Individualized image guided iso-NTCP based liver cancer SBRT
Individualized image guided iso-NTCP based liver cancer SBRT
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DOI：
10.1080/02841860600936369
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发表时间：
2006-09-01
期刊：
影响因子：
3.1
通讯作者：
Craig, Tim
中科院分区：
文献类型：
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作者：
Dawson, Laura A.;Eccles, Cynthia;Craig, Tim
一种高度个性化的立体定向全身放射治疗(SBRT)策略被开发出来，以允许广泛的肝癌患者接受治疗。这项I/II阶段的研究包括固定的个体化、放射计划、PTV边缘确定、图像引导策略和处方剂量。在可行的情况下，使用主动呼吸控制屏气来固定肝脏。图像引导策略包括以横隔膜为肝脏替代物的正交MV图像和正交千伏透视，以及以肝脏或肿瘤为引导的千伏锥束CT。处方剂量是个性化的，以保持相同的估计放射性肝病(RILD)风险，基于正常组织并发症概率(NTCP)模型，最大允许剂量为60Gy6次。自2003年8月以来，共收治肝细胞癌33例，肝内胆管细胞癌12例，肝转移癌34例。肿瘤体积中位数为293cm3(2.9~3088cm3)。中位剂量为36.6Gy24.0Gy57.0Gy6次。照射后肝脏有效体积的中位数为45%(9-80%)。60%的患者接受了屏气固定肝脏的治疗。重复屏气的肝脏的分数内重复性(Sigma)很好(1.5 mm)，但分数间重复性(Sigma)较差(3.4 mm)。成像制导显著降低了残馀的系统误差和随机误差。
A highly individualized stereotactic body radiotherapy (SBRT) strategy was developed to allow a wide spectrum of patients with liver cancer to be treated. This phase I/II study encompasses individualization of immobilization, radiation planning, PTV margin determination, image guidance strategy and prescription dose. Active breathing control breath hold is used to immobilize the liver when feasible. Image guidance strategies include orthogonal MV images and orthogonal kV fluoroscopy using the diaphragm for a surrogate for the liver, and kV cone beam CT using the liver or tumour for guidance. The prescription dose is individualized to maintain the same estimated risk of radiation-induced liver disease (RILD), based on a normal tissue complication probability (NTCP) model, with a maximum permitted dose of 60 Gy in 6 fractions. Since August 2003, 79 patients with hepatocellular carcinoma (33), intrahepatic cholangiocarcinoma (12) and liver metastases ( 34) were treated. The median tumour volume was 293 cm 3 (2.9 - 3 088 cm 3). The median prescribed dose was 36.6 Gy ( 24.0 Gy - 57.0 Gy) in 6 fractions. The median effective liver volume irradiated was 45% (9 - 80%). Sixty percent of patients were treated with breath hold to immobilize their liver. Intra-fraction reproducibility (sigma) of the liver with repeat breath holds was excellent (1.5 mm); however inter-fraction reproducibility (sigma) was worse (3.4 mm). Image guidance reduced the residual systematic and random setup errors significantly.