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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Large topographic variability of upper abdominal lymphatics and the consequences for radiation treatment planning.
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Large topographic variability of upper abdominal lymphatics and the consequences for radiation treatment planning.

机译：上腹部淋巴管的巨大地形变化及其对放射治疗计划的影响。

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摘要

BACKGROUND AND PURPOSE: Inclusion of regional lymph nodes usually is indicated when treating upper gastrointestinal malignancies. Lymphatics follow the large vessels of this region. Vascular variability with consequences for planning treatment volume (PTV) was studied. MATERIALS AND METHODS: Upper abdominal metric relationship of the vascular origins was analysed in CT scans in 104 patients to estimate its influence on PTV variability. PTV volumes were calculated based on these. Additionally, the PTV size of 3D plans of 34 patients with pancreatic adenocarcinoma (PDAC) was analysed depending on different PTV definitions. RESULTS: Vascular origin varied most for the inferior mesenteric artery (IMA) with substantial PTV size differences. Volumetric variability was analysed for PDAC (IMA versus renal hilum as caudal margin). Additional PTV for IMA was < 100 cc (median) but ranged up to 350 cc in CT (100-199 ml in 14/34 and > 200 ml in 3/34 patients). Data from treatment planning confirmed this observation. CONCLUSIONS: Considerable vascular and lymphatic variability obliges to base PTV on the individual vascular anatomy. For most patients the caudal PTV margin for PDAC can safely be set at the IMA. But PTV should be restricted when the additional volume would lead to a significant increase to avoid haematotoxicity from concomitant gemcitabine which is proportional with PTV size. The risk of kidney toxicity is also subject to PTV expansion in the caudal direction.
机译：背景与目的：通常在治疗上消化道恶性肿瘤时应纳入区域淋巴结。淋巴瘤跟随该地区的大型船只。研究了血管变异性对计划治疗量（PTV）的影响。材料与方法：在104位患者的CT扫描中分析了血管起源的上腹部度量关系，以评估其对PTV变异性的影响。 PTV音量是基于这些来计算的。此外，根据不同的PTV定义，分析了34例胰腺腺癌（PDAC）患者3D计划的PTV大小。结果：肠系膜下动脉（IMA）的血管起源变化最大，PTV大小差异较大。分析了PDAC的体积变异性（IMA与肾门作为尾缘）。 IMA的其他PTV小于100 cc（中位数），但CT范围最大为350 cc（14/34中为100-199 ml，3/34中为200 ml）。治疗计划的数据证实了这一观察结果。结论：相当大的血管和淋巴变异性使得PTV必须基于个体的血管解剖结构。对于大多数患者，可以在IMA上安全设置PDAC的尾部PTV裕度。但是当增加的使用量会导致显着增加时应限制PTV，以避免吉西他滨引起的血液毒性与PTV的大小成正比。肾毒性的风险也受制于PTV向尾方向扩展。

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