Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Prostat Kanserli Hastaların Radyoterapi Planlamalarında VMAT ve D-IMRT Tekniklerinin Karşılaştırılması
Comparison of VMAT and D-IMRT Planning Techniques in Radiotherapy of Patients with Prostate Cancer
Yılmaz BİLEKa, Aylin Fidan KORCUM ŞAHİNb, Timur KOCAb, Nina TUNÇELb
aRadyasyon Onkolojisi Kliniği, Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi,
bRadyasyon Onkolojisi ABD, Akdeniz Üniversitesi Tıp Fakültesi, Antalya, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(3):263-70
doi: 10.5336/medsci.2018-63761
Article Language: TR
Full Text
ÖZET
 Amaç: Prostat kanseri radyoterapisinde dinamik yoğunluk ayarlı radyoterapi (D-IMRT) ve hacimsel yoğunluk ayarlı ark tedavisi (VMAT) tekniklerinin, hasta tedavi planları ile dozimetrik olarak karşılaştırılmasıdır. Gereç ve Yöntemler: Yüksek riskli 10 prostat kanseri hastası için, CMS Monaco Tedavi Planlama Sistemi (TPS) kullanılarak 6MV enerjide X ışını üreten Linak tabanlı 9-alan D-IMRT ve çift ark VMAT teknikleri ile planlar tasarlandı. İki planlama tekniği; planlanmış hedef hacim (PTV) 46, PTV 56, PTV 74 yapılarındaki doz sarımı ve homojenite indeksi (HI) ile konformite indeksi (CI) değerleri bakımından karşılaştırıldı. Kritik organlarda, rektum için V50, V60, V65, V70 (doz volümleri) değerleri mesane için V65, V70 değerleri, femur başları için ise V40 değerleri incelendi. Her iki teknik ile elde edilen planların tedavi süreleri, segment sayıları ve monitör ünite (MU) değerleri karşılaştırıldı. Ayrıca, hastaların aldığı integral doz olarak V37 değerlendirildi. Elde edilen tüm veriler Wilcoxon işaretli sıra testi uygulanarak, istatistiksel olarak karşılaştırıldı. Bulgular: D-IMRT ve VMAT teknikleri ile hedef hacimler için, birbirlerine yakın doz sarımları elde edilmiştir. PTV 74 için hesaplanan HI ve CI değerleri her iki teknikte benzer bulunmuştur. Her iki planlama tekniği ile tüm kritik organlar, doz sınırlamalarının altında tutulabilmiştir. Genel olarak, risk altındaki organ dozları bakımından her iki teknik ile birbirlerine yakın sonuçlar elde edilmiştir. Ancak; rektum için V70 değerleri bakımından her iki teknik arasında anlamlı bir fark bulunmuştur. İntegral doz açısından da her iki teknik arasında anlamlı fark bulunmuştur. VMAT tekniği ile oluşturulan planlardan elde edilen segment ve MU sayıları, D-IMRT tekniği ile oluşturulan planlara göre fazla olmasına rağmen tedavi süresinin daha kısa olduğu gözlenmiştir. Sonuç: Prostat kanseri radyoterapisinde kullanılan 9-alan D-IMRT tekniği ve VMAT teknikleri tedavi planlama sistemi üzerinden karşılaştırıldığında, hem PTV sarımları hem de kritik organ korumaları açısından benzer dozimetrik sonuçlar elde edilmiştir. Sadece tedavi süresi açısından, VMAT tekniğinin D-IMRT tekniğine belirgin bir üstünlüğü gözlenmiştir.

Anahtar Kelimeler: Prostat kanseri; D-IMRT; VMAT
ABSTRACT
 Objective: The aim of this study is to compare dosimetric values of dynamic intensity modulated radiation therapy (dIMRT) and volumetric modulated arc therapy (VMAT) treatment techniques in the treatment of prostate cancer radiotherapy. Material and Methods: Treatment plans were designed for 10 high-risk prostate cancer patient with Linac based 9-fields D-IMRT and double arc VMAT techniques using CMS Monaco Treatment Planning System (TPS). Two planning techniques; were compared to homogeneity index (HI) and conformity index (CI) values as well as the dose coverage of planning target volume (PTV) structures. Critical organs were assessed V50, V60, V65, V70 for the rectum, V65, V70 for the bladder and V40 for the femoral heads. The treatment time, segment number and monitor unit (MU) values of the plans obtained with the two techniques were compared. V37 was also evaluated as integral dose of the patients. All obtained data were statistically evaluated by Wilcoxon signed rank test. Results: With the D-IMRT and VMAT techniques, similar dose coverage were obtained for target volumes. HI and CI values calculated for PTV 74 were found to be the similar in both techniques. With both planning techniques, all critical organs could be kept below the dose limits. In general, in terms of organs at risk doses, close results were obtained from both techniques. However, there was a significant difference between the two techniques in terms of V70 values for rectum. A significant difference was also found between the two techniques in terms of integral dose. Although the segment and MU numbers obtained from the plans generated by the VMAT technique were higher than the plans generated by the D-IMRT technique, the treatment time was found shorter. Conclusion: Similar dosimetric results were obtained from 9-fields D-IMRT and VMAT techniques used in the treatment of prostate cancer radiotherapy in terms of PTV dose coverage and critical organ protection. The VMAT technique has an advantage over the D-IMRT technique only in terms of treatment time.

Keywords: Prostate cancer; D-IMRT; VMAT
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