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由中枢神经系统导向的强度调节质子疗法诱导的增强对比的病变:分布模式,动力学,危险因素和结果
Omer Gal1, Jen Yu2, Minesh P Mehta2
1Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida.
概括
辐射诱导对比增强 (RICE) 在强度调制质子疗法 (IMPT) 后常见于脑瘤,通常出现在高剂量区域. 将剂量最小化到周周结膜区域可能会降低RICE风险.
科学领域:
- 辐射瘤学 辐射瘤学
- 神经瘤学神经瘤学
- 医疗成像医学成像
背景情况:
- 强度调节质子疗法 (IMPT) 为脑瘤提供精确的辐射输送.
- 内辐射诱导的对比度增强 (RICE) 是IMPT的潜在副作用,但其特征尚不清楚.
研究的目的:
- 确定IMPT后RICE的发病率,分布,动力学,易感因素和临床结果.
- 为了研究辐射剂量,线性能量转移 (LET) 和RICE发展之间的关联.
主要方法:
- 对137名脑瘤患者的RISE分析,这些患者接受了至少50 Gy IMPT治疗,随访1年和3次MRI扫描.
- 与瘤床和高剂量区域相对的RICE分布的分类 (≤5毫米从95%的同剂量线).
- 对于RICE病变,可计算发声剂量和LET;使用逻辑回归进行风险因素评估.
主要成果:
- 26%的患者 (36/137) 患有RICE,在IMPT后11个月的中位数观察到73个病变.
- 大多数RICE病变 (67%) 位于高剂量区域 (B组),78%的病变在5个月内改善或消失.
- 随着患者年龄的增长,瘤体积的增加 (> 30 cc),以及95%的异线与心室的接近,RICE风险也会增加.
结论:
- 在IMPT后,RICE是常见的放射性发现,主要发生在周周结节和高剂量区域.
- 大米很少表现出症状,大多数病变随着时间的推移而有所改善.
- 在IMPT规划过程中考虑周周节约技术可能会减轻RICE风险.
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