ADAPTIVE DOSE PAINTING BY NUMBERS FOR HEAD-AND-NECK CANCER
ADAPTIVE DOSE PAINTING BY NUMBERS FOR HEAD-AND-NECK CANCER
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DOI：
10.1016/j.ijrobp.2010.03.028
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发表时间：
2011-07-15
影响因子：
7
通讯作者：
Madani, Indira
中科院分区：
文献类型：
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作者：
Duprez, Frederic;De Neve, Wilfried;Madani, Indira
目的：探讨数字剂量绘画（DPBN）调强适形放射治疗（IMRT）治疗头颈部癌的可行性。方法和材料：每位患者的治疗采用三种不同的治疗计划：部分1-10使用DPBN（[（18）-F]nuoro-2-deoxy-D-glucose positron emission tomography [F-18-FDG-PET]）基于体素强度的IMRT计划，该计划基于预处理F-18-FDG-PET。FDG-PET/计算机断层扫描（CT）;第11-20次使用基于第8次后采集的F-18-FDG-PET/CT扫描的DPBN计划;第21-32次使用常规（均匀剂量）IMRT计划。在I期试验中，测试了两个剂量处方水平：高剂量临床靶体积（CTVhigh_dose）的中位剂量为80.9戈伊（剂量水平I），总肿瘤体积（GTV）的中位剂量为85.9戈伊（剂量水平II）。2007年2月至2009年8月，剂量水平I组7例，剂量水平II组14例。治疗适应（即，基于第二次F-18-FDG-PET/CT扫描的计划）减少了GTV的体积（41.%，p = 0.01）、CTVhigh_dose（18%，p = 0.01）、高剂量计划靶体积（14%，p = 0.02）和腮腺（9- 12%，p < 0.05）。由于GTV远小于CTVhigh_dose和目标适应，剂量水平II的进一步剂量递增导致的毒性严重程度低于剂量水平I。结论：据我们所知，这是第一项将适应性治疗与数字剂量绘制相结合的临床研究。如上所述的治疗是可行的。(C)2011 Elsevier Inc.
Purpose: To investigate the feasibility of adaptive intensity-modulated radiation therapy (IMRT) using dose painting by numbers (DPBN) for head-and-neck cancer.Methods and Materials: Each patient's treatment used three separate treatment plans: fractions 1-10 used a DPBN ([(18)-F]nuoro-2-deoxy-D-glucose positron emission tomography [F-18-FDG-PET]) voxel intensity-based IMRT plan based on a pretreatment F-18-FDG-PET/computed tomography (CT) scan; fractions 11-20 used a DPBN plan based on a F-18-FDG-PET/CT scan acquired after the eighth fraction; and fractions 21-32 used a conventional (uniform dose) IMRT plan. In a Phase I trial, two dose prescription levels were tested: a median dose of 80.9 Gy to the high-dose clinical target volume (CTVhigh_dose) (dose level I) and a median dose of 85.9 Gy to the gross tumor volume (GTV) (dose level II). Between February 2007 and August 2009, 7 patients at dose level I and 14 patients at dose level II were enrolled.Results: All patients finished treatment without a break, and no Grade 4 acute toxicity was observed. Treatment adaptation (i.e., plans based on the second F-18-FDG-PET/CT scan) reduced the volumes for the GTV (41.%, p = 0.01), CTVhigh_dose (18%, p = 0.01), high-dose planning target volume (14%, p = 0.02), and parotids (9-12%, p < 0.05). Because the GTV was much smaller than the CTVhigh_dose and target adaptation, further dose escalation at dose level II resulted in less severe toxicity than that observed at dose level I.Conclusion: To our knowledge, this represents the first clinical study that combines adaptive treatments with dose painting by numbers. Treatment as described above is feasible. (C) 2011 Elsevier Inc.