Potentials of robust intensity modulated scanning proton plans for locally advanced lung cancer in comparison to intensity modulated photon plans
Potentials of robust intensity modulated scanning proton plans for locally advanced lung cancer in comparison to intensity modulated photon plans
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DOI：
10.1016/j.radonc.2012.03.017
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发表时间：
2012-07-01
影响因子：
5.7
通讯作者：
Farr, Jonathan
中科院分区：
文献类型：
--
作者：
Stuschke, Martin;Kaiser, Andreas;Farr, Jonathan
背景和目的：研究了通过多种场景下的极小极大优化获得的肺保护、剂量递增和强度调制质子计划 (IMPRobust) 的稳健性的潜力。材料和方法：Fredriksson 等人描述的 IMPRobust 优化。 [23] 使用来自 6 名非小细胞肺癌 (NSCLC) 患者的屏气 CT 数据进行比较治疗计划进行评估。将 IMPRobust 和单场均匀剂量 (SFUD) 质子计划与断层放疗和 7 场强度调制光子疗法 (IMXT) 进行比较。分析了针对设置误差、范围不确定性和场运动之间的计划鲁棒性，并通过平均肺剂量 (MLD) 和接受至少 20、10 和 5 Gy(RBE) (V20、V10、V5) 的部分肺体积量化肺暴露。对有效均匀剂量 (EUD) 的稳定性以及 95% 的 CTV (D95) 达到或超过的剂量水平进行稳健性分析。 结果：每位患者的 IMPRobust 的 MLD 低于 SFUD 和断层放疗，平均低 14.8% 和 28.5%（p < 0.05，Friedman 检验）。与两种质子治疗技术相比，Tomotherapy 的 V20-V5 更高，平均高出 1.8 倍以上。 IMPRobust 的鲁棒性很高。对于所有测试场景，EUD 和 D95 值均保持在参考计划值的 96% 和 94% 以上。随着剂量增加到 86 Gy(RBE)，肺组织的耐受性得以维持。结论：IMPRobust 被证明在肺暴露和可能的剂量增加方面具有优势，同时也具有明显的稳健性。然而，场传递过程中的运动仍然是 IMPRobust 的一个主要问题，需要通过高扫描速度和可变光斑尺寸来缓解。 (C) 2012 Elsevier Ireland Ltd. 保留所有权利。放射治疗与肿瘤学104（2012）45-51
Background and purpose: The potentials of lung sparing, dose escalation, and the robustness of intensity modulated proton plans (IMPTrobust), obtained by minimax optimization on multiple scenarios, were studied.Materials and methods: IMPTrobust optimization as described by Fredriksson et al. [23] was evaluated by means of comparative treatment planning using breath hold CT data from 6 non-small cell lung cancer (NSCLC) patients. IMPTrobust and single field uniform dose (SFUD) proton plans were compared to Tomotherapy and 7-field intensity modulated photon therapy (IMXT). Plan robustness against set-up errors, range uncertainties, and between field motions were analyzed as well as lung exposure quantified by the mean lung dose (MLD) and the partial lung volumes receiving at least 20, 10, and 5 Gy(RBE) (V20, V10, V5). Robustness was analyzed with regard to stability of the effective uniform dose (EUD) and the dose level reached or exceeded in 95% of the CTV (D95).Results: MLD by IMPTrobust was less than by SFUD, and Tomotherapy in each patient, on average by 14.8% and 28.5% (p < 0.05, Friedman test). V20-V5 were higher with Tomotherapy compared to both proton therapy techniques, on average by a factor of >1.8. Robustness of IMPTrobust was high. EUD and D95 values were maintained above 96% and 94% of the reference plan values for all tested scenarios. With dose escalation to 86 Gy(RBE) lung tissue tolerances were maintained.Conclusions: IMPTrobust Proved advantageous in terms of lung exposure and possible dose escalation while being also markedly robust. However, motion during delivery of a field remains a major problem of IMPTrobust to be mitigated by high scanning speed and variable spot size. (C) 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 45-51