Effective Dose Reduction to Cardiac Structures Using Protons Compared With 3DCRT and IMRT in Mediastinal Hodgkin Lymphoma
Effective Dose Reduction to Cardiac Structures Using Protons Compared With 3DCRT and IMRT in Mediastinal Hodgkin Lymphoma
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DOI：
10.1016/j.ijrobp.2011.12.034
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发表时间：
2012-10-01
影响因子：
7
通讯作者：
Mendenhall, Nancy P.
中科院分区：
文献类型：
--
作者：
Hoppe, Bradford S.;Flampouri, Stella;Mendenhall, Nancy P.
目的：研究质子治疗（PT）对霍奇金淋巴瘤（HL）患者各种心脏亚单位的剂量学影响。方法和材料：从2009年6月到2010年12月，13名患者参加了机构审查委员会批准的HL合并受病灶淋巴结放疗（INRT）方案。通过三维适形放疗（3DCRT）、调强放疗（IMRT）和PT，前瞻性地制定了三种独立的治疗方案。通过静脉造影剂模拟扫描对11例患者的心脏亚单位进行回顾性轮廓，并计算所有治疗方案的剂量。采用Wilcoxon配对检验，比较3DCRT、IMRT治疗与PT治疗的差异有统计学意义（p < 0.05）。结果：3DCRT、IMRT、PT治疗的心脏平均剂量分别为21 Gy、12 Gy、8 Gy（相对生物效应[RBE]）。与3DCRT和IMRT相比，PT降低左、右心房平均剂量；左心室和右心室；主动脉瓣、二尖瓣和三尖瓣；还有左前降支，左旋冠状动脉和右旋冠状动脉。结论：与3DCRT和IMRT相比，PT降低了对心脏各主要亚单位的辐射剂量。限制这些结构的剂量应该可以降低心脏毒性的发生率。(C) 2012爱思唯尔公司
Purpose: We investigated the dosimetric impact of proton therapy (PT) on various cardiac subunits in patients with Hodgkin lymphoma (HL).Methods and Materials: From June 2009 through December 2010, 13 patients were enrolled on an institutional review board-approved protocol for consolidative involved-node radiotherapy (INRT) for HL. Three separate treatment plans were developed prospectively by using three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and PT. Cardiac subunits were retrospectively contoured on the 11 patients with intravenous-contrast simulation scans, and the doses were calculated for all treatment plans. A Wilcoxon paired test was performed to evaluate the statistical significance (p < 0.05) of 3DCRT and IMRT compared with PT.Results: The mean heart doses were 21 Gy, 12 Gy, and 8 Gy (relative biologic effectiveness [RBE]) with 3DCRT, IMRT, and PT, respectively. Compared with 3DCRT and IMRT, PT reduced the mean doses to the left and right atria; the left and right ventricles; the aortic, mitral, and tricuspid valves; and the left anterior descending, left circumflex, and right circumflex coronary arteries.Conclusions: Compared with 3DCRT and IMRT, PT reduced the radiation doses to all major cardiac subunits. Limiting the doses to these structures should translate into lower rates of cardiac toxicities. (C) 2012 Elsevier Inc.