The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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Usefulness evaluation of Hybrid planning through dosimetric comparision of Three Dimensinal Conformal Radiation Radiotherapy and Hybrid planning for left breast cancer

유방암 환자의 방사선 치료시 Energy와 Wedge를 combine한 Hybrid plan의 유용성 평가

  • Chae, Moon Ki (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Byung Soo (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Jong Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Ki Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 채문기 (삼성서울병원 방사선종양학과) ;
  • 박병수 (삼성서울병원 방사선종양학과) ;
  • 안종호 (삼성서울병원 방사선종양학과) ;
  • 송기원 (삼성서울병원 방사선종양학과)
  • Received : 2014.03.21
  • Accepted : 2014.04.30
  • Published : 2014.06.30
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Abstract

Purpose : To compare the dosimetry for the left breast cancer treatment between three dimensional conformal radiation radiotherapy (3D-CRT) and Hybrid planning and to estimate usefulness of Hybrid planning Materials and Methods : Five patients with left breast cancer were included in the study. They were planned using several different radiotherapy techniques including: 1)open rectangular field, 2)tangential wedge-based field 3)field in field, 4)hybrid planning(energy, wedge combine). For each patient planning was using Light Speed RT-16 CT and PINNACLE planning system-ver.9.2. Hybrid plan was made using same system and using the same targets and optimization goals. We comparing the Homogeneity Index(HI), normal organs at the does-volume histogram(DVH) Results : In all plans, the Homogeneity Index(HI) of Hybrid planning was significantly better than other. Dose comparison of HI= 2D-RT:38.32, TW:38.32, FIF:29.22, HYBRID:30.57. 2D-RT, TW, FIF Hybrid$V_{75_-lung}$=112.33, 125.14, 121.3, 123.78. $V_{50_-lung}$=155.43, 159.62, 157.96, 159.06. $V_{25_-lung}$=199.86, 200.22, 198.65, 200.31. $V_{50_-heart}$=26.07, 27.1, 26.85, 27.17 $V_{30_-heart}$=33.71, 34.37, 34.15, 34.65 Conclusion : In summary, 3D-CRT, Hybrid planning techniques were found to have acceptableCTV coverage in our study. However the Hybrid planning increased radiation dose exposure to normal tissue. If you apply for treatment of inhomogeneity areas like lung, For best results will be achieved.

목 적 : 본 연구에서는 기존의 방사선 치료 기법인 3D-CRT 방법을 기반으로 치료 Energy와 Wedge를 변형 시킨 Hybrid 치료계획을 세워, open rectangular field를 사용한 2D-RT와 현재 가장 많이 시행되고 있는 방사선치료의 형태인 3D-CRT, 그리고 Hyrid paln 의 각각의 치료계획에 따른 선량분포, 선량-체적 히스토그램을 이용하여 산출된 값들을 비교, 분석하여 Hybrid 치료계획의 유용성을 평가하고자 한다. 대상 및 방법 : 본원에서 방사선 치료를 받은 환자 5명을 대상으로 전산화 단층촬영장치(RT-16GE)를 이용해 CT모의치료를 시행하여 영상을 획득하였다. 치료계획실에서는 이미지 관심영역표시는 종양은 CTV으로, 정상장기는 폐, 심장으로 나타냈다. 치료계획은(pinncle-ver 9.2)은 표적에는 충분한 선량을 정상장기에는 선량이 최소화 되도록 치료계획을 세웠다. 결 과 : Homogeneity Index의 선량비교는 2D-RT (open rectangular field): 38.32, TW(conformal wedge field): 32.01 FIF(field in field): 29.22, HYBRID(energy combine, wedge combine): 30.57으로 나타났다. 2D-RT, TW, FIF Hybrid $V_{75_-lung}$은 각각 112.33, 125.14, 121.3, 123.78. $V_{50_-lung}$은 155.43, 159.62, 157.96, 159.06. $V_{25_-lung}$은 199.86, 200.22, 198.65, 200.31. $V_{50_-heart}$는 각각 26.07, 27.1, 26.85, 27.17 $V_{30_-heart}$ 33.71, 34.37, 34.15, 34.65로 나타났다. 결 론 : HYBRID planning에서 표적에는 3D-CRT 에 비해 비교적 뛰어난 선량분포와 유방을 보호함을 보여주지만 폐와 심장에 많은 선량이 조사됨을 치료계획 시 주의해야 하고 앞으로 해결해야 할 과제라 생각된다. HYBRID 으로 Energy를 혼합하여 사용한다면, 타겟에 보다 더 적절한 coverage가 이루어질 수 있을 것으로 보인다. breast 뿐만 아닌 Lung cacner 치료와 같이 불균질한 부위의 치료에 적용한다면 보다 더 최적을 결과를 이루어낼 수 있을 것으로 사료된다.

