Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation
Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation
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DOI：
10.1080/02841860600907329
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发表时间：
2006-09-01
期刊：
影响因子：
3.1
通讯作者：
Mehta, Minesh P.
中科院分区：
文献类型：
--
作者：
Hodge, Wes;Tome, Wolfgang A.;Mehta, Minesh P.
我们报告的技术可行性，剂量测定方面，和日常的图像引导能力与兆伏CT（MVCT）的立体定向体部放疗（SBRT）使用螺旋断层治疗医学上不能手术的T1/2 N 0 M0非小细胞肺癌。9名患者在双真空固定系统中接受了4D-CT治疗计划，以最大限度地减少肿瘤运动并定义病变特异性4D运动包络。患者在10天内分5次接受60戈伊治疗，达到PTV，PTV由运动包络加上6 mm的显微镜扩展和使用断层治疗的设置错误定义，每日预处理MVCT图像引导。主要终点是技术可行性。次要终点是定义急性和亚急性毒性以及肿瘤缓解。45个组分中有43个成功递送，平均递送时间为22分钟。MVCT为日常图像引导提供了极好的肿瘤可视化。在治疗期间，在任何患者的MVCT上均未观察到显著的肿瘤消退。中位平均标准化总剂量为：肿瘤117戈伊（10）;残留肺9戈伊（3）。最大分割尺寸等效剂量值为：食管5戈伊（3）（9）;脊髓7戈伊（3）（6）。无患者发生≥ 2级肺毒性。观察到3例完全缓解、4例部分缓解和2例稳定缓解，中位随访时间< 3个月。平均肿瘤消退为72%。使用断层治疗的SBRT被证明是可行的，安全的，没有重大的技术限制或急性毒性。每日治疗前MVCT成像允许患者在实际治疗位置上进行精确的每日肿瘤靶向，因此提供了精确的图像引导。
We report on the technical feasibility, dosimetric aspects, and daily image-guidance capability with megavoltage CT (MVCT) of stereotactic body radiotherapy (SBRT) using helical tomotherapy for medically inoperable T1/2 N0 M0 non-small cell lung cancer. Nine patients underwent treatment planning with 4D-CT in a double vacuum based immobilization system to minimize tumor motion and to define a lesion-specific 4D-motion envelope. Patients received 60 Gy in 5 fractions within 10 days to a PTV defined by a motion envelope plus a 6 mm expansion for microscopic extension and setup error using tomotherapy, with daily pretreatment MVCT image guidance. The primary endpoint was technical feasibility. Secondary endpoints were defining the acute and sub-acute toxicities and tumor response. Forty three of 45 fractions were successfully delivered, with an average delivery time of 22 minutes. MVCT provided excellent tumor visualization for daily image guidance. No significant tumor regression was observed on MVCT in any patient during therapy. Median mean normalized total doses were: tumor 117 Gy(10); residual lung 9 Gy(3). Maximum fraction-size equivalent dose values were: esophagus 5 Gy(3)(9); cord 7 Gy(3)(6). No patient experienced >= grade 2 pulmonary toxicity. 3 complete, 4 partial and 2 stable responses were observed, with < 3 months median follow-up. The mean tumor regression is 72%. SBRT using tomotherapy proved to be feasible, safe and free of major technical limitations or acute toxicities. Daily pretreatment MVCT imaging allows for precise daily tumor targeting with the patient in the actual treatment position, and therefore provides for precise image guidance.