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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >A potential to reduce pulmonary toxicity: the use of perfusion SPECT with IMRT for functional lung avoidance in radiotherapy of non-small cell lung cancer.
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A potential to reduce pulmonary toxicity: the use of perfusion SPECT with IMRT for functional lung avoidance in radiotherapy of non-small cell lung cancer.

机译：降低肺毒性的潜力：将灌注SPECT与IMRT结合用于非小细胞肺癌放疗中的功能性肺部回避。

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BACKGROUND AND PURPOSE: The study aimed to examine specific avoidance of functional lung (FL) defined by a single photon emission computerized tomography (SPECT) lung perfusion scan, using intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3-DCRT) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients with NSCLC underwent planning computerized tomography (CT) and lung perfusion SPECT scan in the treatment position using fiducial markers to allow co-registration in the treatment planning system. Radiotherapy (RT) volumes were delineated on the CT scan. FL was defined using co-registered SPECT images. Two inverse coplanar RT plans were generated for each patient: 4-field 3-DCRT and 5-field step-and-shoot IMRT. 3-DCRT plans were created using automated AutoPlan optimisation software, and IMRT plans were generated employing Pinnacle(3) treatment planning system (Philips Radiation Oncology Systems). All plans were prescribed to 64 Gy in 32 fractions using data for the 6 MV beam from an Elekta linear accelerator. The objectives for both plans were to minimize the volume of FL irradiated to 20 Gy (fV(20)) and dose variation within the planning target volume (PTV). A spinal cord dose was constrained to 46 Gy. Volume of PTV receiving 90% of the prescribed dose (PTV(90)), fV(20), and functional mean lung dose (fMLD) were recorded. The PTV(90)/fV(20) ratio was used to account for variations in both measures, where a higher value represented a better plan. RESULTS: Thirty-four RT plans of 17 patients with stage I-IIIB NSCLC suitable for radical RT were analysed. In 6 patients with stage I-II disease there was no improvement in PTV(90), fV(20), PTV/fV(20) ratio and fMLD using IMRT compared to 3-DCRT. In 11 patients with stage IIIA-B disease, the PTV was equally well covered with IMRT and 3-DCRT plans, with IMRT producing better PTV(90)/fV(20) ratio (mean ratio - 7.2 vs. 5.3, respectively, p=0.001) and reduced fMLD figures compared to 3-DCRT (mean value- 11.5 vs. 14.3 Gy, p=0.001). This was due to reduction in fV(20) while maintaining PTV coverage. CONCLUSION: The use of IMRT compared to 3-DCRT improves the avoidance of FL defined by perfusion SPECT scan in selected patients with locally advanced NSCLC. If the dose to FL is shown to be the primary determinant of lung toxicity, IMRT would allow for effective dose escalation by specific avoidance of FL.
机译：背景与目的：本研究旨在检查使用强度调制放疗（IMRT）和三维适形放疗（3-DCRT）的单光子发射计算机断层扫描（SPECT）肺灌注扫描所定义的功能性肺（FL）的具体规避非小细胞肺癌（NSCLC）患者中。材料和方法：NSCLC患者接受计划计算机断层扫描（CT）和肺灌注SPECT扫描，在治疗位置使用基准标记，以允许在治疗计划系统中进行共同注册。在CT扫描上划定了放疗（RT）量。使用共同注册的SPECT图像定义FL。为每位患者生成了两个逆共面RT计划：4场3-DCRT和5场步进连拍IMRT。使用自动AutoPlan优化软件创建3-DCRT计划，并使用Pinnacle（3）治疗计划系统（Philips Radiation Oncology Systems）生成IMRT计划。使用来自Elekta线性加速器的6 MV光束的数据，将所有计划按32馏分规定为64 Gy。两项计划的目标都是将照射到20 Gy的FL的体积最小化（fV（20）），并在计划目标体积（PTV）内使剂量变化最小。脊髓剂量限制在46 Gy。记录接受90％规定剂量（PTV（90）），fV（20）和功能性平均肺部剂量（fMLD）的PTV的体积。 PTV（90）/ fV（20）的比率用于说明两种度量的变化，其中较高的值表示更好的计划。结果：分析了17例适合根治性RT的I-IIIB期NSCLC患者的34项RT计划。与3-DCRT相比，使用IMRT的6例I-II期疾病患者的PTV（90），fV（20），PTV / fV（20）比和fMLD没有改善。在11例IIIA-B期患者中，IMRT和3-DCRT计划同样覆盖了PTV，IMRT产生了更好的PTV（90）/ fV（20）比率（平均比率分别为7.2和5.3，p与3-DCRT相比，fMLD值降低了（= 0.001）（平均值-11.5 vs. 14.3 Gy，p = 0.001）。这是由于在保持PTV覆盖范围的同时降低了fV（20）。结论：与3-DCRT相比，IMRT的使用改善了局部SPECT扫描对部分晚期NSCLC患者的FL避免。如果显示出FL剂量是肺毒性的主要决定因素，那么IMRT将通过避免FL来有效提高剂量。

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