Voxel-based population analysis for correlating local dose and rectal toxicity in prostate cancer radiotherapy
Voxel-based population analysis for correlating local dose and rectal toxicity in prostate cancer radiotherapy
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DOI：
10.1088/0031-9155/58/8/2581
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发表时间：
2013-04-21
影响因子：
3.5
通讯作者：
de Crevoisier, Renaud
中科院分区：
文献类型：
--
作者：
Acosta, Oscar;Drean, Gael;de Crevoisier, Renaud
目前用于预测前列腺癌放射治疗毒性的大多数模型是基于剂量-体积直方图。它们的主要缺点之一是缺乏空间准确性，因为它们将器官视为一个整体体积，从而忽略了器官内放射敏感性的异质性。在本文中，我们提出了一个基于剂量图像的框架，以揭示局部剂量和毒性之间的关系。在该方法中，跨群体的三维（3D）计划剂量分布被非刚性地配准到公共坐标系中并且在体素水平进行比较，因此使得能够识别3D解剖图案，这可能至少在某种程度上导致毒性。此外，还采用了不同的指标来评估剂量分布的质量。根据CTCAE v3.0分类，通过前瞻性分析105例前列腺接受80戈伊调强放射治疗（IMRT）患者的直肠出血（2年时>= 1级），证实了该方法的价值。在出现出血的患者中，在直肠前壁区域发现了显著的剂量过量（平均6戈伊，p < 0.01）。该区域靠近前列腺（1 cm），占直肠的不到10%。这种有前途的体素明智的方法允许子区域内定义的器官，可能涉及的毒性，因此，必须考虑在逆调强放射治疗计划步骤。
The majority of current models utilized for predicting toxicity in prostate cancer radiotherapy are based on dose-volume histograms. One of their main drawbacks is the lack of spatial accuracy, since they consider the organs as a whole volume and thus ignore the heterogeneous intra-organ radiosensitivity. In this paper, we propose a dose-image-based framework to reveal the relationships between local dose and toxicity. In this approach, the three-dimensional (3D) planned dose distributions across a population are non-rigidly registered into a common coordinate system and compared at a voxel level, therefore enabling the identification of 3D anatomical patterns, which may be responsible for toxicity, at least to some extent. Additionally, different metrics were employed in order to assess the quality of the dose mapping. The value of this approach was demonstrated by prospectively analyzing rectal bleeding (>= Grade 1 at 2 years) according to the CTCAE v3.0 classification in a series of 105 patients receiving 80 Gy to the prostate by intensity modulated radiation therapy (IMRT). Within the patients presenting bleeding, a significant dose excess (6 Gy on average, p < 0.01) was found in a region of the anterior rectal wall. This region, close to the prostate (1 cm), represented less than 10% of the rectum. This promising voxel-wise approach allowed subregions to be defined within the organ that may be involved in toxicity and, as such, must be considered during the inverse IMRT planning step.