CONTINUOUS ARC ROTATION OF THE COUCH THERAPY FOR THE DELIVERY OF ACCELERATED PARTIAL BREAST IRRADIATION: A TREATMENT PLANNING ANALYSIS
CONTINUOUS ARC ROTATION OF THE COUCH THERAPY FOR THE DELIVERY OF ACCELERATED PARTIAL BREAST IRRADIATION: A TREATMENT PLANNING ANALYSIS
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DOI：
10.1016/j.ijrobp.2010.03.004
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发表时间：
2011-07-01
影响因子：
7
通讯作者：
Grills, Inga S.
中科院分区：
文献类型：
--
作者：
Shaitelman, Smona F.;Kim, Leonard H.;Grills, Inga S.
目的：我们提出了一种新的弧形治疗形式：床上连续弧形旋转(C-ARC)，并将其与三维适形放射治疗(3D-CRT)、调强放疗(IMRT)和体积调制弧形治疗(VMAT)在加速部分乳腺照射(APBI)中的剂量学进行了比较。C-ARC和VMAT一样，使用调制的射束孔径和剂量率，但与床架而不是门架一起旋转。方法和材料：12名先前使用3D-CRT进行APBI治疗的患者重新计划(1)C-ARC，(2)调强放射治疗和(3)VMAT。C-ARC平面设计有一个内侧和一个外侧弧线，沙发通过这个弧线旋转，而门架保持固定在切线角度。目标剂量覆盖范围与3D-CRT计划归一化。结果：与3D-CRT相比，C-ARC、IMRT和VMAT均可显著降低同侧乳腺V50%(平均7.8%)。只有C-ARC和IMRT计划显著降低了对侧乳房的最大剂量、同侧肺的V5GY和心脏的V5%。与3D-CRT、IMRT和VMAT相比，C-ARC平均少使用40%、30%和10%的监测单元。结论：C-ARC具有更好的剂量学和治疗效率，可降低毒性和继发性恶性肿瘤的风险。它的切线几何结构避免了关键结构的辐射，而这是使用VMAT的正面几何图形不可避免的。(C)2011年爱思唯尔公司。
Purpose: We present a novel form of arc therapy: continuous arc rotation of the couch (C-ARC) and compare its dosimetry with three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) for accelerated partial breast irradiation (APBI). C-ARC, like VMAT, uses a modulated beam aperture and dose rate, but with the couch, not the gantry, rotating.Methods and Materials: Twelve patients previously treated with APBI using 3D-CRT were replanned with (1) C-ARC, (2) IMRT, and (3) VMAT. C-ARC plans were designed with one medial and one lateral arc through which the couch rotated while the gantry was held stationary at a tangent angle. Target dose coverage was normalized to the 3D-CRT plan. Comparative endpoints were dose to normal breast tissue, lungs, and heart and monitor units prescribed.Results: Compared with 3D-CRT, C-ARC, IMRT, and VMAT all significantly reduced the ipsilateral breast V50% by the same amount (mean, 7.8%). Only C-ARC and IMRT plans significantly reduced the contralateral breast maximum dose, the ipsilateral lung V5Gy, and the heart V5%. C-ARC used on average 40%, 30%, and 10% fewer monitor units compared with 3D-CRT, IMRT, and VMAT, respectively.Conclusions: C-ARC provides improved dosimetry and treatment efficiency, which should reduce the risks of toxicity and secondary malignancy. Its tangent geometry avoids irradiation of critical structures that is unavoidable using the en face geometry of VMAT. (C) 2011 Elsevier Inc.