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Decrease of Irradiated Volume using Rotational Treatment by Avoidance Sector in Radiation Therapy for Esophageal Cancer

식도암의 방사선치료에서 부분 각도에 의한 회전 치료를 이용한 조사체적의 감소

  • Hwang, Chulhwan (Departments of Radiology, Masan University) ;
  • Kim, Seong Hu (Departments of Radiology, Masan University) ;
  • Koo, Jae Heung (Departments of Radiology, Masan University) ;
  • Son, Jong Ki (Departments of Radiation Oncology, Pusan National University Hospital)
  • 황철환 (마산대학교 방사선과) ;
  • 김성후 (마산대학교 방사선과) ;
  • 구재흥 (마산대학교 방사선과) ;
  • 손종기 (부산대학교병원 방사선종양학과)
  • Received : 2018.06.25
  • Accepted : 2018.10.31
  • Published : 2018.10.31

Abstract

In this study, plans to apply 3D conformal radiotherapy, intensity modulated radiotherapy, and volumetric intensity modulated arc radiotherapy to esophageal cancer radiotherapy were compared. In particular, arc therapy was applied to reduce irradiated volume and spread of low-dose during intensity modulated radiation therapy and volumetric intensity modulated arc radiotherapy by limiting part of irradiated angle, in order to compare target doses and dose for surrounding normal tissues of the two methods and those of 3D conformal radiotherapy. No significant difference in target dose was found among the three methods. The 5 Gy volume(V5) of the lung showed 56.53% of conformal radiotherapy, 52.03% of intensity modulated radiotherapy, and 47.84% of volumetric modulated arc therapy(CRT-IMRT p=0.035, CRT-VMAT p<0.001, IMRT-VMAT p<0.001). The 10 Gy volume(V10) showed a significant difference in conformal radiotherapy 35.12%, intensity modulated radiotherapy 34.04%, and volumetric modulated arc radiotherapy 33.28%, showing significant difference in intensity modulated radiotherapy(p=0.018), volumetric modulated arc therapy(p=0.035), no significant difference in dose was found at 20 Gy volume. The mean dose and 20 Gy volume of the heart were not significantly different according to the treatment plan, but the 30 and 40 Gy volumes were 37.16% and 22.46% in the volumetric modulated arc radiotherapy, showing significant differences(p=0.028) in comparison with conformal radiotherapy. It is believed that, by limiting part of the irradiated angle during intensity modulated radiotherapy and volumetric intensity modulated arc radiotherapy, the irradiated volume and, thereby, the 5-10 Gy area and toxicity of the lung can be reduced while maintaining dose distribution of the target dose.

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