Analysis of esophageal-sparing treatment plans for patients with high-grade esophagitis.
Analysis of esophageal-sparing treatment plans for patients with high-grade esophagitis.
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DOI：
10.1120/jacmp.v14i4.4248
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发表时间：
2013-07-08
影响因子：
2.1
通讯作者：
Court LE
中科院分区：
文献类型：
--
作者：
Niedzielski J;Bluett JB;Williamson RT;Liao Z;Gomez DR;Court LE
我们回顾性地为14例发生2级或3级食管炎（CTCAE 3.0版）的NSCLC患者制定了IMRT计划。我们生成了11射束和减少食管剂量计划类型，以比较接受50、55、60、65和70戈伊剂量的食管体积和长度的变化。还比较了计划目标体积（PTV）剂量覆盖范围的变化。如有必要，计划将重新规范化，以恢复95%的PTV覆盖率。检查的关键器官剂量为平均肺剂量、平均心脏剂量和接受50戈伊的脊髓体积。通过对剂量网格应用三维刚性位移来确定分次间运动的影响。对于食管计划，与临床计划相比，食管V50、V55、V60、V65和V70戈伊的平均减少量分别为2.8、4.1、5.9、7.3和9.5 cm 3。LE50、LE55、LE60、LE65和LE70戈伊的平均减少分别为2.0、3.0、3.8、4.0和4.6 cm。心脏和肺的平均剂量分别减少3.0戈伊和2.4戈伊。在90%和95% PTV覆盖率的平均下降分别为1.7戈伊和2.8戈伊。与临床计划相比，标准化计划的食管V50、V55、V60、V65和V70戈伊平均减少量分别为1.6、2.0、2.9、3.9和5.5 cm 3。标准化计划的LE50、LE55、LE60、LE65和LE70戈伊平均减少量分别为4.9、5.2、5.4、4.9和4.8 cm。临床计划类型和食管计划类型的模拟分次间运动的最大食管剂量平均减少分别为3.0戈伊和1.4戈伊。在许多情况下，食管剂量可以大大减少，同时保持关键结构剂量限制。PTV覆盖范围可以通过增加射束输出来恢复，同时仍然获得食管剂量减少并保持剂量限制。PACS编号：87.53 Tf
We retrospectively generated IMRT plans for 14 NSCLC patients who had experienced grade 2 or 3 esophagitis (CTCAE version 3.0). We generated 11‐beam and reduced esophagus dose plan types to compare changes in the volume and length of esophagus receiving doses of 50, 55, 60, 65, and 70 Gy. Changes in planning target volume (PTV) dose coverage were also compared. If necessary, plans were renormalized to restore 95% PTV coverage. The critical organ doses examined were mean lung dose, mean heart dose, and volume of spinal cord receiving 50 Gy. The effect of interfractional motion was determined by applying a three‐dimensional rigid shift to the dose grid. For the esophagus plan, the mean reduction in esophagus V50, V55, V60, V65, and V70 Gy was 2.8, 4.1, 5.9, 7.3, and 9.5 cm3, respectively, compared with the clinical plan. The mean reductions in LE50, LE55, LE60, LE65, and LE70 Gy were 2.0, 3.0, 3.8, 4.0, and 4.6 cm, respectively. The mean heart and lung dose decreased 3.0 Gy and 2.4 Gy, respectively. The mean decreases in 90% and 95% PTV coverage were 1.7 Gy and 2.8 Gy, respectively. The normalized plans’ mean reduction of esophagus V50, V55, V60, V65, and V70 Gy were 1.6, 2.0, 2.9, 3.9, and 5.5 cm3, respectively, compared with the clinical plans. The normalized plans’ mean reductions in LE50, LE55, LE60, LE65, and LE70 Gy were 4.9, 5.2, 5.4, 4.9, and 4.8 cm, respectively. The mean reduction in maximum esophagus dose with simulated interfractional motion was 3.0 Gy and 1.4 Gy for the clinical plan type and the esophagus plan type, respectively. In many cases, the esophagus dose can be greatly reduced while maintaining critical structure dose constraints. PTV coverage can be restored by increasing beam output, while still obtaining a dose reduction to the esophagus and maintaining dose constraints. PACS number: 87.53 Tf