A Comparative Study of Radiation Therapy Planning between Volumetric-Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Nasopharyngeal Cancer

비인두암의 방사선치료 시 삼차원입체조형 치료기법과 용적세기조절회전치료기법의 비교연구

  • Kim, Ji-Sung (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Lee, Seok-Ho (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Lee, Seung-Heon (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Kim, Hye-Young (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Choi, Jin-Ho (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Lee, Kyu-Chan (Department of Radiation Oncology, Gachon University of Medical and Science) ;
  • Kim, Dong-Young (Department of Otolaryngology, Gachon University of Medical and Science)
  • 김지성 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 이석호 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 이승헌 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 김혜영 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 최진호 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 이규찬 (가천의과학대학교 의학전문대학원 방사선종양학교실) ;
  • 김동영 (가천의과학대학교 의학전문대학원 이비인후과학교실)
  • Published : 2010.11.26

Abstract

연구목적 : 비인두암 환자들을 대상으로 방사선치료 시 삼차원입체조형치료기법과 용적세기조절회전치료기법을 비교하고 이하선을 포함한 정상조직 보호에 있어 그 차이점을 알아 보고자 본 연구를 시행하였다. 대상 및 방법 : 비인두암 환자 5명을 대상으로 치료계획용 CT(computed tomography)를 시행 후 삼차원입체조형방사선치료계획 과 용적세기조절회전치료계획을 시행하였다. 이를 바탕으로 얻은 선량분포, conformity index(CI) 그리고 선량체적 히스토그램을 통해 손상위험장기(organ at risk)와 계획용표적체적(planning target volume)을 비교 분석하였다. 결 과 : 분석결과 이하선에 조사되는 평균선량이 용적세기조절회전치료계획에서는 43.9%로 삼차원입체조형치료계획에서의 89.4% 보다 유의하게(p=0.043) 감소하였다. 계획용표적체적 conformity index의 경우 용적세기조절회전치료계획 (CI=1.06)에서 삼차원입체조형치료계획(CI=2.55) 보다 유의하게(p=0.043) 향상된 결과를 보였다. 결 론 : 비인두암 환자에서 용적세기조절회전 치료계획 시 삼차원입체조형치료계획 보다 유의하게 이하선에 평균선량이 줄었고 계획용 표적체적에 대한 conformity도 유의하게 향상되는 결과를 보였다. 본 연구가 적은 수의 환자를 대상으로 하였으나 용적세기조절회전치료기법을 시행 시 구강건조증의 발생을 줄일 수 있을 것으로 기대된다. 향후 더 많은 환자군을 대상으로 한 임상연구가 필요할 것으로 사료된다.

