单片断片胸部立体性除性放射治疗后的胸壁疼痛:来自iSABR试验的剂量分析
Brianna Lau1, Yufan F Wu1, Sunan Cui2
1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
概括
对于胸壁附近的瘤,单片断片立体性除性放射疗法 (SABR) 显示严重疼痛的发生率很低. 先进的技术允许安全的治疗,最大限度地降低胸壁毒性风险.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 临床试验 临床试验
背景情况:
- 关于对胸壁相邻瘤的单片段立体性除性放射治疗 (SABR) 的胸壁毒性存在争论.
- 评估胸壁疼痛发生率和剂量反应对于指导放射计划至关重要.
研究的目的:
- 确定使用单片式SABR治疗的患者胸壁疼痛的发生率和程度.
- 为了建模胸壁疼痛的剂量反应关系.
- 为了指导辐射规划和估计SABR在胸壁附近的毒性风险.
主要方法:
- 对来自前性iSABR试验的92名患者中的99个瘤的二次分析.
- 治疗涉及25 Gy在一个分数,剂量根据瘤大小和位置个性化.
- 毒性事件被前性收集和分级 (CTCAE v4);剂量反应建模使用后勤回归.
主要成果:
- 发生了22次1级以上胸壁疼痛事件 (5级2,0级3+).
- 接收量 11 Gy (V11Gy) 和最低剂量至最热 2 cc (D2cc) 与毒性相关.
- >=20%的毒性发生率的预测约束:D2cc> 17 Gy和V11Gy> 28 cc.
结论:
- 针对小,外围瘤的单片式SABR与低度的胸壁疼痛有关.
- 瘤靠近胸壁可能不是适合性,图像导向SABR的禁忌.
- 在先进的技术中,敏的剂量梯度可以减轻胸壁毒性.
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