −2.4% and −14.2% to the left ventricle, −16.4% and −8.4% to the right ventricle, −7.0% and −14.2% to the LAD, and −52.2% and −13.4% to the spinal cord. Differences in V5 were +6.2% for right breast, +2.8% for left breast, +12.9% for total lung, −3.5% for heart, −8.2% for left ventricle, −1.5% for right ventricle, +0.1% for LAD, and −0.1% for spinal cord. Use of IMRT significantly reduced the volume of tissue receiving 107% of the dose (mean 754 cm3 reduction). This butterfly technique for IMRT avoids excess exposure of heart, breast, lung, and spinal cord to doses of 30 or 20 Gy; mildly increases V5 to the breasts; and decreases the V107%.