Helical and Static-port Tomotherapy Using the Newly-developed Dynamic Jaws Technology for Lung Cancer.
Helical and Static-port Tomotherapy Using the Newly-developed Dynamic Jaws Technology for Lung Cancer.
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DOI：
10.7785/tcrtexpress.2013.600280
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发表时间：
2015-10
影响因子：
2.8
通讯作者：
Yanagi T
中科院分区：
文献类型：
--
作者：
Manabe Y;Shibamoto Y;Sugie C;Hayashi A;Murai T;Yanagi T
利用新开发的动态钳口技术，可以在断层治疗中降低靶区头尾边缘的辐射剂量。我们比较了肺癌的动态颌和固定颌模式计划。在35例患者中，生成了使用2.5 cm动态、2.5 cm固定、5.0 cm动态和5.0 cm固定钳口模式的4个计划。对10例上叶I期肺癌患者，采用螺旋断层治疗模式。规定五十六戈伊分8次作为95%靶区（D95%）的最小覆盖剂量。对于25例局部晚期肺癌患者，制定了使用四个静态端口（TomoDirect®模式）的计划。原发性肿瘤和淋巴结肿大的剂量为60戈伊，每日30次;预防性淋巴结区域的剂量为51戈伊，每日30次。四个计划的计划靶体积的平均符合性指数相似。2.5 cm动态、2.5 cm固定、5.0 cm动态和5.0 cm固定钳口模式计划的肺平均V5戈伊分别为18.5%、21.8%、20.1%和29.4（p <0.0001），局部晚期肺癌患者分别为37.3%、38.7%、40.4%和44.0%（p <0.0001）。I期肺癌患者全身平均V5戈伊分别为1，826、2，143、1，983和2，939 ml（p <0.0001），局部晚期肺癌患者分别为4，849、5，197、5，220和6，154 ml（p <0.0001）。与2.5 cm计划相比，5.0 cm动态钳口计划的治疗时间缩短了21 - 39%。关于剂量分布，2.5 cm动态颌计划最佳，5.0 cm动态颌计划与2.5 cm固定颌计划相当，治疗时间更短。在肺癌断层治疗中，应采用动态颌模式代替传统的固定颌模式。
With the newly developed dynamic jaws technology, radiation dose for the cranio-caudal edges of a target can be lowered in the treatment with tomotherapy. We compared dynamic-jaw- and fixed-jaw-mode plans for lung cancer. In 35 patients, four plans using the 2.5-cm dynamic-, 2.5-cm fixed-, 5.0-cm dynamic-, and 5.0-cm fixed-jaw modes were generated. For 10 patients with upper lobe stage I lung cancer, the helical tomotherapy mode was used. Fifty-six Gy in 8 fractions was prescribed as a minimum coverage dose for 95% of the target (D95%). For 25 patients with locally advanced lung cancer, plans using four static ports (TomoDirect® mode) were made. Sixty Gy in 30 daily fractions for the primary tumor and swollen lymph nodes and 51 Gy in 30 fractions for prophylactic lymph node areas were prescribed as median doses. The mean conformity index of the planning target volume were similar among the four plans. The mean V5 Gy of the lung for 2.5-cm dynamic-, 2.5-cm fixed-, 5.0-cm dynamic-, and 5.0-cm fixed-jaw mode plans were 18.5%, 21.8%, 20.1%, and 29.4%, respectively (p < 0.0001), for patients with stage I lung cancer, and 37.3%, 38.7%, 40.4%, and 44.0%, respectively (p < 0.0001), for patients with locally advanced lung cancer. The mean V5 Gy of the whole body was 1,826, 2,143, 1,983, and 2,939 ml, respectively (p < 0.0001), for patients with stage I lung cancer and 4,849, 5,197, 5,220, and 6,154 ml, respectively (p < 0.0001), for patients with locally advanced lung cancer. Treatment time was reduced by 21-39% in 5.0-cm dynamic-jaw plans compared to 2.5-cm plans. Regarding dose distribution, 2.5-cm dynamic-jaw plans were the best, and 5.0-cm dynamic-jaw plans were comparable to 2.5-cm fixed-jaw plans with shorter treatment times. The dynamic-jaw mode should be used instead of the conventional fixed-jaw mode in tomotherapy for lung cancer.