THE USE OF 3-D-DOSE VOLUME ANALYSIS TO PREDICT RADIATION HEPATITIS
THE USE OF 3-D-DOSE VOLUME ANALYSIS TO PREDICT RADIATION HEPATITIS
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DOI：
10.1016/0360-3016(92)90651-w
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
LICHTER, AS
中科院分区：
文献类型：
--
作者：
LAWRENCE, TS;TENHAKEN, RK;LICHTER, AS
虽然众所周知，肝脏对外部射线照射的耐受性取决于受照射肝脏的体积，但很少有数据能够量化这种依赖性。因此，我们的临床试验进行了审查，为治疗肝内恶性肿瘤，其中提供的辐射剂量取决于治疗的正常肝脏的体积。所有患者均使用正常肝脏剂量-体积直方图分析的三维治疗计划。治疗的79例患者中有9例发生临床放射性肝炎。评估的患者相关变量均与放射性肝炎无关。所有发生放射性肝炎的患者均接受全肝照射，作为其治疗的全部或部分，其产生的平均剂量大于或等于37戈伊。剂量体积直方图用于计算正常组织并发症概率的基础上从文献中获得的参数。在接受高剂量放射治疗的患者中，并发症的风险被大大高估。基于临床结果的模型参数估计表明，“体积效应参数”的幅度大于文献估计值（n = 0.69 +/- 0.05 vs 0.32; p < 0.00 1）。使用较大的n值计算正常组织并发症概率，可以很好地描述观察到的放射性肝炎风险。这些结果表明，剂量体积直方图分析可以用来量化肝脏的辐射耐受性。正常组织并发症概率模型的参数化的预测值需要用来自独立临床试验的肝脏耐受性和剂量体积直方图数据进行测试。
Although it is well known that the tolerance of the liver to external beam irradiation depends on the volume of liver irradiated, few data exist which quantify this dependence. Therefore, a review was carried out of our clinical trial for the treatment of intrahepatic malignancies in which the dose of radiation delivered depended on the volume of normal liver treated. Three dimensional treatment planning using dose-volume histogram analysis of the normal liver was used for all patients. Nine of the 79 patients treated developed clinical radiation hepatitis. None of the patient related variables assessed were associated with radiation hepatitis. All patients who developed radiation hepatitis received whole liver irradiation, as all or part of their treatment, which produced a mean dose greater-than-or-equal-to 37 Gy. Dose volume histograms were used to calculate normal tissue complication probabilities based on parameters derived from the literature. The risk of complication was greatly overestimated among patients receiving a high dose of radiation to part of the liver without whole liver treatment. An estimation of model parameters based on the clinical results indicated a larger magnitude for the "volume effect parameter" than the literature estimate (n = 0.69 +/- 0.05 vs 0.32; p < 0.00 1). Computation of the normal tissue complication probabilities using the larger value of n produced a good description of the observed risk of radiation hepatitis. These findings suggest that dose volume histogram analysis can be used to quantify the tolerance of the liver to radiation. The predictive value of this parameterization of the normal tissue complication probability model will need to be tested with liver tolerance and dose volume histogram data from an independent clinical trial.