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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer.
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A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer.

机译：鼻腔癌和鼻旁窦癌的非共面IMRT与螺旋CT的剂量学比较。

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PURPOSES: To determine if there are clinically significant differences between the dosimetry of sinus tumors delivered by non-coplanar LINAC-based IMRT techniques and Helical Tomotherapy (HT). HT is capable of delivering highly conformal and uniform target dosimetry. However, HT lacks non-coplanar capability, which is commonly used for linear accelerator-based IMRT for nasal cavity and paranasal sinus tumors. METHODS AND MATERIALS: We selected 10 patients with representative early and advanced nasal cavity and paranasal sinus malignancies treated with a preoperative dose of 50 Gy/25 fractions without coverage of the cervical lymphatics for dosimetric comparison. Each plan was independently optimized using either Corvus inverse treatment planning system, commissioned for a Varian 2300 CD linear accelerator with 1cm multileaf collimator (MLC) leaves, or the HT inverse treatment planning system. A non-coplanar seven field technique was used in all Corvus plans with five mid-sagittal fields and two anterior oblique fields as described by Claus et al. [F. Claus, W. De Gersem, C. De Wagter, et al., An implementation strategy for IMRT of ethmoid sinus cancer and bilateral sparing of the optic pathways, Int J Radiat Oncol Biol Phys 51 (2001) 318-331], whereas only coplanar beamlets were used in HT planning. Dose plans were compared using DVHs, the minimum PTV dose to 1cm3 of the PTV, a uniformity index of planned treatment volume (PTV), and a comprehensive quality index (CQI) based on the maximum dose to optical structures, parotids and the brainstem which were deemed as the most critical adjacent structures. RESULTS: Both planning systems showed comparable PTV dose coverage, but HT had significantly higher uniformity (p<0.01) inside the PTV. The CQI for all organs at risk were equivalent except ipsilateral lenses and eyes, which received statistically lower dose from HT plans (p<0.01). CONCLUSIONS: Overall HT provided equivalent or slightly better normal structure avoidance with a more uniform PTV dose fornasal cavity and paranasal sinus cancer treatment than non-coplanar LINAC-based IMRT. The disadvantage of coplanar geometry in HT is apparently counterbalanced by the larger number of fields.
机译：目的：确定在基于非共面LINAC的IMRT技术和螺旋断层扫描（HT）之间进行的鼻窦肿瘤剂量测定之间是否存在临床上的显着差异。 HT能够提供高度保形且均匀的目标剂量。但是，HT缺乏非共面能力，通常用于基于线性加速器的IMRT用于鼻腔和鼻旁窦肿瘤。方法和材料：我们选择10例具有代表性的早期和晚期鼻腔和鼻旁窦恶性肿瘤的患者，术前剂量为50 Gy / 25分数，但未覆盖颈淋巴管，进行剂量学比较。每个计划都使用Corvus逆向治疗计划系统（针对具有1cm多叶准直器（MLC）叶片的Varian 2300 CD线性加速器）或HT逆向治疗计划系统进行了独立优化。如克劳斯等人所述，在所有Corvus计划中均使用非共面七视野技术，具有五个中矢状视野和两个前斜视野。 [F。 Claus，W。De Gersem，C。De Wagter等人，筛窦窦癌IMRT的实施策略和双侧保留光通路，《国际放射医学杂志》 51（2001）318-331]，而仅共面子束用于HT规划。使用DVHs，最小PTV剂量至PTV的1cm3，计划治疗量的均匀性指数（PTV）和基于最大剂量的光学结构，腮腺和脑干的综合质量指数（CQI）比较剂量计划被认为是最关键的相邻结构。结果：两个计划系统均显示出相当的PTV剂量覆盖范围，但HT在PTV内部的均匀性明显更高（p <0.01）。除患侧晶状体和眼外，所有有风险的器官的CQI均相等，它们从HT计划接受统计学上较低的剂量（p <0.01）。结论：与非共面基于LINAC的IMRT相比，总体HT提供了相当或略微更好的正常结构规避，更均匀的PTV剂量的鼻腔和鼻旁窦癌治疗。 HT中共面几何的缺点显然可以通过更大数量的场来抵消。

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