目的:比较碳离子二维放射治疗(two-dimensional carbon-ion radiotherapy,2D-CIRT)计划与光子容积调强放射治疗(volume modulated arc therapy,VMAT)计划在Ⅲ期非小细胞肺癌中剂量学优劣,为临床碳离子治疗提供依据。方法:选取我中心13...目的:比较碳离子二维放射治疗(two-dimensional carbon-ion radiotherapy,2D-CIRT)计划与光子容积调强放射治疗(volume modulated arc therapy,VMAT)计划在Ⅲ期非小细胞肺癌中剂量学优劣,为临床碳离子治疗提供依据。方法:选取我中心13例Ⅲ期非小细胞肺癌患者,使用相同的处方剂量及危及器官约束条件,分别在Ciplan计划系统上设计2D-CIRT计划和Eclipse计划系统上设计VMAT计划,比较剂量-体积直方图,评价靶区剂量分布及危及器官受量。采用SPSS 22.0软件进行数据分析。结果:CIRT和VMAT计划肿瘤覆盖率均较好,PTV1的D_(98)、D_(95)、D_(50)差异无统计学意义,两种计划的均匀性指数(homogeneity index,HI)相似(CIRT与VMAT:0.39 Gy与0.38 Gy,P>0.05)。PTV2两种方案在D_(95)、D_(98)、D_(50)、D_(2)均有显著性差异,PTV2采用CIRT的HI也明显优于VMAT(CIRT vs VMAT:0.08 Gy vs 0.16 Gy,P=0.003)。与光子VMAT相比,CIRT计划中健侧肺的V_(5)、V_(10)、V_(20)、V_(30)、V_(40)和D_(mean)明显降低。患侧肺中CIRT的V_(5)低于VMAT(CIRT vs VMAT:53.00 vs 64.41,P=0.003),V_(10)、V_(20)、V_(30)、V_(40)、D_(mean)两种计划均无统计学差异;CIRT有较低的脊髓D max(CIRT vs VMAT:18.61 Gy vs 43.03 Gy,P=0.000)、食管D_(mean)(CIRT vs VMAT:16.25 Gy vs 20.38 Gy,P=0.031)和V_(5)0(CIRT vs VMAT:4.49 Gy vs 11.43 Gy,P=0.005)、骨V_(10)和V_(30),以及气管和支气管树的V_(5)0。结论:与光子VMAT相比,2D-CIRT被动束流扫描技术在Ⅲ期非小细胞肺癌治疗中显著降低了对危及器官的辐射剂量,对正常组织有更好的保护作用。展开更多
Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report t...Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report the results of PSQA conducted at the QST Hospital during the period from September 2017 to March 2018. Methods: We analyzed PSQA results for 1448 fields for 10 disease sites with various target volumes, target depths and number of energy layers. For the PSQA, all the planned beams were recalculated on a water phantom with treatment planning software. The recalculated dose distributions were compared with the measured distributions using a 2D ionization chamber array at three depths, including 95% of the area of the prescription dose. These recalculated dose distributions were evaluated using the 3%/3mm gamma index with a passing threshold of 90%. Results: The passing rates for prostate, head and neck, and bone and soft tissue were 96.8%, 99.3%, and 91.7%, respectively. Additionally, 94.7% of lung plans with low energy beams passed. Overall, the CIRT in the QST Hospital reached a high passing rate of more than 95%. Although the remaining 5% failed to pass, there was no dependence between measurement depth and disease sites in these failures. Conclusion: Using PSQA measurements, we confirmed consistency between the planned and delivered doses for CIRT using the full energy scanning method.展开更多
Hepatocellular carcinoma(HCC)is the fifth most common malignancy and the second leading cause of cancer mortality worldwide.The cornerstone to improving the prognosis of HCC patients has been the control of loco-regio...Hepatocellular carcinoma(HCC)is the fifth most common malignancy and the second leading cause of cancer mortality worldwide.The cornerstone to improving the prognosis of HCC patients has been the control of loco-regional disease progression and the lesser toxicities of local treatment.Although radiotherapy has not been considered a preferred treatment modality for HCC,charged particle therapy(CPT),including proton beam therapy(PBT)and carbon ion radiotherapy(CIRT),possesses advantages(for example,it allows ablative radiation doses to be applied to tumors but simultaneously spares the normal liver parenchyma from radiation)and has emerged as an alternative treatment option for HCC.With the technological advancements in CPT,various radiation dosages of CPT have been used for HCC treatment via CPT.However,the efficacy and safety of the evolving dosages remain uncertain.To assess the association between locoregional control of HCC and the dose and regimen of CPT,we provide a brief overview of selected literature on dose regimens from conventional to hypofractionated short-course CPT in the treatment of HCC and the subsequent determinants of clinical outcomes.Overall,CPT provides a better local control rate compared with photon beam therapy,ranging from 80%to 96%,and a 3-year overall survival ranging from 50%to 75%,and it results in rare grade 3 toxicities of the late gastrointestinal tract(including radiation-induced liver disease).Regarding CPT for the treatment of locoregional HCC,conventional CPT is preferred to treat central tumors of HCC to avoid late toxicities of the biliary tract.In contrast,the hypo-fractionation regimen of CPT is suggested for treatment of larger-sized tumors of HCC to overcome potential radio-resistance.展开更多