Keywords

References

  1. Bennett BR, Lamba MA, Elson HR: Analysis of peripheral doses for base of tongue treatment by linear accelerator and helical TomoTherapy IMRT. J Appl Clin Med Phys 2010, 11(3):31-36.
  2. Wiezorek T, Schwahofer A, Schubert K: The influence of different IMRT techniques on the peripheral dose: a comparison between sMLM-IMRT and helical tomotherapy. Strahlenther Onkol 2009, 185(10):696-702. https://doi.org/10.1007/s00066-009-2005-9
  3. Wiezorek T, Georg D, Schwedas M, Salz H, Wendt TG: Experimental determination of peripheral photon dose components for different IMRT techniques and linear accelerators. Z Med Phys 2009, 19(2):120-8. https://doi.org/10.1016/j.zemedi.2009.01.008
  4. Georg D, Kroupa B, Georg P, Winkler P, Bogner J, Dieckmann K, Potter R: Inverse planning - a comparative intersystem and interpatient constraint study. Strahlenther Onkol 2006, 182(8):473-80. https://doi.org/10.1007/s00066-006-1531-y
  5. Georg P, Georg D, Hillbrand M, Kirisits C, P?tter R: Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies. Radiother Oncol 2006, 80(1):19-26, Epub 2006 Jun 12. https://doi.org/10.1016/j.radonc.2006.04.014
  6. Hunt MA, Jackson A, Narayana A, Lee N: Geometric factors influencing dosimetric sparing of the parotid glands using IMRT. Int J Radiat Oncol Biol Phys 2006, 66(1):296-304. https://doi.org/10.1016/j.ijrobp.2006.05.028
  7. Luan S, Wang C, Cao D, et al: Leaf-sequencing for intensity-modulated arc therapy using graph algorithms. Med Phys 2008, 35:61-69. https://doi.org/10.1118/1.2818731
  8. Shepard DM, Earl MA, Li XA, et al: Direct aperture optimization: A turnkey solution for step-and-shoot IMRT. Med Phys 2002, 29:1007-1018. https://doi.org/10.1118/1.1477415
  9. Sondergaard J, Høyer M, Petersen JB, Wright P, Grau C, Muren LP: The normal tissue sparing obtained with simultaneous treatment of pelvic lymph nodes and bladder using intensity-modulated radiotherapy. Acta Oncol 2009, 48(2):238-44.
  10. Ulrich S, Nill S, Oelfke U: Development of an optimization concept for arc-modulated cone beam therapy. Phys Med Biol 2007, 52:4099-4119. https://doi.org/10.1088/0031-9155/52/14/006
  11. Cameron C: Sweeping-window arc therapy: An implementation of rotational IMRT with automatic beam-weight calculation. Phys Med Biol 2005, 50:4317-4336. https://doi.org/10.1088/0031-9155/50/18/006
  12. Ansari DO, Esiashvili N, Dhabaan AH, Jarrio CS, Elder ES, Crowder M, Koontz-Raisig W, Shu HG: Is Intensity Modulated Arc Therapy (IMAT) Better Than Non-rotational Intensity Modulated Radiation Therapy (IMRT) for Pediatric Brain Tumors Int J Radiat Oncol Biol Phys 2009, 75(3):510.
  13. Cao D, Holmes TW, Afghan MKN, et al: Comparison of plan quality provided by intensity-modulated arc therapy and helical tomotherapy. Int J Rad Oncol Biol Phys 2007, 69:240-250. https://doi.org/10.1016/j.ijrobp.2007.04.073
  14. Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetricmodulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92(1):118-124. https://doi.org/10.1016/j.radonc.2008.12.020
  15. Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89(2):180-191. https://doi.org/10.1016/j.radonc.2008.06.013
  16. Doornaert P, Verbakel WF, Bieker M, Slotman BJ, Senan S: RapidArc Planning and Delivery in Patients with Locally Advanced head-and-neck Cancer Undergoing Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011, 79(2):429-435. https://doi.org/10.1016/j.ijrobp.2009.11.014
  17. Jacob V, Bayer W, Astner ST, Busch R, Kneschaurek P: A Planning Comparison of Dynamic IMRT for Different Collimator Leaf Thicknesses with Helical Tomotherapy and RapidArc for Prostate and Head and Neck Tumors. Strahlenther Onkol 2010, 186(9):502-510, Epub 2010 Aug 30. https://doi.org/10.1007/s00066-010-2124-3
  18. Otto K: Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2007, 35:310-317.
  19. Sheng K, Molloy J, Read PW: Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: a comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy. Int J Radiat Oncol Biol Phys 2006, 65:917-23. https://doi.org/10.1016/j.ijrobp.2006.02.038
  20. Dae Woong Kim, Jong Won Kim, Yun Kyung Choi, Jung Soo Kim, Jae Woong Hwang, Kyung SinJeong, Gye Suk Choi: Dosimetric Comparosion of Three Dimensional Conformal Radiation Radiotherapy and Helical Tomotherapy Partical Breast Cancer.