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Estimating PTV Margins in Head and Neck Stereotactic Ablative Radiation Therapy (SABR) Through Target Site Analysis of Positioning and Intrafractional Accuracy.

通过定位和内照射精度的靶位点分析,估计头颈部立体定向消融放射治疗 (SABR) 中的PTV边缘。

  • 影响因子:3.70
  • DOI:10.1016/j.ijrobp.2019.09.010
  • 作者列表:"Mesko S","Wang H","Tung S","Wang C","Pasalic D","Chapman BV","Moreno AC","Reddy JP","Garden AS","Rosenthal DI","Gunn GB","Frank SJ","Fuller CD","Morrison W","Phan J
  • 发表时间:2020-01-01
Abstract

PURPOSE:Recurrent or previously irradiated head and neck cancers (HNC) are therapeutically challenging and may benefit from high-dose, highly accurate radiation techniques, such as stereotactic ablative radiation therapy (SABR). Here, we compare set-up and positioning accuracy across HNC subsites to further optimize the treatment process and planning target volume (PTV) margin recommendations for head and neck SABR. METHODS AND MATERIALS:We prospectively collected data on 405 treatment fractions across 79 patients treated with SABR for recurrent/previously irradiated HNC. First, interfractional error was determined by comparing ExacTrac x-ray to the treatment plan. Patients were then shifted and residual error was measured with repeat x-ray. Next, cone beam computed tomography (CBCT) was compared with ExacTrac for positioning agreement, and final shifts were applied. Lastly, intrafractional error was measured with x-ray before each arc. Results were stratified by treatment site into skull base, neck/parotid, and mucosal. RESULTS:Most patients (66.7%) were treated to 45 Gy in 5 fractions (range, 21-47.5 Gy in 3-5 fractions). The initial mean ± standard deviation interfractional errors were -0.2 ± 1.4 mm (anteroposterior), 0.2 ± 1.8 mm (craniocaudal), and -0.1 ± 1.7 mm (left-right). Interfractional 3-dimensional vector error was 2.48 ± 1.44, with skull base significantly lower than other sites (2.22 vs 2.77; P = .0016). All interfractional errors were corrected to within 1.3 mm and 1.8°. CBCT agreed with ExacTrac to within 3.6 mm and 3.4°. CBCT disagreements and intrafractional errors of >1 mm or >1° occurred at significantly lower rates in skull base sites (CBCT: 16.4% vs 50.0% neck, 52.0% mucosal, P < .0001; intrafractional: 22.0% vs 48.7% all others, P < .0001). Final PTVs were 1.5 mm (skull base), 2.0 mm (neck/parotid), and 1.8 mm (mucosal). CONCLUSIONS:Head and neck SABR PTV margins should be optimized by target site. PTV margins of 1.5 to 2 mm may be sufficient in the skull base, whereas 2 to 2.5 mm may be necessary for neck and mucosal targets. When using ExacTrac, skull base sites show significantly fewer uncertainties throughout the treatment process, but neck/mucosal targets may require the addition of CBCT to account for positioning errors and internal organ motion.

摘要

目的: 复发性或既往照射过的头颈部肿瘤 (HNC) 具有治疗挑战性,可能受益于高剂量、高精度的放射技术,如立体定向消融放射治疗 (SABR)。在此,我们比较了HNC各亚位点的设置和定位精度,以进一步优化头颈部SABR的治疗过程和计划目标体积 (PTV) 边缘建议。 方法和材料: 我们前瞻性收集了 79 例接受SABR治疗的复发性/既往照射HNC患者的 405 个治疗组分的数据。首先,通过比较ExacTrac x射线与治疗计划确定分数间误差。然后对患者进行移位,用重复x线测量残余误差。接下来,将锥形束计算机断层扫描 (CBCT) 与ExacTrac进行定位一致性比较,并应用最终移位。最后,在每条圆弧前用x射线测量运动内误差。结果按治疗部位分为颅底、颈部/腮腺和粘膜。 结果: 大多数患者 (66.7%) 接受了 5 次 45 Gy的治疗 (3-5 次 21-47.5 Gy)。初始平均 ± 标准差分次误差为-0.2 ± 1.4毫米 (前后位) 、 0.2 ± 1.8毫米 (颅侧) 和-0.1 ± 1.7毫米 (左右)。分数阶间 3 维向量误差为 2.48 ± 1.44,颅底明显低于其他部位 (2.22 vs 2.77; P = .0016)。所有分数间误差均校正到 1.3毫米和 1.8 ° 以内。CBCT同意ExacTrac在 3.6毫米和 3.4 ° 内。在颅底部位,CBCT分歧和> 1毫米或> 1 ° 的动作内错误发生率显著较低 (CBCT: 16.4% vs 50.0% 颈部,52.0% 粘膜,P <。0001; 牵引力内: 22.0% vs 48.7% 所有其他,P <.0001)。最终PTVs为 1.5毫米 (颅底) 、 2.0毫米 (颈部/腮腺) 和 1.8毫米 (粘膜)。 结论: 头颈部SABR PTV边缘应按靶位点优化。1.5 至 2毫米的PTV边缘在颅底可能足够,而 2 至 2.5毫米可能是颈部和粘膜靶点所必需的。当使用ExacTrac时,颅底部位在整个治疗过程中表现出明显较少的不确定性,但颈部/粘膜靶点可能需要添加CBCT来解释定位错误和内部器官运动。

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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