Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans
Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans
复制标题
DOI：
10.1186/1748-717x-2-41
复制
发表时间：
2007-11-15
影响因子：
3.6
通讯作者：
Fenoglietto, Pascal
中科院分区：
文献类型：
--
作者：
Menkarios, Cathy;Azria, David;Fenoglietto, Pascal
背景资料：比较三种不同的调强放射治疗（IMRT）计划的剂量学优势的三维（3D）的常规放射治疗肛门癌的器官在危险（OAR）avoidance，包括髂骨bone marrow.Methods：5例T1 - 3 N0 - 1肛门癌和5例T4和/或N2 - 3肿瘤被选中。临床肿瘤体积（CTV）包括肿瘤、肛管和腹股沟、直肠周围和髂内/髂外淋巴结（T4/N2 - 3肿瘤加上骶前淋巴结）。生成了四个计划：（A）具有3D适形增强的AP/PA，（B）具有适形增强的骨盆IMRT，（C）具有IMRT增强的骨盆IMRT和（D）具有同时整合增强的IMRT（SI B）。计划（A）至（C）的剂量为45戈伊/25，随后为14.4戈伊/8加强，计划（D）（SIB）的总剂量为59.4戈伊/33。PTV和OAR数量的覆盖范围（小肠、生殖器、髂嵴和股骨头）接受超过10、20、30和40戈伊（V10，V20，V30，V40）进行非参数统计比较。与计划（A）相比，IMRT计划（B）至（D）显著降低了所有患者小肠、膀胱和生殖器的V30和V40。N0 - 1组的髂嵴V10和V20相似，但N2 - 3/T4组的IMRT显著降低（A组V20 = 50.2%，B组= 33%，C组= 32.8%，D组= 34.3%）。2期（C臂）和单期（SIB，D臂）IMRT plannes.Conclusion：IMRT是上级三维适形放射治疗肛门癌方面保留OAR，包括骨髓保留无统计学差异。
Background: To compare the dosimetric advantage of three different intensity-modulated radiation therapy (IMRT) plans to a three dimensional (3D) conventional radiation treatment for anal cancer with regards to organs-at-risk (OAR) avoidance, including iliac bone marrow.Methods: Five patients with T1-3 N0-1 anal cancer and five with T4 and/or N2-3 tumors were selected. Clinical tumor volume (CTV) included tumor, anal canal and inguinal, peri-rectal, and internal/external iliac nodes (plus pre-sacral nodes for T4/N2-3 tumors). Four plans were generated: (A) AP/PA with 3D conformal boost, (B) pelvic IMRT with conformal boost (C) pelvic IMRT with IMRT boost and ( D) IMRT with simultaneous integrated boost (SIB). The dose for plans (A) to (C) was 45 Gy/25 followed by a 14.4 Gy/8 boost, and the total dose for plan (D) (SIB) was 59.4 Gy/33. Coverage of both PTV and the volume of OAR (small bowel, genitalia, iliac crest and femoral heads) receiving more than 10, 20, 30, and 40 Gy (V10, V20, V30, V40) were compared using non parametric statistics.Results: Compared to plan (A), IMRT plans (B) to (D) significantly reduced the V30 and V40 of small bowel, bladder and genitalia for all patients. The V10 and V20 of iliac crests were similar for the N0-1 group but were significantly reduced with IMRT for the N2-3/T4 group (V20 for A = 50.2% compared to B = 33%, C = 32.8%, D = 34.3%). There was no statistical difference between 2-phase (arm C) and single-phase (SIB, arm D) IMRT plans.Conclusion: IMRT is superior to 3D conformal radiation treatment for anal carcinoma with respect to OAR sparing, including bone marrow sparing.