Volumetric intensity-modulated Arc (RapidArc) therapy for primary hepatocellular carcinoma: comparison with intensity-modulated radiotherapy and 3-D conformal radiotherapy.
Volumetric intensity-modulated Arc (RapidArc) therapy for primary hepatocellular carcinoma: comparison with intensity-modulated radiotherapy and 3-D conformal radiotherapy.
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DOI：
10.1186/1748-717x-6-76
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发表时间：
2011-06-21
期刊：
影响因子：
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通讯作者：
Hwang JJ
中科院分区：
文献类型：
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作者：
Kuo YC;Chiu YM;Shih WP;Yu HW;Chen CW;Wong PF;Lin WC;Hwang JJ
应用剂量学方法比较RapidArc计划与三维适形放射治疗(3DCRT)和调强放射治疗(IMRT)治疗原发性肝细胞癌的疗效。本研究共纳入9例不能切除的肝细胞癌患者。计算RapidArc、IMRT和3DCRT的剂量学值，总剂量为45~50.4Gy1.8Gy日。参数包括计划靶区(PTV)的适形指数(CI)、均匀指数(HI)、热点(V107%)以及计划效率的监测单位(MUS)、危险器官(OAR)的平均剂量(Dean)和脊髓1%体积下的最大剂量(D1%)。同时评估接受≥40、30、20和10(V40、V30、V20和V10)照射的正常肝脏体积百分比和正常组织并发症概率，以确定肝脏毒性。这三种方法对PTV都实现了类似的同质性。RapidArc的CI和V107%值显著高于IMRT或3DCRT(p<；0.05)。RapidArc组和3DCRT组的MUS分别为323.8±60.70和322.3±28.6，明显低于IMRT组的1165.4±170.7(p<；0.001)。调强放射治疗获得的正常肝脏的平均血流速度明显低于3DCRT或RapidArc(p=0.001)。3DCRT对正常肝脏的V40Gy值和V30Gy值高于RapidArc或IMRT。虽然RapidArc组正常肝脏的V10Gy值(75.8±13.1%)高于3DCRT组(60.5±10.2%)和调强放射治疗组(57.2±10.0%；p<0.01)，但RapidArc组(4.38±2.69)和IMRT组(3.98±3.00)无显著差异，均优于3DCRT组(7.57±4.36)(p=0.02)。与调强放疗或3DCRT相比，RapidArc提供了良好的肿瘤覆盖范围，但在肝脏保护方面，RapidArc并不优于调强放疗。需要进一步的研究来确定三种方法之间的治疗结果差异。
To compare the RapidArc plan for primary hepatocellular carcinoma (HCC) with 3-D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans using dosimetric analysis. Nine patients with unresectable HCC were enrolled in this study. Dosimetric values for RapidArc, IMRT, and 3DCRT were calculated for total doses of 45~50.4 Gy using 1.8 Gy/day. The parameters included the conformal index (CI), homogeneity index (HI), and hot spot (V107%) for the planned target volume (PTV) as well as the monitor units (MUs) for plan efficiency, the mean dose (Dmean) for the organs at risk (OAR) and the maximal dose at 1% volume (D1%) for the spinal cord. The percentage of the normal liver volume receiving ≥ 40, > 30, > 20, and > 10 Gy (V40 Gy, V30 Gy, V20 Gy, and V10 Gy) and the normal tissue complication probability (NTCP) were also evaluated to determine liver toxicity. All three methods achieved comparable homogeneity for the PTV. RapidArc achieved significantly better CI and V107% values than IMRT or 3DCRT (p < 0.05). The MUs were significantly lower for RapidArc (323.8 ± 60.7) and 3DCRT (322.3 ± 28.6) than for IMRT (1165.4 ± 170.7) (p < 0.001). IMRT achieved a significantly lower Dmean of the normal liver than did 3DCRT or RapidArc (p = 0.001). 3DCRT had higher V40 Gy and V30 Gy values for the normal liver than did RapidArc or IMRT. Although the V10 Gy to the normal liver was higher with RapidArc (75.8 ± 13.1%) than with 3DCRT or IMRT (60.5 ± 10.2% and 57.2 ± 10.0%, respectively; p < 0.01), the NTCP did not differ significantly between RapidArc (4.38 ± 2.69) and IMRT (3.98 ± 3.00) and both were better than 3DCRT (7.57 ± 4.36) (p = 0.02). RapidArc provided favorable tumor coverage compared with IMRT or 3DCRT, but RapidArc is not superior to IMRT in terms of liver protection. Further studies are needed to establish treatment outcome differences between the three approaches.