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Image-guidance triggered adaptive replanning of radiation therapy for locally advanced lung cancer: an evaluation of cases requiring plan adaptation.

图像引导触发局部晚期肺癌放射治疗的适应性重新计划: 对需要计划适应的病例的评价。

  • 影响因子:2.12
  • DOI:10.1259/bjr.20190743
  • 作者列表:"Appel S","Bar J","Alezra D","Ben-Ayun M","Rabin-Alezra T","Honig N","Katzman T","Chatterji S","Symon Z","Lawrence YR
  • 发表时间:2020-01-01
Abstract

OBJECTIVES:Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases. METHODS:We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1/2016-3/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes. RESULTS:Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1 Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3 Gy (SD 4.4) vs 15.3 Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).2 year local control was 60.7% (95% confidence interval, 34.5-79.2%), and median overall survival was 19.7 months. CONCLUSION:Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered. ADVANCES IN KNOWLEDGE:In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.

摘要

目的: 肺癌放化疗治疗过程中可能发生解剖结构改变,需要适应性重新规划。这里我们描述这些病例。 方法: 我们回顾性研究了 1/2016-3/2019 期间接受再模拟和适应性再计划的肺癌病例。我们比较了第一和第二次 CT 模拟关于肿瘤位置、变化时间、肿瘤体积、解剖改变和模拟技术的变化。我们还比较了计划、记录的局部控制和总生存结局之间的剂量学参数。 结果: 在 281 例患者中,58 例接受了重新计划 (20.6%)。组织学包括小细胞 (22.4%) 和非小细胞 (77.6%)。第三阶段为 91.4%。平均辐射剂量为 59.4 Gray (Gy) (范围 50-66Gy)。53.5% 肿瘤位于支气管周围。重新计划的时间分别为 26% 、 43% 和 31% 疗程的第一、第二和最后三分之一。观察到 74% 的大体肿瘤体积变化; 平均大体肿瘤体积为 276.7cc vs 192.7 cc (第一次 vs 第二次模拟,p = 0.001)。35.4% 的解剖改变包括胸水积聚、肺不张或气胸改变。25.9% 进行了模拟技术的改变,包括屏气或持续气道正压。使用相同技术时剂量学参数的变化: 肺 V20Gy 26% (标准差,SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), 平均肺剂量 15.1 gy (SD 3.7) vs 14。 7Gy(SD 3.3) (p = 0.23),心脏 V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037)。当模拟技术改变时: 肺 V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012),平均肺剂量 17.3 gy (SD 4.4) vs 15.3 gy (SD 3.8) (p = 0.007),心脏 V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7)(P = 0.014).2 年局部对照为 60.7% (95% 置信区间,34.5-79.2%),中位总生存期为 19.7 个月。 结论: 五分之一的局部晚期肺癌患者进行了放射适应性重新计划。在大多数情况下,肿瘤体积缩小,或肺不张消退,引起纵隔移位,如果不明而未矫正,可能导致局部失败和毒性增加。所有病例的心脏 V40Gy 均显著减少,但只有改变模拟技术,肺剂量才显著减少。 知识进步: 在局部晚期肺癌图像引导下,锥形束 CT 可以检测到显著的纵隔移位和肿瘤体积变化,增加了适应性重新规划的需要。在局部晚期肺癌的晚期放射治疗计划中,应加入图像引导触发的适应性重新计划。

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影响因子:1.84
发表时间:2020-01-01
来源期刊:Oncology letters
DOI:10.3892/ol.2019.11149
作者列表:["Das SK","Huang YY","Li B","Yu XX","Xiao RH","Yang HF"]

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影响因子:8.44
发表时间:2020-02-01
DOI:10.1016/j.annonc.2019.10.022
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