Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer.
Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer.
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DOI：
10.1016/j.ijrobp.2008.05.014
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发表时间：
2008-09-01
影响因子：
7
通讯作者：
Liao, Zhongxing
中科院分区：
文献类型：
--
作者：
Zhang, Xiaodong;Zhao, Kuai-le;Guerrero, Thomas M.;Mcguire, Sean E.;Yaremko, Brian;Komaki, Ritsuko;Cox, James D.;Hui, Zhouguang;Li, Yupeng;Newhauser, Wayne D.;Mohan, Radhe;Liao, Zhongxing
比较食管癌质子治疗或调强放射治疗（IMRT）的基于三维（3D）和4D计算机断层扫描（CT）的治疗计划对肺、心脏和脊髓的剂量以及靶区覆盖和正常组织保留的变化。15例食管远端癌患者的调强放疗和质子计划是根据3D平均CT扫描设计的，然后在10个4D CT数据集上重新计算。比较肿瘤覆盖和正常组织保留的剂量数据。与调强放疗相比，两束质子计划暴露于5、10和20戈伊的中位肺体积和平均肺剂量分别减少35.6%、20.5%、5.8%和5.1戈伊，三束质子计划分别减少17.4%、8.4%、5%和2.9戈伊。与IMRT计划（CI=1.55，心脏-V40 =35.7%）或三束质子计划（CI =1.46，心脏-V40 =27.7%）相比，双束质子计划中实现了更大的肺部保护，但代价是对目标的符合性较差（符合性指数CI=1.99）和对心脏的照射更大（心脏-V40 =41.8%）。对于在三束质子和IMRT计划中有大量横膈膜运动的患者，3D和4D计划之间的目标覆盖率差异超过2%。对于质子计划，3D和4D计划之间的脊髓最大剂量差异可能超过5戈伊，部分原因是胃充气的变化。质子治疗提供了显着更好的保留肺比调强放疗。在评估靶区覆盖和脊髓剂量时，必须考虑膈肌运动和胃充气。
To compare three-dimensional (3D) and 4D computed tomography (CT)– based treatment plans for proton therapy or intensity-modulated radiation therapy (IMRT) for esophageal cancer in terms of doses to the lung, heart, and spinal cord and variations in target coverage and normal tissue sparing. IMRT and proton plans for 15 patients with distal esophageal cancer were designed from the 3D average CT scans and then recalculated on 10 4D CT data sets. Dosimetric data were compared for tumor coverage and normal tissue sparing. Compared with IMRT, median lung volumes exposed to 5,10, and 20 Gy and mean lung dose were reduced by 35.6%, 20.5%,5.8%, and 5.1 Gy for a two-beam proton plan and by 17.4%,8.4%,5%, and 2.9 Gy for a three-beam proton plan. The greater lung sparing in the two-beam proton plan was achieved at the expense of less conformity to the target (conformity index CI=1.99) and greater irradiation of the heart (heart-V40=41.8%) compared with the IMRT plan(CI=1.55, heart-V40=35.7%) or the three-beam proton plan (CI=1.46, heart-V40=27.7%). Target coverage differed by more than 2% between the 3D and 4D plans for patients with substantial diaphragm motion in the three-beam proton and IMRT plans. The difference in spinal cord maximum dose between 3D and 4D plans could exceed 5 Gy for the proton plans partly owing to variations in stomach gas-filling. Proton therapy provided significantly better sparing of lung than did IMRT. Diaphragm motion and stomach gas-filling must be considered in evaluating target coverage and cord doses.
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