不同強度調控放射線治療計畫系統在頭頸部腫瘤結果之比較

A Study for Comparing Two Different IMRT Treatment Planning Systems for Head and Neck Cancer

賴鵬安(Peng-An Lai) ； 邱仲峰(Jeng-Fong Chiou) ； 趙坤山(K. C. Clifford Chao) ； 翁培豐(Pei-Fong Wong) ； 葉啓源(Chi-Yuan Yeh)

《中華放射線技術學雜誌》 30卷1期 (2006/06) Pp. 27-40

https://doi.org/10.30045/CJRT.200606.0004

摘要

放射線治療的發展至今已有一百多年的歷史，全身的腫瘤幾乎都可以利用放射線來做治療，尤其是頭頸部腫瘤，已經變成是最主要的治療方式。而且在頭頸部這個區域有很多的神經、血管及其他重要的器官，例如：腦幹、脊髓、眼睛、視神經、唾液腺等，不僅限制了其他的治療方式，對放射治療來說也是一個重大的挑戰。
強度調控放射線治療(Intensity Modulated Radiotherapy; IMRT)是一種新型態的3-DCRT，利用反算式治療計畫電腦，配合多葉式準直儀(Multi-leaves collimator; MLC)可以在每一個治療照野產生不同強度以及不同形狀的劑量分佈，相對於傳統3-D放射線治療計畫可以得到比較好的結果。對於頭頸部腫瘤與周圍正常器官之間距離太近以及腫瘤形狀如此複雜的關係，正好可以發揮其最大功效。在和3-D的治療技術比較起來，特別是腫瘤在接近驢底的位置或是鼻竇附近的腫瘤，都有比較好的控制率，而且也可以降低副作用的發生。
強度調控放射線治療在臨床上的表現不論是在腫瘤控制率或是產生副作用的機率及嚴重的程度，都比傳統2-D或是3-D的治療來得好，在臨床上已有好幾種不同的系統可以進行強度調控放射線治療的治療。這次的研究主要是針對在MD Anderson cancer center現有的Pinnacle Version 7.4 (Philips Medical Systems, Madison, WI)治療計畫電腦及Eclipse Version 7.2 (Varian Medical Systems, Palo Alta, CA)治療計畫電腦兩套不同的系統來進行比較。

關鍵字

強度調控放射線治療 ； 治療計畫系統 ； 頭頸部腫瘤

並列摘要

Since 1895 the German physicist Wilhelm Conrad RÖntgen discovered x-ray, the developed of radiation treatment was over one hundred years. Most of cancers could be treated by radiation, especially for head and neck cancers. In head and neck region, there were a lot of critical organs such as brainstem spinal cord、eyes、optical nerves and parotid glands. This was not only restricted the treatment modalities but also a big challenge for radiation treatment.
Intensity-modulated radiation therapy (IMRT) is an advanced mode of 3-D conformal radiotherapy that utilizes inverse treatment planning computer and multileaf collimators controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor with different intensity. Delivered IMRT dose plans showed a systematic and highly significant improvement in terms of dose coverage for complex tumor shapes or tumors near the skull base compared to reference 3DCRT. IMRT technique also can guarantee a better degree of confinement of high dose levels in the neighborhood of target volumes compared to 3DCRT.
IMRT has been demonstrated to often produce superior dose distributions in terms of improved tumor coverage to increase tumor control rate and lower doses to reduce normal tissue complications than 2-D or 3-D treatment plans for a variety of cancers originating in the head-and-neck region. There were many treatment-planning systems has been used for IMRT. This report aims to summarize the clinical performances and dosimetric factors to be taken into consideration to assess the advantages of the Eclipse and Pinnacle treatment planning systems in MD Anderson Cancer Canter.

並列關鍵字

IMRT ； treatment planning system ； head and neck cancer