文摘目的:比较碳离子二维放射治疗(two-dimensional carbon-ion radiotherapy,2D-CIRT)计划与光子容积调强放射治疗(volume modulated arc therapy,VMAT)计划在Ⅲ期非小细胞肺癌中剂量学优劣,为临床碳离子治疗提供依据。方法:选取我中心13例Ⅲ期非小细胞肺癌患者,使用相同的处方剂量及危及器官约束条件,分别在Ciplan计划系统上设计2D-CIRT计划和Eclipse计划系统上设计VMAT计划,比较剂量-体积直方图,评价靶区剂量分布及危及器官受量。采用SPSS 22.0软件进行数据分析。结果:CIRT和VMAT计划肿瘤覆盖率均较好,PTV1的D_(98)、D_(95)、D_(50)差异无统计学意义,两种计划的均匀性指数(homogeneity index,HI)相似(CIRT与VMAT:0.39 Gy与0.38 Gy,P>0.05)。PTV2两种方案在D_(95)、D_(98)、D_(50)、D_(2)均有显著性差异,PTV2采用CIRT的HI也明显优于VMAT(CIRT vs VMAT:0.08 Gy vs 0.16 Gy,P=0.003)。与光子VMAT相比,CIRT计划中健侧肺的V_(5)、V_(10)、V_(20)、V_(30)、V_(40)和D_(mean)明显降低。患侧肺中CIRT的V_(5)低于VMAT(CIRT vs VMAT:53.00 vs 64.41,P=0.003),V_(10)、V_(20)、V_(30)、V_(40)、D_(mean)两种计划均无统计学差异;CIRT有较低的脊髓D max(CIRT vs VMAT:18.61 Gy vs 43.03 Gy,P=0.000)、食管D_(mean)(CIRT vs VMAT:16.25 Gy vs 20.38 Gy,P=0.031)和V_(5)0(CIRT vs VMAT:4.49 Gy vs 11.43 Gy,P=0.005)、骨V_(10)和V_(30),以及气管和支气管树的V_(5)0。结论:与光子VMAT相比,2D-CIRT被动束流扫描技术在Ⅲ期非小细胞肺癌治疗中显著降低了对危及器官的辐射剂量,对正常组织有更好的保护作用。
文摘Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report the results of PSQA conducted at the QST Hospital during the period from September 2017 to March 2018. Methods: We analyzed PSQA results for 1448 fields for 10 disease sites with various target volumes, target depths and number of energy layers. For the PSQA, all the planned beams were recalculated on a water phantom with treatment planning software. The recalculated dose distributions were compared with the measured distributions using a 2D ionization chamber array at three depths, including 95% of the area of the prescription dose. These recalculated dose distributions were evaluated using the 3%/3mm gamma index with a passing threshold of 90%. Results: The passing rates for prostate, head and neck, and bone and soft tissue were 96.8%, 99.3%, and 91.7%, respectively. Additionally, 94.7% of lung plans with low energy beams passed. Overall, the CIRT in the QST Hospital reached a high passing rate of more than 95%. Although the remaining 5% failed to pass, there was no dependence between measurement depth and disease sites in these failures. Conclusion: Using PSQA measurements, we confirmed consistency between the planned and delivered doses for CIRT using the full energy scanning method.
基金Supported by the Ministry of Science and Technology,Taiwan,No.MOST 107-2314-B-002-217-MY3National Taiwan University Hospital,Taiwan,No.NTUH 108-S4143
文摘Hepatocellular carcinoma(HCC)is the fifth most common malignancy and the second leading cause of cancer mortality worldwide.The cornerstone to improving the prognosis of HCC patients has been the control of loco-regional disease progression and the lesser toxicities of local treatment.Although radiotherapy has not been considered a preferred treatment modality for HCC,charged particle therapy(CPT),including proton beam therapy(PBT)and carbon ion radiotherapy(CIRT),possesses advantages(for example,it allows ablative radiation doses to be applied to tumors but simultaneously spares the normal liver parenchyma from radiation)and has emerged as an alternative treatment option for HCC.With the technological advancements in CPT,various radiation dosages of CPT have been used for HCC treatment via CPT.However,the efficacy and safety of the evolving dosages remain uncertain.To assess the association between locoregional control of HCC and the dose and regimen of CPT,we provide a brief overview of selected literature on dose regimens from conventional to hypofractionated short-course CPT in the treatment of HCC and the subsequent determinants of clinical outcomes.Overall,CPT provides a better local control rate compared with photon beam therapy,ranging from 80%to 96%,and a 3-year overall survival ranging from 50%to 75%,and it results in rare grade 3 toxicities of the late gastrointestinal tract(including radiation-induced liver disease).Regarding CPT for the treatment of locoregional HCC,conventional CPT is preferred to treat central tumors of HCC to avoid late toxicities of the biliary tract.In contrast,the hypo-fractionation regimen of CPT is suggested for treatment of larger-sized tumors of HCC to overcome potential radio-resistance.
