避免部门对食道癌治疗知识为基础的规划的影响
Vishruta Dumane1, Victoria Olsen2, Ting Jiang3
1Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY 10029, USA.
概括
用于食道癌治疗的RapidPlan显著降低了高剂量的位体积,降低了毒性风险. 这种基于知识的模型,没有回避部门,与传统方法相比,提高了计划质量和目标覆盖率.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 在瘤学瘤学.
背景情况:
- 食道癌治疗计划需要精确的剂量输送到计划目标体积 (PTV),同时节省有风险的器官 (OAR).
- 基于知识的治疗计划系统,如RapidPlan,旨在提高计划的质量和一致性.
- 在治疗规划中使用回避部门是避免OAR的常见策略,但可能会影响计划的均性和覆盖范围.
研究的目的:
- 开发和验证一个RapidPlan模型,用于治疗食道癌在上部,中部和下部胸部区域.
- 为了比较RapidPlan模型的性能,使用和不使用回避部门.
- 评估对剂量覆盖,均性和OAR节省的影响.
主要方法:
- 基于知识的RapidPlan模型使用45个食道癌患者计划进行了训练.
- 使用RapidPlan重新规划了临床计划,包括避免部门和没有避免部门.
- 在23个独立计划上验证了模型性能,将RapidPlan (有/没有避免部门) 与临床计划进行了比较.
主要成果:
- 与临床计划相比,没有避免部门的RapidPlan显著减少了PTV中的高剂量量 (V105%) 100.1 cc (p<0.001),并提高了符合性指数 (CI) 7-8%.
- 虽然肺V5 Gy增加了5.5% (p=0.02),但关键的OAR剂量 (心脏,脏,脊髓) 没有受到影响.
- 使用RapidPlan的避开部门使CI恶化3-5%,肺V20 Gy增加2.8% (p=0.01),心脏平均剂量增加1.1 Gy (p=0.04).
结论:
- 对于胸腔食道癌的RapidPlan模型,配置没有回避部门,有效地减少了目标内高剂量体积.
- 这种方法可以提高计划质量,并可能减少食道毒性,而不会显著影响肺部剂量.
- 在这种情况下,使用避免部门并没有提高计划质量,并为OARs引入了不必要的剂量增加.
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