总瘤体积增加和适应性放射治疗的需要在中线结构的儿科类型的扩散高度质瘤中
Fasco van Ommen1, Toon van Genechten2, Mirjam E Willemsen-Bosman1
1Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
概括
儿科高度质瘤的放射治疗需要计划调整,因为总瘤体积 (GTV) 在60%的患者中增加. 在治疗期间定期进行MRI扫描对于确保足够的辐射输送至关重要.
科学领域:
- 儿科瘤学 儿科瘤学
- 辐射瘤学 辐射瘤学
- 神经瘤学神经瘤学
背景情况:
- 目前的儿科类型扩散高度质瘤放射治疗方案使用1.0厘米的临床目标体积 (CTV) 边缘围绕总瘤体积 (GTV).
- 成人质母细胞瘤研究显示,放射治疗期间GTV的显著变化,质疑固定利率方法.
研究的目的:
- 在使用连续MRI的儿科高度质瘤的6周放射治疗过程中映射GTV变异.
- 根据观察到的GTV变化,评估放射治疗计划调整的必要性.
- 评估GTV增加和疾病进展时间 (TTP) 之间的关系.
主要方法:
- 符合条件的患者是新诊断的扩散性中线结质瘤或中线结构的儿科类型高度结质瘤.
- 在治疗前 (MRI0) 和分数10和20 (rMRI10/rMRI20) 进行了连续MRI扫描.
- 在所有扫描中都界定了GTV;>5%的增加定义了GTV变化. 计划的调整是基于剂量测量和视觉标准. GTV的增加与TTP相关.
主要成果:
- 在rMRI10/rMRI20的20名患者中,有12名患者 (60%) 观察到GTV的增加,影响了庞丁和非庞丁瘤.
- 在20名患者中有14名 (70%) 需要调整放射治疗计划,总共进行了20次调整.
- 在GTV增加和没有GTV增加的患者之间没有发现TTP的显著差异 (中位数8.1与7.6个月,p=0.66).
结论:
- 连续成像显示,在放射治疗期间,儿科高度质瘤患者中的60%的GTV显著增加.
- 70%的患者需要调整计划,以考虑GTV的变化.
- 一个1.0厘米的CTV边缘可能是不够的,适应性放射治疗是最优的治疗交付建议.
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