.: ORİJİNAL ARAŞTIRMA
Comparison of Three Dimensional Conformal, Intensity Modulated and Hybrid Intensity Modulated Planning Techniques for Thorasic Esophageal Cancer
Torasik Özofagus Kanserinde Üç Boyutlu Konformal, Yoğunluk Ayarlı ve Hibrit Yoğunluk Ayarlı Radyoterapi Planlama Tekniklerinin Karşılaştırılması
Turkiye Klinikleri J Med Sci.2020;40(4):443-50
doi: 10.5336/medsci.2020-77226
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The aim of this study is dosimetric comparison of 3-D conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and hybrid IMRT (h-IMRT) planning techniques above the recommended standard treatment doses for esophageal cancer patients in terms of target volume dose distribution and critical organ protection. The routine applicability of the h-IMRT technique have also been evaluated. Material and Methods: Totally 42 treatment plans for 59.4 Gy dose were designed for 14 esophageal cancer patients with 3D-CRT, IMRT and h-IMRT techniques. Dosimetric evaluation and comparison of the techniques were performed according to the parameters of dose volume histogram (DVH), homogeneity index (HI), conformity index (CI) and monitor unit (MU) calculations. The quality control of the dose distributions was calculated by treatment planning system (TPS) and, 2-dimensional dose distributions and point absolute doses were measured with MatriXX and ion chambers respectively. Results: In all regions of the esophagus, IMRT technique was found to be more successful than the 3D-CRT and h-IMRT techniques in terms of PTV coverage. HI was in accepted limits for all techniques but, IMRT and h-IMRT techniques were better for CI. As expected, treatment duration and MU parameters were found to be high in IMRT technique. Conclusion: Although all plans were within acceptable limits, dosimetric comparison of different planning techniques, revealed that 3D-CRT had statistically significant differences from IMRT planning technique in terms of planned target volume (PTV) coverage, OAR protection, HI, CI, MU and treatment duration above the standart doses. From the aspect of treatment duration and MU parameters, h-IMRT technique can be considered as an alternative planning option.
Keywords: IMRT; esophageal cancer; radiotherapy
Objective: The aim of this study is dosimetric comparison of 3-D conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and hybrid IMRT (h-IMRT) planning techniques above the recommended standard treatment doses for esophageal cancer patients in terms of target volume dose distribution and critical organ protection. The routine applicability of the h-IMRT technique have also been evaluated. Material and Methods: Totally 42 treatment plans for 59.4 Gy dose were designed for 14 esophageal cancer patients with 3D-CRT, IMRT and h-IMRT techniques. Dosimetric evaluation and comparison of the techniques were performed according to the parameters of dose volume histogram (DVH), homogeneity index (HI), conformity index (CI) and monitor unit (MU) calculations. The quality control of the dose distributions was calculated by treatment planning system (TPS) and, 2-dimensional dose distributions and point absolute doses were measured with MatriXX and ion chambers respectively. Results: In all regions of the esophagus, IMRT technique was found to be more successful than the 3D-CRT and h-IMRT techniques in terms of PTV coverage. HI was in accepted limits for all techniques but, IMRT and h-IMRT techniques were better for CI. As expected, treatment duration and MU parameters were found to be high in IMRT technique. Conclusion: Although all plans were within acceptable limits, dosimetric comparison of different planning techniques, revealed that 3D-CRT had statistically significant differences from IMRT planning technique in terms of planned target volume (PTV) coverage, OAR protection, HI, CI, MU and treatment duration above the standart doses. From the aspect of treatment duration and MU parameters, h-IMRT technique can be considered as an alternative planning option.
