Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment, helical tomotherapy and volumetric arc therapy for primary radiation - an intraindividual comparison
Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment, helical tomotherapy and volumetric arc therapy for primary radiation - an intraindividual comparison
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DOI：
10.1186/s13014-015-0402-z
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发表时间：
2015-04-17
影响因子：
3.6
通讯作者：
Cozzi, Luca
中科院分区：
文献类型：
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作者：
Marnitz, Simone;Wlodarczyk, Waldemar;Cozzi, Luca
背景：旨在比较螺旋断层放疗（HT）、RapidArc（RA）、质子调强放疗（IMPT）对局部晚期宫颈癌患者进行的高度精密调强放疗（IMRT）。方法和材料：20 名宫颈癌患者接受常规 IMRT、VMAT 或 HT 照射； 10 名接受了盆腔照射 (PEL)，10 名接受了大范围照射 (EFRT)。计划目标体积 A（PTV_A：子宫颈、子宫、盆腔 +/- 主动脉旁淋巴结）的剂量为 1.8/50.4 Gy。宫旁 (PTV_B) 的 SIB 剂量为 2.12/59.36 Gy。 MRI 引导近距离放射治疗分 5 次进行，剂量高达 25 Gy。对于 EBRT，较低的目标限制是 95% 的目标体积中的 95% 的处方剂量。受照射的小肠（SB）体积保持尽可能低。对于每位患者，均对 IMRT、HT、VMAT 和 IMPT 的目标参数以及危及器官（SB、膀胱、直肠）的剂量进行了个体内部评估。结果：所有技术均提供了出色的目标体积覆盖、均匀性和一致性。 IMPT 后，SB 的平均剂量 (Dmean) 从 30.2 +/- 4.0 Gy (IMRT) 显着降低； 27.6 +/- 5.6 戈瑞（高温）；盆腔放射为 34.1 +/- 7.0 (RA) 至 18.6 +/- 5.9 Gy (IMPT)，26.3 +/- 3.2 Gy (IMRT)； 24.0 +/- 4.1（高温）； EFRT 患者的剂量为 25.3 +/- 3.7 (RA) 至 13.8 +/- 2.8 Gy (IMPT)，相当于 Dmean (SB) 减少 38-52%。此外，与所有光子技术相比，IMPT 对小肠的低剂量浴 (V-10Gy) 减少了 50%。此外，在盆腔放射和 EFRT 专利中，IMPT 使膀胱和直肠的 Dmean 减少了 7-9 Gy。结论：所有现代技术（已证明在目标的覆盖范围、一致性和均匀性方面在剂量学上是足够的。质子提供了对小肠和直肠的最佳保护，因此有助于显着减少急性和晚期 宫颈癌治疗中的毒性。
Background: To compare highly sophisticated intensity-modulated radiotherapy (IMRT) delivered by either helical tomotherapy (HT), RapidArc (RA), IMRT with protons (IMPT) in patients with locally advanced cervical cancer.Methods and materials: Twenty cervical cancer patients were irradiated using either conventional IMRT, VMAT or HT; ten received pelvic (PEL) and ten extended field irradiation (EFRT). The dose to the planning-target volume A (PTV_A: cervix, uterus, pelvic +/- para-aortic lymph nodes) was 1.8/50.4 Gy. The SIB dose for the parametrium (PTV_B), was 2.12/59.36 Gy. MRI-guided brachytherapy was administered with 5 fractions up to 25 Gy. For EBRT, the lower target constraints were 95% of the prescribed dose in 95% of the target volume. The irradiated small bowel (SB) volumes were kept as low as possible. For every patient, target parameters as well as doses to the organs at risk (SB, bladder, rectum) were evaluated intra-individually for IMRT, HT, VMAT and IMPT.Results: All techniques provided excellent target volume coverage, homogeneity, conformity. With IMPT, there was a significant reduction of the mean dose (Dmean) of the SB from 30.2 +/- 4.0 Gy (IMRT); 27.6 +/- 5.6 Gy (HT); 34.1 +/- 7.0 (RA) to 18.6 +/- 5.9 Gy (IMPT) for pelvic radiation and 26.3 +/- 3.2 Gy (IMRT); 24.0 +/- 4.1 (HT); 25.3 +/- 3.7 (RA) to 13.8 +/- 2.8 Gy (IMPT) for patients with EFRT, which corresponds to a reduction of 38-52% for the Dmean (SB). Futhermore, the low dose bath (V-10Gy) to the small bowel was reduced by 50% with IMPT in comparison to all photon techniques. Furthermore, Dmean to the bladder and rectum was decresed by 7-9 Gy with IMPT in patents with pelvic radiation and EFRT.Conclusion: All modern techniques (were proved to be dosimetrically adequate regarding coverage, conformity and homogeneity of the target. Protons offered the best sparing of small bowel and rectum and therefore could contribute to a significant reduction of acute and late toxicity in cervical cancer treatment.