Assessing the robustness of passive scattering proton therapy with regard to local recurrence in stage III non-small cell lung cancer: a secondary analysis of a phase II trial.
Assessing the robustness of passive scattering proton therapy with regard to local recurrence in stage III non-small cell lung cancer: a secondary analysis of a phase II trial.
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DOI：
10.1186/1748-717x-9-108
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发表时间：
2014-05-06
期刊：
影响因子：
--
通讯作者：
Chang JY
中科院分区：
文献类型：
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作者：
Zhu Z;Liu W;Gillin M;Gomez DR;Komaki R;Cox JD;Mohan R;Chang JY
我们通过使用最坏情况方法评估了被动散射质子治疗（PSPT）计划对III期非小细胞肺癌（NSCLC）患者的II期试验的稳健性，并将最坏情况剂量分布与局部复发病变的外观进行了比较。通过模拟和纳入计划过程中与设置、呼吸诱导的器官运动和质子范围相关的不确定性，对9例III期NSCLC在同步化疗和PSPT至74 Gy（RBE）后复发的患者产生最坏情况剂量分布。然后将最坏情况的CT扫描与正电子发射断层扫描（PET）融合以定位复发。尽管在最坏情况剂量分布中，处方等剂量线所包围的体积始终小于标称计划中所包围的体积，但目标剂量覆盖范围并未受到显著影响：在最坏情况计划中，只有一名患者在处方等剂量线之外复发。PSPT是一种相对健壮的技术。9例中有8例的局部复发与由于估计不确定而导致的靶剂量不足无关。
We assessed the robustness of passive scattering proton therapy (PSPT) plans for patients in a phase II trial of PSPT for stage III non-small cell lung cancer (NSCLC) by using the worst-case scenario method, and compared the worst-case dose distributions with the appearance of locally recurrent lesions. Worst-case dose distributions were generated for each of 9 patients who experienced recurrence after concurrent chemotherapy and PSPT to 74 Gy(RBE) for stage III NSCLC by simulating and incorporating uncertainties associated with set-up, respiration-induced organ motion, and proton range in the planning process. The worst-case CT scans were then fused with the positron emission tomography (PET) scans to locate the recurrence. Although the volumes enclosed by the prescription isodose lines in the worst-case dose distributions were consistently smaller than enclosed volumes in the nominal plans, the target dose coverage was not significantly affected: only one patient had a recurrence outside the prescription isodose lines in the worst-case plan. PSPT is a relatively robust technique. Local recurrence was not associated with target underdosage resulting from estimated uncertainties in 8 of 9 cases.