Dosimetric analysis and comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy for patients with hepatocellular carcinoma and radiation-induced liver disease
Dosimetric analysis and comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy for patients with hepatocellular carcinoma and radiation-induced liver disease
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DOI：
10.1016/s0360-3016(03)00091-9
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发表时间：
2003-05-01
影响因子：
7
通讯作者：
Huang, AT
中科院分区：
文献类型：
--
作者：
Cheng, JCH;Wu, JK;Huang, AT
目的：本研究比较了三维适形放射治疗（3D-CRT）和调强放射治疗（IMRT）对肝细胞癌（HCC）和先前记录的放射性肝病（RILD）患者3D-CRT后的剂量-体积数据的差异。方法和材料：1993年11月至1999年12月，68例HCC患者在我们的机构与3D-CRT治疗。其中12例在3D-CRT完成后4个月内被诊断为RILD。RILD定义为无黄疸性碱性磷酸酶水平升高至少2倍和非恶性腹水，或转氨酶升高至少5倍正常上限或治疗前水平。使用正常肝脏剂量-体积直方图的三维治疗计划用于获得剂量-体积数据。12例RILD患者在IMRT计划系统中采用5个野（机架角度0 °、72 °、144 °、216 °和288 °）步进-射击技术重新计划，比较3D-CRT和IMRT在靶区和危及器官的剂量学差异。肝脏使用平均剂量和正常组织并发症概率，文献引用的体积效应参数为0.32，曲线陡度参数为0.15，TD 50（1）为40戈伊，而其他关键结构使用给定剂量水平的体积分数。结果：3D-CRT和5野步进-发射IMRT的靶区覆盖率相当，IMRT在脊髓中的剂量减少率较大（5.7%vs.33.2%，p = 0.007），在肾脏和胃中的器官保留率也相当。调强放射治疗对肝脏的剂量学效应不同，正常组织的并发症发生率明显降低（23.7% vs. 36.6%，p = 0.009），但平均剂量显著增加（2924 cGy vs. 2504 cGy，p = 0.009）。调强放射治疗能够保留可接受的靶区覆盖，改善或至少维持3D-CRT后诊断为RILD的HCC患者的非肝器官保留。这项技术对肝脏的真正影响仍然不确定，可能取决于该器官的确切体积效应。(C)2003年爱思唯尔公司
Purpose: This study compares the difference in dose-volume data between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for patients with hepatocellular carcinoma (HCC) and previously documented radiation-induced liver disease (RILD) after 3D-CRT.Methods and Materials: Between November 1993 and December 1999, 68 patients with HCC were treated with 3D-CRT at our institution. Twelve of them were diagnosed with RILD within 4 months of completion of 3D-CRT. RILD was defined as either anicteric elevation of alkaline phosphatase level of at least twofold and nonmalignant ascites, or elevated transaminases of at least fivefold the upper limit of normal or of pretreatment levels. Three-dimensional treatment planning using dose-volume histograms of normal liver was used to obtain the dose-volume data. These 12 patients with RILD were replanned with an IMRT planning system using the five-field (gantry angles 0degrees, 72degrees, 144degrees, 216degrees, and 288degrees) step-and-shoot technique to compare the dosimetric difference in targets and organs at risk between 3D-CRT and IMRT. Mean dose and normal tissue complication probability with literature-cited volume effect parameter of 0.32, curve steepness parameter of 0.15, and TD50(1) of 40 Gy, were used for the liver, whereas volume fraction at a given dose level was used for other critical structures. Paired Student t-test with 2-tailed p < 0.05 was used to assess the statistical difference between the two techniques.Results: With comparable target coverage between 3D-CRT and five-field step-and-shoot IMRT, IMRT was able to obtain a large dose reduction in the spinal cord (5.7% vs. 33.2%,p = 0.007), and achieved at least similar organ sparing for kidneys and stomach. IMRT had diverse dosimetric effect on liver, with significant reduction in normal tissue complication probability (23.7% vs. 36.6%,p = 0.009), but significant increase in mean dose (2924 cGy vs. 2504 cGy, p = 0.009), as compared with 3D-CRT.Conclusion: IMRT is capable of preserving acceptable target coverage and improving or at least maintaining the nonhepatic organ sparing for patients with HCC and previously diagnosed RILD after 3D-CRT. The true impact of this technique on the liver remains unsettled and may depend on the exact volume effect of this organ. (C) 2003 Elsevier Inc.