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STEREOTACTIC BODY RADIATION THERAPY FOR HUGE HEPATOCELLULAR CARCINOMA: DOSIMETRIC COMPARISON OF 3D CONFORMAL RADIOTHERAPY, INTENSITY-MODULATED RADIOTHERAPY AND CYBERKNIFE

軀體立體定位放射線治療於巨大肝癌之應用:比較三度空間順形放射治療、強度調控放射治療與電腦刀的劑量分布差異性

摘要


Introduction : To compare stereotactic body radiation therapy (SBRT) of three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and Cyberknife for huge hepatocellular carcinoma (≥10 cm) using dosimetric analysis. Methods and Materials : Ten patients with huge hepatocellular carcinoma (HCC) of the right liver lobe treated with Cyberknife SBRT were enrolled in this study. The dosimetric values for 3D-CRT, IMRT and Cyberknife were calculated for total doses of 40 Gy / 5 fx. Treatments were individualized on the basis of the effective liver volume irradiated maintaining ≤ 5 % risk of radiation-induced liver disease (V15 Gy to ≤ 700 ml normal liver volume). Other parameters included the conformal index (CI), homogeneity index (HI) and hot spot (Dmax) for the planning target volume (PTV). Results : The GTV was covered adequately by all techniques PTV coverage of Cyberknife was comparable to 3D-CRT and IMRT (p= 0.0544); CI of IMRT were significantly lower than 3D-CRT and Cyberknife (p=0.0082). While HI and Dmax were significantly lower with 3D-CRT than with IMRT and Cyberknife (p= 0.0001). Conclusions : SBRT with Cyberknife provided an option for huge HCC in the right lobe although tumor coverage compared with 3D-CRT or IMRT was of borderline significance. IMRT and 3D-CRT resulted in a more conformal and homogenous plan than Cyberknife. And in terms of organ sparing, 3D-CRT was the most effective in the sparing of non-liver organs. However, Cyberknife had the advantage for accurate target localization by real time tracking as compared with other SBRT modalities and eliminated the discomfort of abdominal compression or respiratory control used in other SBRT techniques.

並列摘要


前言:此篇回溯性研究的目的是為了比較軀體立體定位放射線治療(SBRT)應用三度空間順形放射治療(3DCRT),強度調控放射治療(IMRT)與電腦刀(Cyberknife)於右側巨大肝癌(≥ 10 cm)治療時其劑量分布的差異性。材料與方法:本研究篩選10名接受電腦刀軀體立體定位放射線治療之右側巨大肝癌患者(≥ 10 cm),利用三種治療技術,包含三度空間順形放射治療(3DCRT)、強度調控放射治療(IMRT)與電腦刀(Cyberknife),以總劑40 Gy分5次治療,比較其劑量分布的差異性。為使放射線引起之肝病變(RILD)之風險為 ≤5%,治療計劃結果需符合 ≥ 700 cc 的正常肝臟體積其劑量需 ≤ 15 Gy。除腫瘤覆蓋率之外,其他劑量分布的分析項目還包括:劑量順形率(Conformityindex),劑量同質率(Homogeneity index),最高點劑量(Dmax)。結果:結果顯示,三個技術都可達到不錯的覆蓋腫瘤體積(GTV),電腦刀的計劃標靶體積覆蓋率優於其他兩種技術(p < 0.0544);而強度調控放射治療的劑量順形率顯著低於三度空間順形放射治療與電腦刀(p < 0.0082)。在劑量同質率與最高點劑量方面,三度空間順形放射治療顯著低於強度調控放射治療與電腦刀(p < 0.0001)。結論:電腦刀軀體立體定位放射線治療,可為於右側巨大肝癌患者提供肝癌治療的另一個選項,雖然腫瘤覆蓋率跟三度空間順形放射治療與強度調控放射治療並無明顯差異,且劑量順形率與同質率並無優於其他兩種技術。不過電腦刀的呼吸同步追蹤治療與其他軀體立體定位放射線治療方式相較之下,更能精確比對目標而達到定位優勢,病患也不會因腹部壓迫裝置或呼吸調控而在治療中有所不適。

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