Quality of interstitial PDR-brachytherapy-implants of head-and-neck-cancers: Predictive factors for local control and late toxicity?
Quality of interstitial PDR-brachytherapy-implants of head-and-neck-cancers: Predictive factors for local control and late toxicity?
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DOI：
10.1016/j.radonc.2006.12.004
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发表时间：
2007-02-01
影响因子：
5.7
通讯作者：
Strnad, Vratislav
中科院分区：
文献类型：
--
作者：
Melzner, Winfrid J.;Lotter, Michael;Strnad, Vratislav
背景和目的：在低剂量率近距离放射治疗的基础上，提出了用于描述组织间近距离放射治疗中体积植入质量的植入体几何形状相关参数和指标。我们的研究的目的是评估其有用性预测晚期毒性和局部控制的PDR-近距离放射治疗的head-andneck-tumors.Patients和方法：2000年1月至2004年10月，210例患者进行了治疗与PDR-近距离放射治疗，这是管理无论是术后或作为确定性治疗。在某些情况下，近距离放射治疗被用作唯一治疗，而在其他情况下，与EBRT相结合。为了评估植入物的质量，我们使用单变量卡方检验和多变量逻辑回归分析分析了以下指标和参数：V85、V120和V150（由85%、120%和150%等剂量表面包围的体积），UI（均匀度指数），QI（质量指数），HI（均匀性指数），VGR（体积梯度比），DNR（剂量不均匀性比），LD（低剂量），HD（高剂量），PD（峰值剂量）和源间间距。在中位随访24个月（4-50个月）后，软组织坏死（通常为一过性）的发生率为11%，放射性骨坏死（ORN）发生率为7.6%，局部复发率为7%。单变量分析显示V85对软组织坏死的发展有显著影响，HD和PD对放射性骨坏死有显著影响。在多变量分析中，发现软组织坏死与QI之间存在相关性。对于局部控制，使用单变量分析发现与QI、VGR和最小管距之间存在相关性。在头颈部肿瘤中使用间质PDR近距离放射治疗，局部控制和软组织坏死或骨放射性坏死的发展的概率取决于剂量和体积参数，如参考等剂量的体积，高剂量值和峰值剂量值与剂量分布的均匀性有关，通过质量指数或体积梯度比以及最小管距进行量化。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Background and Purpose: Parameters and indices related to the implant geometry in use for describing the quality of volume implants in interstitial brachytherapy were developed on the basis of LDR-brachytherapy. The aim of our study was to evaluate their usefulness for predicting late toxicity and local control in the PDR-brachytherapy of head-andneck-tumors.Patients and methods: Between January 2000 and October 2004, 210 patients were treated with PDR-brachytherapy which was administered either postoperatively or as definitive treatment. Brachytherapy was used as sole treatment in some cases while in others a combination with EBRT was used. For assessment of quality of implants we analyzed the following indices and parameters using the univariate chi(2) test and multivariate logistic regression analysis: V85, V120 and V150 (volume enclosed by the surface of the 85%-, 120%- and 150%-isodose), UI (uniformity index), QI (quality index), HI (homogeneity index), VGR (volume gradient ratio), DNR (dose non-uniformity ratio), LD (low dose), HD (high dose), PD (peak dose) and the intersource spacing.Results: After a median follow-up of 24 months (4-50) the rate of - usually transient - soft tissue necrosis (STN) was 11%, osteoradionecrosis (ORN) was seen in 7.6% of cases and local relapse occurred in 7% of cases. Univariate analysis shows a significant influence on the development of soft tissue necrosis for V85, and on osteoradionecrosis for HD and PD. In the multivariate analysis a correlation between soft tissue necrosis and QI was found. For local control a correlation with QI, VGR and minimal tube distance was found using univariate analysis.Conclusions: Using interstitial PDR-brachytherapy in head-and-neck-tumors the probability of local control and of the development of soft tissue necrosis or osteoradionecrosis is dependent on dose and volume parameter like the volume of the reference isodose, the high and peak dose values, on the homogeneity of the dose distribution, quantified by the quality index or the volume gradient ratio as well on the minimal tube distance. (c) 2007 Elsevier Ireland Ltd. All rights reserved.