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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization.
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Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization.

机译：各种在线IGRT策略的比较：重新优化在线治疗计划的好处。

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摘要

PURPOSE: To compare the dosimetric differences of various online IGRT strategies and to predict potential benefits of online re-optimization techniques in prostate cancer radiation treatments. MATERIALS AND METHODS: Nine prostate patients were recruited in this study. Each patient has one treatment planning CT images and 10-treatment day CT images. Five different online IGRT strategies were evaluated which include 3D conformal with bone alignment, 3D conformal re-planning via aperture changes, intensity modulated radiation treatment (IMRT) with bone alignment, IMRT with target alignment and IMRT daily re-optimization. Treatment planning and virtual treatment delivery were performed. The delivered doses were obtained using in-house deformable dose mapping software. The results were analyzed using equivalent uniform dose (EUD). RESULTS: With the same margin, rectum and bladder doses in IMRT plans were about 10% and 5% less than those in CRT plans, respectively. Rectum and bladder doses were reduced as much as 20% if motion margin is reduced by 1cm. IMRT is more sensitive to organ motion. Large discrepancies of bladder and rectum doses were observed compared to the actual delivered dose with treatment plan predication. The therapeutic ratio can be improved by 14% and 25% for rectum and bladder, respectively, if IMRT online re-planning is employed compared to the IMRT bone alignment approach. The improvement of target alignment approach is similar with 11% and 21% dose reduction to rectum and bladder, respectively. However, underdosing in seminal vesicles was observed on certain patients. CONCLUSIONS: Online treatment plan re-optimization may significantly improve therapeutic ratio in prostate cancer treatments mostly due to the reduction of PTV margin. However, for low risk patient with only prostate involved, online target alignment IMRT treatment would achieve similar results as online re-planning. For all IGRT approaches, the delivered organ-at-risk doses may be significantly different from treatment planning prediction.
机译：目的：比较各种在线IGRT策略的剂量学差异，并预测在线重新优化技术在前列腺癌放射治疗中的潜在优势。材料与方法：本研究招募了9名前列腺患者。每个患者都有一个治疗计划的CT图像和10个治疗日的CT图像。评估了五种不同的在线IGRT策略，包括3D保形与骨对齐，通过孔径变化进行3D保形重新规划，强度调制放射治疗（IMRT）与骨对齐，IMRT与靶标对齐以及IMRT每日重新优化。执行治疗计划和虚拟治疗交付。使用内部可变形剂量绘图软件获得输送剂量。使用等效均匀剂量（EUD）分析结果。结果：在相同的余量下，IMRT计划中的直肠和膀胱剂量分别比CRT计划中的分别低10％和5％。如果运动余量减少1厘米，直肠和膀胱的剂量最多可减少20％。 IMRT对器官运动更敏感。观察到膀胱和直肠剂量与实际治疗计划预测剂量相比存在较大差异。如果与IMRT骨对齐方法相比，采用IMRT在线重新计划，则直肠和膀胱的治疗率可分别提高14％和25％。目标对准方法的改进与直肠和膀胱的剂量减少分别相似，分别为11％和21％。然而，在某些患者中观察到精囊中的剂量不足。结论：在线治疗计划的重新优化可能会显着提高前列腺癌治疗的治疗率，这主要是由于PTV余量的减少。但是，对于仅涉及前列腺的低风险患者，在线目标对准IMRT治疗将获得与在线重新计划相似的结果。对于所有IGRT方法，所递送的有风险器官剂量可能与治疗计划的预测有很大不同。

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