Keywords: IMRT; esophageal cancer; radiotherapy
ÖZET
Amaç: Bu çalışmanın amacı özofagus kanserli hastalarda, hedef hacim doz dağılımı ve kritik organ korunması açısından, üç boyutlu konformal radyoterapi (3-DCRT), yoğunluk ayarlı radyoterapi (IMRT) ve hibrit IMRT (hIMRT) planlama tekniklerinin dozimetrik olarak karşılaştırılmasıdır. H-IMRT tekniğinin rutin kullanımı da ayrıca değerlendirilmiştir. Gereç ve Yöntemler: Özofagus kanserli 14 hastaya, 3D-CRT, IMRT ve h-IMRT tekniklerinin her biri ile 59,4 Gy total doz için toplam 42 plan yapılmıştır. Dozimetrik değerlendirmeler ve tekniklerin karşılaştırılması, doz hacim histogramları (DVH), homojenite index (HI), konformite indexi (CI) ve monitör ünite (MU) hesaplama parametrelerine göre yapılmıştır. Doz dağılımlarının kalite kontrolleri tedavi planlama sistemi (TPS) yardımıyla yapılmıştır, iki boyutlu doz dağılımları ve nokta dozlar sırasıyla MatriXX ve iyon çemberleriyle ölçülmüştür. Bulgular: Özofagusun tüm bölgelerinde IMRT tekniği PTV kapsaması açısından 3D-CRT ve h-IMRT tekniklerinden daha başarılı bulunmuştur. HI, tüm tekniklerde kabul edilebilir limitlerdedir, ancak CI açısından IMRT ve h-IMRT teknikleri daha iyi bulunmuştur. Beklenildiği üzere, tedavi süresi ve MU, IMRT tekniğinde yüksek bulunmuştur. Sonuç: Tüm tekniklerle yapılan planlamalar kabul edilebilir sınırlarda olsa da, farklı planlama tekniklerinin dozimetrik karşılaştırmaları, standart tedavi dozlarının üstündeki dozlarda 3D-CRT planlama tekniğinin PTV sarımı, riskli organ korunması (OAR), HI, CI, MU ve tedavi süresi bakımından belirgin istatistiksel farklılıkları olduğunu ortaya koymuştur. Tedavi süresi ve MU parametreleri açısından, h-IMRT tekniği alternatif planlama tekniği olarak değerlendirilebilir
Anahtar Kelimeler: IMRT; özofagus kanseri; radyoterapi
Amaç: Bu çalışmanın amacı özofagus kanserli hastalarda, hedef hacim doz dağılımı ve kritik organ korunması açısından, üç boyutlu konformal radyoterapi (3-DCRT), yoğunluk ayarlı radyoterapi (IMRT) ve hibrit IMRT (hIMRT) planlama tekniklerinin dozimetrik olarak karşılaştırılmasıdır. H-IMRT tekniğinin rutin kullanımı da ayrıca değerlendirilmiştir. Gereç ve Yöntemler: Özofagus kanserli 14 hastaya, 3D-CRT, IMRT ve h-IMRT tekniklerinin her biri ile 59,4 Gy total doz için toplam 42 plan yapılmıştır. Dozimetrik değerlendirmeler ve tekniklerin karşılaştırılması, doz hacim histogramları (DVH), homojenite index (HI), konformite indexi (CI) ve monitör ünite (MU) hesaplama parametrelerine göre yapılmıştır. Doz dağılımlarının kalite kontrolleri tedavi planlama sistemi (TPS) yardımıyla yapılmıştır, iki boyutlu doz dağılımları ve nokta dozlar sırasıyla MatriXX ve iyon çemberleriyle ölçülmüştür. Bulgular: Özofagusun tüm bölgelerinde IMRT tekniği PTV kapsaması açısından 3D-CRT ve h-IMRT tekniklerinden daha başarılı bulunmuştur. HI, tüm tekniklerde kabul edilebilir limitlerdedir, ancak CI açısından IMRT ve h-IMRT teknikleri daha iyi bulunmuştur. Beklenildiği üzere, tedavi süresi ve MU, IMRT tekniğinde yüksek bulunmuştur. Sonuç: Tüm tekniklerle yapılan planlamalar kabul edilebilir sınırlarda olsa da, farklı planlama tekniklerinin dozimetrik karşılaştırmaları, standart tedavi dozlarının üstündeki dozlarda 3D-CRT planlama tekniğinin PTV sarımı, riskli organ korunması (OAR), HI, CI, MU ve tedavi süresi bakımından belirgin istatistiksel farklılıkları olduğunu ortaya koymuştur. Tedavi süresi ve MU parametreleri açısından, h-IMRT tekniği alternatif planlama tekniği olarak değerlendirilebilir
Anahtar Kelimeler: IMRT; özofagus kanseri; radyoterapi
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