Keywords

References

  1. Eisbruch A, Ship JA, Dawson LA, Kim HM, Bradford CR, Terrell JE, et al. Salivary gland sparing and improved target irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg. 2003;27:832-837. https://doi.org/10.1007/s00268-003-7105-6
  2. Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981-991. https://doi.org/10.1016/j.ijrobp.2006.06.013
  3. Braam PM, Terhaard CH, Roesink JM, Raaijmakers CP. Intensitymodulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:975-980. https://doi.org/10.1016/j.ijrobp.2006.06.045
  4. Dijkema T, Terhaard CH, Roesink JM, Braam PM, van Gils CH, Moerland MA, et al. Large cohort dose volume response analysis of parotid gland function after radiotherapy: Intensity-modulated versus conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:1101-1109. https://doi.org/10.1016/j.ijrobp.2008.02.059
  5. Lee SH, Kim TH, Kim JY, Park SY, Pyo HR, Shin KH, et al. Evaluation of parotid gland function following intensity modulated radiation therapy for head and neck cancer. Cancer Res Treat. 2006;38:84-91. https://doi.org/10.4143/crt.2006.38.2.84
  6. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008;35:310-317. https://doi.org/10.1118/1.2818738
  7. David Palma, Emily Vollans, Nakano S, Moiseenko V, Shaffer R, et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy:comparison with intensity-modulated radiotherapy and three-dimentional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:996-1001. https://doi.org/10.1016/j.ijrobp.2008.02.047
  8. Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol. 2008;89:180-191. https://doi.org/10.1016/j.radonc.2008.06.013
  9. Vergeer MR, Doornaert PA, Rietveld DH, Leemans CR, Slotman BJ, Langendijk JA. Intensity-modulated radiotherapy reduces radiation- induced morbidity and imrpvoes health-related quality of life: results of a nonrandomized prospective study using a followup program. Int J Radiat Oncol Biol Phys. 2009;74:1-8. https://doi.org/10.1016/j.ijrobp.2008.07.059
  10. Meirovitz A, Murdoch-Kinch CA, Schipper M, Pan C, Eisbruch A. Grading xerostomia by physicians or by patients after intensity- modulated radiotherapy of head and neck cancer. Int J Radiat Oncol Biol Phys. 2006;66:445-453. https://doi.org/10.1016/j.ijrobp.2006.05.002
  11. Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, et al. Volumetric arc modulated radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92:118-124. https://doi.org/10.1016/j.radonc.2008.12.020
  12. Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L. Intensity modulation with photons for benign intracranial tumours: A planning comparison of volumetric single arc, helical arc and fixed gantry techniques. Radiother Oncol. 2008;89:254-262. https://doi.org/10.1016/j.radonc.2008.07.021
  13. Kjaer-Kristoffersen F, Ohlhues L, Medin J, Korreman S. RapidArc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol. 2008;14:1-6.
  14. Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy: Comparison with intensity modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:996-1001. https://doi.org/10.1016/j.ijrobp.2008.02.047
  15. Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, et al. Volumetric arc modulated radiotherapy for carcinomas of the oro-pharynx, hypopharynx and larynx: A treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92:111-117. https://doi.org/10.1016/j.radonc.2008.12.008
  16. Lagerwaard FJ, Meijer OW, van der Hoorn EA, Verbakel WF, Slotman BJ, Senan S. Volumetric modulated arc radiotherapy for vestibular schwannomas. Int J Radiat Oncol Biol Phys. 2009; 74:610-615. https://doi.org/10.1016/j.ijrobp.2008.12.076
  17. Verbakel WF, Cuijpers JP, Hoffmans D, Bieker M, Slotman BJ, Senan S. Volumetric intensity modulated arc therapy versus conventional IMRT in head and neck cancer: A comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys. 2009; 74:252-259. https://doi.org/10.1016/j.ijrobp.2008.12.033
  18. Verbakel WFAR, Senan S, Lagerwaard FJ, Hoffmans D, Slotman BJ. RapidArc vs. IMRT Planning: comparative Study with Dosimetric Validation for Head and Neck, Glioma and Pancreas Cancer. Int J Radiat Oncol Biol Phys. 2008;72:596-597.
  19. Wagner D, Christiansen H, Wolff H, Vorwerk H. Radiotherapy of malignant gliomas: Comparison of volumetric single arc technique( RapidArc), dynamic intensity-modulated technique and 3D conformal technique. Radiother Oncol. 2009;93:593-596. https://doi.org/10.1016/j.radonc.2009.10.002
  20. Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume and function relationships in parotid salivry glands following conformal and intensity modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45:577-587. https://doi.org/10.1016/S0360-3016(99)00247-3
  21. Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head and neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49:907-916. https://doi.org/10.1016/S0360-3016(00)01441-3
  22. Saarilahti K, Kouri M, Collan J, Hamalainen T, Atula T, Joensuu H, et al. Intensity modulated radiotherapy for head and neck cancer: evidence for preserved salivary gland function. Radiother Oncol. 2005;74:251-258. https://doi.org/10.1016/j.radonc.2004.11.004
  23. Amosson CM, Teh BS, Van TJ, Uy N, Huang E, Mai WY, et al. Dosimetric predictors of xerostomia for head and neck cancer patients treated with the smart(simultaneous modulated accelerated radiation therapy) boost technique. Int J Radiat Oncol Biol Phys. 2003;56:136-144. https://doi.org/10.1016/S0360-3016(03)00093-2
  24. Franzen L, Funegard U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck. A consecutive study of salivary flow and patient discomfort. Eur J Cancer. 1992;28:457-462. https://doi.org/10.1016/S0959-8049(05)80076-0
  25. Feuvret L, Noel G, Mazeron JJ, Bey P. Conformity index: review. Int J Radiat Oncol Biol Phys. 2006;64:333-342. https://doi.org/10.1016/j.ijrobp.2005.09.028