The impact of 4DCT-ventilation imaging-guided proton therapy on stereotactic body radiotherapy for lung cancer
The impact of 4DCT-ventilation imaging-guided proton therapy on stereotactic body radiotherapy for lung cancer
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DOI：
10.1007/s12194-020-00572-5
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发表时间：
2020-06-14
影响因子：
1.6
通讯作者：
Jingu, Keiichi
中科院分区：
文献类型：
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作者：
Ieko, Yoshiro;Kadoya, Noriyuki;Jingu, Keiichi
放疗期间功能性肺部回避有助于减少肺部毒性。本研究通过将四维计算机断层扫描 (4DCT) 通气成像引导质子放射治疗 (PT) 与采用光子束的三维适形放射治疗 (3D-CRT) 和体积调制弧治疗 (VMAT) 进行比较，评估了四维计算机断层扫描 (4DCT) 通气成像引导质子放射治疗 (PT) 对立体定向放射治疗 (SBRT) 的潜在影响。该研究纳入了 13 名接受 3D-CRT SBRT 的肺癌患者。使用患者的 4DCT 数据、变形图像配准和基于密度变化的算法计算 4DCT 通气。使用 3D-CRT、VMAT 和 PT 为每位患者制定了三种功能性治疗计划，保留了功能性肺部区域。规定剂量和剂量限制基于放射治疗肿瘤学组 0618 方案。我们评估了 4DCT 通气和照射剂量的感兴趣区域 (ROI) 和基于功能图的剂量函数指标。使用 3D-CRT、VMAT 和 PT，接受≥ 5 Gy (fV5) 的功能性肺区域的百分比分别为 26.0%、21.9% 和 10.7%； fV10分别为14.4%、11.4%和9.0%； fV20 和 fV20 分别为 6.5%、6.4% 和 6.6%，功能平均肺剂量 (fMLD) 分别为 5.6 Gy、5.2 Gy 和 3.8 Gy。这些结果表明，PT 导致 fMLD、fV5 和 fV10 显着降低，但 fV20 没有显着降低。与 3D-CRT 和 VMAT 相比，PT 的使用减少了对高功能肺部区域的辐射，同时满足所有剂量限制。
Functional lung avoidance during radiotherapy can help reduce pulmonary toxicity. This study assessed the potential impact of four-dimensional computed tomography (4DCT)-ventilation imaging-guided proton radiotherapy (PT) on stereotactic body radiotherapy (SBRT) by comparing it with three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT), which employ photon beams. Thirteen lung cancer patients who received SBRT with 3D-CRT were included in the study. 4DCT ventilation was calculated using the patients' 4DCT data, deformable image registration, and a density-change-based algorithm. Three functional treatment plans sparing the functional lung regions were developed for each patient using 3D-CRT, VMAT, and PT. The prescribed doses and dose constraints were based on the Radiation Therapy Oncology Group 0618 protocol. We evaluated the region of interest (ROI) and functional map-based dose-function metrics for 4DCT ventilation and the irradiated dose. Using 3D-CRT, VMAT, and PT, the percentages of the functional lung regions that received >= 5 Gy (fV5) were 26.0%, 21.9%, and 10.7%, respectively; the fV10 were 14.4%, 11.4%, and 9.0%, respectively; and fV20 were 6.5%, 6.4%, and 6.6%, respectively, and the functional mean lung doses (fMLD) were 5.6 Gy, 5.2 Gy, and 3.8 Gy, respectively. These results indicated that PT resulted in a significant reduction in fMLD, fV5, and fV10, but not fV20. The use of PT reduced the radiation to highly functional lung regions compared with those for 3D-CRT and VMAT while meeting all dose constraints.