Radiation treatment planning techniques for lymphoma of the stomach
Radiation treatment planning techniques for lymphoma of the stomach
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DOI：
10.1016/j.ijrobp.2004.10.025
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发表时间：
2005-07-01
影响因子：
7
通讯作者：
Yahalom, J
中科院分区：
文献类型：
--
作者：
Della Biancia, C;Hunt, M;Yahalom, J
目的：胃受累野放射治疗常用于胃淋巴瘤的根治性治疗。然而，以最小的发病率照射胃的最佳技术尚未得到很好的确立。本研究旨在评估胃放疗的治疗方案选择，包括调强放疗（IMRT），以确定哪种方法可以改善剂量分布，并确定可能影响治疗方案选择的患者特异性解剖因素。方法与材料：15例胃淋巴瘤患者（14例粘膜相关淋巴组织淋巴瘤，1例弥漫性大b细胞淋巴瘤）根据规划靶体积（PTV）与肾脏的几何关系分为3型。为每位患者制作AP/PA和3D适形放射治疗（3DCRT）计划。我们计划对4例PTV与肾脏之间具有挑战性的几何关系的患者进行IMRT，以确定使用IMRT是否有利。结果：对于I型患者（PTV和肾脏之间没有重叠），使用3DCRT比AP/PA基本上没有好处。然而，对于ptv靠近肾脏（II型）或高度重叠（III型）的患者，4场3DCRT计划更优越，II型患者肾脏V-15 Gy降低约90%，III型患者降低50%。对于III型，使用3DCRT计划而不是AP/PA计划可使右肾的V-II Gy降低约65%，左肾降低45%。在选定的病例中，IMRT导致左肾剂量和平均肝脏剂量进一步降低。结论：靶体与肾脏的几何关系对最佳光束布置的选择有重要影响。使用4场3DCRT可显著降低肾脏剂量。在选定的患者中，IMRT的增加导致左肾和肝剂量进一步增加。(c) 2005爱思唯尔公司
Purpose: Involved-field radiation therapy of the stomach is often used in the curative treatment of gastric lymphoma. Yet, the optimal technique to irradiate the stomach with minimal morbidity has not been well established. This study was designed to evaluate treatment planning alternatives for stomach irradiation, including intensity-modulated radiation therapy (IMRT), to determine which approach resulted in improved dose distribution and to identify patient-specific anatomic factors that might influence a treatment planning choice.Methods and Materials: Fifteen patients with lymphoma of the stomach (14 mucosa-associated lymphoid tissue lymphomas and 1 diffuse large B-cell lymphoma) were categorized into 3 types, depending on the geometric relationship between the planning target volume (PTV) and kidneys. AP/PA and 3D conformal radiation therapy (3DCRT) plans were generated for each patient. IMRT was planned for 4 patients with challenging geometric relationship between the PTV and the kidneys to determine whether it was advantageous to use IMRT.Results: For type I patients (no overlap between PTV and kidneys), there was essentially no benefit from using 3DCRT over AP/PA. However, for patients with PTVs in close proximity to the kidneys (type II) or with high degree of overlap (type III), the 4-field 3DCRT plans were superior, reducing the kidney V-15 Gy by approximately 90% for type II and 50% for type III patients. For type III, the use of a 3DCRT plan rather than an AP/PA plan decreased the V-II Gy by approximately 65% for the right kidney and 45% for the left kidney. In the selected cases, IMRT led to a further decrease in left kidney dose as well as in mean liver dose.Conclusions: The geometric relationship between the target and kidneys has a significant impact on the selection of the optimum beam arrangement. Using 4-field 3DCRT markedly decreases the kidney dose. The addition of IMRT led to further incremental improvements in the left kidney and liver dose in selected patients. (c) 2005 Elsevier Inc.