TY  - JOUR
T1  - Pankreas Kanseri Radyoterapisinde 3 Farklı Tedavi Tekniğinin Dozimetrik Karşılaştırılması: Retrospektif Çalışma
TT  - DOSIMETRIC COMPARISON OF 3 DIFFERENT TREATMENT TECHNIQUES IN PANCREATIC CANCER RADIOTHERAPY: RETROSPECTIVE STUDY
AU  - İbicioğlu, Burcu
AU  - Kurt, Meral
AU  - Gözcü Tunç, Sema
AU  - Demiröz Abakay, Candan
AU  - Kahraman Çetintaş, Sibel
AU  - Turan, Abdulhamit
AU  - Cura, Ece Ayfer
AU  - Altaş, Habibe
PY  - 2018
DA  - August
Y2  - 2018
DO  - 10.32708/uutfd.431268
JF  - Journal of Uludağ University Medical Faculty
JO  - Uludağ Tıp Derg
PB  - Bursa Uludağ University
WT  - DergiPark
SN  - 1300-414X
SP  - 111
EP  - 116
VL  - 44
IS  - 2
LA  - tr
AB  - Çalışmamızdaamacımız pankreas kanseri tanısıyla radyoterapi görmüş, 20 hastaya konformalradyoterapi (3B-KRT), yoğunluk ayarlı radyoterapi (IMRT), hacimsel ayarlı ark terapi(VMAT) teknikleri ile tedavi planlaması yapılarak tekniklerin dozimetrik açıdankarşılaştırılmasıdır. Bu çalışmada 2012-2017 yılları arasında kliniğimizdetedavi görmüş, primer pankreas başı tümörü olan 20 hasta retrospektif olarakdeğerlendirilmiştir. Her hastaya tümör, tümör çevresi ve bölgesel lenfnodlarına yönelik 5 farklı tedavi tekniği planlanmış, tüm planlar hedef hacimdozları 54/45 Gy olacak şekilde seçilmiştir. Planlar VMAT ve IMRT için 6 MV X-ışını,3BKRT için 6/15 MV X-ışını kullanılarak hazırlanmıştır. Planlanan hedef hacimdozları (PTV), Conformite indeksi (CI), Homojenite indeksi (HI), riskli organlar(böbrekler, spinal cord, karaciğer) açısından teknikler karşılaştırılmıştır.PTV54 ve PTV45 için ortalama CI indeksleri VMAT 1 arkplanlarında sırasıyla 1,16 ve 1,03 VMAT 2 arkda ise 1,01 ve 1,00 bulunmuştur.CI açısından iki grup arasında anlamlı fark olmamasına rağmen en uygun CI değeriVMAT 2 ark planlarında bulunmuştur (PTV45 için p=0,806-PTV54için p=0,595). IMRT ile 3B-KRT teknikleri arasında CI açısından farkbulunamamış, en uygun değer IMRT tekniğinden elde edilmiştir. Kritik organdozları açısından VMAT 1 ark ve VMAT 2 ark planları arasında istatistikselfarklılık olmamasına rağmen VMAT 2 ark planlarının dozları daha düşükbulunmuştur. Pankreas tümörleri yerleşim yeri olarak böbrekler ve karaciğergibi kritik organlara yakın oluşundan 3BKRT planları karaciğer açısından kabul edilebilir;ancak böbrekleri koruma açısından yeterli değildir. VMAT 2 ark tekniği diğertekniklere göre doz sarımı, CI, HI ve kritik organ dozlarında üstünlüksağlamıştır. Bu yüzden yan etkiler göz önüne alındığında tedavi tekniği olarakVMAT tercih edilebilir.
KW  - VMAT
KW  - Pankreas Kanseri
KW  - 3BKRT
KW  - IMRT
N2  - In our study, our aim is to treat 20patients with pancreatic cancer who had radiotherapy, with conformalradiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), volumemodulated arc therapy (VMAT) planning and comparison of the techniques in termsof dosimetric. In this study, 20 patients with primary pancreatic head tumorwho were treated in our clinic between 2012-2017 were retrospectivelyevaluated. Five different treatment techniques were planned for each patient’stumor, around of tumor and regionallymph nodes, and all plans were implemented so that target volume doses wouldbe 54/45 Gy. Plans were prepared using 6 MV X-rays for VMAT and IMRT and 15 MVX-rays for 3BKRT. Techniques were compared interms of planned target volume doses (PTV), conformity index (CI), homogeneityindex (HI), organs at risk (kidneys, spinal cord, liver). The mean CI indicesVMAT 1 arc plans for PTV54 and PTV45 were found to be 1.16 and1.03 for VMAT 2 arc 1.01 and 1.00. Although there was no significant differencebetween the two groups in terms of CI, the most appropriate CI value was foundin VMAT 2 arc plans (p = 0.806 for PTV45 and p = 0.595 for PTV54). There was no difference interms of CI between IMRT and 3D-CRT techniques, the best value being obtainedfrom IMRT technique. Doses of VMAT 2 arc plans were found to belower, although there was no statistical difference between VMAT 1 arc and VMAT2 arc plans in terms of critical organ doses. Since pancreatic tumors arelocated close to critical organs such as kidneys and liver as a settlement, 3DCRTplans can be accepted in terms of liver; but the kidneys have not succeeded interms of protection. The VMAT 2 arc technique excelled in dose sprinning, CI,HI and critical organ doses according to other techniques. Therefore, VMAT maybe preferred as a treatment technique when side effects are taken into account.
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UR  - https://doi.org/10.32708/uutfd.431268
L1  - https://dergipark.org.tr/en/download/article-file/533595
ER  -