3.25, p< 0.05). Mesane değerlerinde anlamlı fark bulunmamıştır. Dört alan tekniklerinde; rektum için en yüksek doz "45°,135°" planında, femur başı için en düşük değerler kutu tekniği ve "45°,135°" planında elde edilmiştir (F> 4.54, p< 0.05). Beş alan tekniklerinde, "0°,72°,144°" planı opere olgularda rektum V90 ve V80, opere olmamış olgularda da rektum V80 veV50 değerleri açısından anlamlı derecede yüksek bulunmuştur (F> 3.58, p< 0.05). Altı ve yedi alan planlama teknikleri kendi içlerinde karşılaştırıldığında rektum, mesane ve femur başı açısından anlamlı fark gözlenmemiştir. Sonuç: Prostat kanserinin hem radikal hem de adjuvan 3B-KRT'sinde başlangıç tedavisinde kutu, ek tedavide yan sahalardan çift yüklemeli altı alan "45°, 90°, 135°" tekniklerinin daha uygun olacağı sonucuna varılmıştır.">

Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Üç Boyutlu Konformal Prostat Radyoterapisinde 3, 4, 5, 6 ve 7 Sahalı Tedavi Tekniklerinin Karşılaştırılması
Comparison of 3, 4, 5, 6 and 7 -Field Therapy Techniques in Three Dimensional Conformal Prostate Radiotherapy
Nezahat OLACAKa, Emin TAVLAYANa, Deniz YALMANa, Özlem AKAGÜNGÜZa, Serdar ÖZKÖKa, B. Arif ARASa
aRadyasyon Onkolojisi AD, Ege Üniversitesi Tıp Fakültesi, İzmir
Turkiye Klinikleri J Med Sci. 2011;31(3):583-9
doi: 10.5336/medsci.2009-16028
Article Language: TR
Full Text
ÖZET
 Amaç: Prostat kanserinin üç boyutlu konformal radyoterapisinde (3B-KRT) farklı planlamalarla hedef hacme maksimum; rektum, mesane ve femur başı gibi kritik organlara minimum dozu veren en uygun planlama tekniğinin belirlenmesi. Gereç ve Yöntemler: Ege Üniversitesi Radyasyon Onkolojisi Anabilim Dalına başvuran prostat kanserli olgular arasından seçilen 17 olgunun (dokuzuna radikal, sekizine adjuvan amaçlı RT) her biri için 18 farklı konformal plan yapılmıştır. Kümülatif doz-volum histogramları kullanılarak her plana ait rektum V50, V80, V90, mesane V90, femur başı (radikal için V70, adjuvan için V80) değerleri incelenmiştir. Onyedi olgunun 18'er planına ait beşer değer ölçülerek elde edilen 1530 adet verinin ortalama ve standart sapmaları hesaplanıp t-testi ve tek-yönlü varyans analizi ile istatistiksel anlamlılık düzeyi değerlendirilmiştir. Bulgular: On sekiz farklı planlama tekniği karşılaştırıldığında üç alan tekniklerinden "0°,90°" planında rektum açısından en düşük, femur başı açısından ise en yüksek doz değerleri gözlenmiştir (F> 3.25, p< 0.05). Mesane değerlerinde anlamlı fark bulunmamıştır. Dört alan tekniklerinde; rektum için en yüksek doz "45°,135°" planında, femur başı için en düşük değerler kutu tekniği ve "45°,135°" planında elde edilmiştir (F> 4.54, p< 0.05). Beş alan tekniklerinde, "0°,72°,144°" planı opere olgularda rektum V90 ve V80, opere olmamış olgularda da rektum V80 veV50 değerleri açısından anlamlı derecede yüksek bulunmuştur (F> 3.58, p< 0.05). Altı ve yedi alan planlama teknikleri kendi içlerinde karşılaştırıldığında rektum, mesane ve femur başı açısından anlamlı fark gözlenmemiştir. Sonuç: Prostat kanserinin hem radikal hem de adjuvan 3B-KRT'sinde başlangıç tedavisinde kutu, ek tedavide yan sahalardan çift yüklemeli altı alan "45°, 90°, 135°" tekniklerinin daha uygun olacağı sonucuna varılmıştır.

Anahtar Kelimeler: Prostat tümörleri; radyoterapi planlama, bilgisayar-yardımlı
ABSTRACT
 Objective: Determination of the most appropriate planning technique implementing maximum dose to target organs; minimum dose to critical organs as rectum, urinary bladder and femoral heads using different plans in three dimensional conformal radiotherapy (3D-CRT) of prostate cancer. Material and Methods: Eighteen distinctive conformal plans were made in each of 17 cases (radical RT for nine and adjuvant RT for eight) selected patients with prostate cancer who applied to Ege University Department of Therapeutic Radiation and Oncology. Values of rectum V50, V80, V90, bladder V90, femoral heads (V70 for radical, V80 for adjuvant) were evaluated using cumulative dose-volume histograms, and the level of statistical significance was assessed with t-test and one-way variance analysis after mean values and standard deviations of 1530 data, for five values of 18 plans of 17 patients, had been calculated. Results: When 18 distinctive planning techniques were compared, of the 3-field techniques, at "0°,90°" plan minimum dose values were detected for rectum and maximum dose values were detected for femoral head (F> 3.25, p< 0.05). A significant difference was not found for urinary bladder values. In the 4-field techniques, maximum dose for rectum was obtained at "45°,135°" plan, minimum values for femoral head were obtained at box technique and "45°,135°" plan (F> 4.54, p< 0.05). In 5-field techniques, "0°,72°,144°" plan was found significantly high in terms of rectum V90 and V80 values in operated subjects and rectum V80 and V50 values in the subjects not operated (F> 3.58, p< 0.05). When 6 and 7-field planning techniques were compared between themselves, a significant difference was not found in terms of rectum, urinary bladder and femoral head doses. Conclusion: It was concluded that box technique would be more appropriate for the initial phase of both radical and adjuvant 3D-CRT of prostate cancer and double-weighted 6-field "45°, 90°, 135°" technique for boost therapy.

Keywords: Prostatic neoplasms; radiotherapy planning, computer-assisted

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