igusabder

İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi

2536-4499 2602-2605

İstanbul Gelisim University

10.38079/igusabder.1628465

Medical Physics

Tıp Fiziği

Mesane Kanseri İçin Tedavi Planlarının Karşılaştırılması: FIF, YART ve SIB: Dozimetrik Bir Çalışma

Comparing Treatment Plans for Bladder Cancer: FIF, IMRT and SIB: A Dosimetric Study

https://orcid.org/0000-0003-2995-0256

İnan

Gökçen

SELÇUK ÜNİVERSİTESİ

https://orcid.org/0000-0002-6773-3132

Gül

Osman Vefa

SELCUK UNIVERSITY

https://orcid.org/0000-0002-2122-8720

Başaran

Hamit

SELCUK UNIVERSITY

04 29 2026

28 57 68 01 28 2025 03 11 2026

2017

Istanbul Gelisim University Journal of Health Sciences

Amaç: Bu çalışmanın amacı, alan içi alan (FIF), yoğunluk ayarlı radyoterapi (YART) ve eşzamanlı entegre boost (SIB) tekniği kullanılarak mesane kanseri için yapılan planları karşılaştırmaktır.Yöntem: Mesane kanseri tanısı almış 20 hastanın tomografi görüntüleri kullanılarak FIF, YART ve SIB tedavi planları oluşturuldu. Her hasta için iki ayrı planlama hedef hacmi (PTV) tanımlandı: PTV1 ve PTV2. FIF ve YART planları için, PTV1 ve PTV2'ye sırasıyla 33 fraksiyonda 50,4 Gray (Gy) ve 60 Gy tedavi dozları verildi. 28 günlük fraksiyonda hedef hacimlerde farklı dozların eş zamanlı olarak verildiği SIB yöntemi kullanıldı. SIB tekniğinde günlük tedavi dozu 2,14 Gy olarak belirlendi. Planlar PTV, rektum, bağırsak, femur başları gibi kritik organlar, homojenlik indeksi (HI), konformite indeksi (HI) ve monitör unit değerleri (MU) açısından karşılaştırıldı.Bulgular: Tüm planlar, hedef hacimdeki dozun %95'ini kapsayacak şekilde tasarlandı. SIB planlarının CI’si FIF ve YART planlarına kıyasla anlamlı derecede daha iyi sonuçlar gösterdi. SIB planlarında rektum için V45 ve V30 dozları, FIF planlarına kıyasla istatistiksel olarak anlamlı derecede daha düşüktü (p<0,05). Rektum V30 BED değerleri, SIB planlarında 57,01±11,94 ve YART planlarında 56,37±10,95 olarak bulundu. MU sayıları, FIF planlarında anlamlı derecede düşüktü (p<0,05).Sonuç: SIB tekniği, mesane radyoterapisinde FIF ve YART tekniklerine kıyasla kritik organları daha iyi korumuştur. Ancak BED analizi, SIB ile daha yüksek dozlara işaret etmektedir. Genel olarak, kritik organlara verilen dozun dikkatlice izlenmesi koşuluyla, SIB uygun hastalar için uygulanabilir bir seçenek gibi görünmektedir.

Aim: The purpose of this study is to compare plans for bladder cancer using field-in-field (FIF), intensity modulated radiotherapy (IMRT) and simultaneous integrated boost (SIB) technique.Method: FIF, IMRT and SIB treatment plans were created using tomography images of 20 patients diagnosed with bladder cancer. Two separate planning target volume (PTV) were defined for each patient: PTV1 and PTV2. For the FIF and IMRT plans, PTV1 and PTV2 received treatment doses of 50.4 Gray (Gy) and 60 Gy in 33 fractions, respectively. In 28 daily fractions, the SIB method was used in which different doses were delivered simultaneously in the target volumes. In the SIB technique, the daily treatment dose was determined as 2.14 Gy. The plans were compared in terms of PTV, organs at risk (OARs) such as rectum, bowel, femoral heads, homogeneity index (HI), conformity index (CI) and monitor unit values (MU).Results: All plans were designed to cover 95% of the dose in the target volume. The CI for SIB plans showed significantly favourable results compared to FIF and IMRT plans. The V45 and V30 doses for the rectum in the SIB plans were statistically significantly lower compared to the FIF (p<0.05). The biologically effective doses (BED) values of rectum V30 were found to be 57.01±11.94 in SIB plans and 56.37±10.95 in IMRT plans. MU counts were significantly lower in FIF plans (p<0.05).Conclusion: The SIB technique demonstrated better sparing of critical organs compared with FIF and IMRT in bladder radiotherapy. BED analysis, however, indicated higher doses with SIB. Overall, SIB appears to be a feasible option for appropriate patients, provided that dose to critical organs is carefully monitored.

Bladder cancer radiotherapy simultaneous integrated boost

Mesane kanseri radyoterapi eş zamanlı integral boost

1. Jemal A, Bray F, Center MM, Ferlay C, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. doi: 10.3322/caac.20107.

2. Martin-Doyle W, Kwiatkowski DJ. Molecular biology of bladder cancer. Hematol. Oncol Clin North Am. 2015;29:191–203. doi: 10.1016/j.hoc.2014.10.002.

3. Lee ST, Lawrentschuk N, Scott AM. PET on prostate and bladder tumors. Semin Nucl Med. 2012;42:231-46.

4. Stenzl A, Cowan NC, De Santis M, et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2009;55(4):815-25.

5. Chavan S, Bray F, Lortet-Tieulent J, Goodman M, Jemal A. International variations in bladder cancer incidence and mortality. Eur Urol. 2014;66(1):59–73.

6. Edward CH, Carlos AP, Luther WB. Perez and Brady’s Principles and Practice of Radiation Oncology. Lippincott Williams&Wilkins (ed.), 5. New York, USA. 2007

7. Agulnik M. Puataweepong P. Advanced Radiation Therapy for Head and Neck Cancer: A New Standard of Practise. 1st Edition. Thailand Intech Press. 2012;232-235.

8. Chao S, Apisarnthanarax S, Ozyigit G. Practical Essentials of Intensity Modulated Radiation Therapy. Lippincott Williams & Wilkins. 2005.

9. Sondergaard J, Hoyer M, Petersen JB, Wright P, Grau C, Muren LP. The normal tissue sparing obtained with simultaneous treatment of pelvik lymph nodes and bladder using intensity-modulated radiotherapy. Acta Oncologica. 2009;48(2):238-44.

10. Wu Q, Mohan R, Morris M, Lauve A, Schmidt-Ullrich, R. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head and neck squamous cell carcinomas: I:dosimetric results. International Journal of Radiation Oncology Biology Physics. 2003;60(2):374-387. doi: 10.1016/s0360-3016(02)04617-5.

11. Mohan R, Wu Q, Manning M, Schmidt-Ulrich R. Radiobiological considerations in teh design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. International Journal of Radiation Oncology Biology Physics. 2000;46(3):619-630. doi: 10.1016/s0360-3016(99)00438-1.

12. Orlandi E, Palazzi M, Pignoli E, Fallai C, Giostra A, Olmi, P. Radiobiological basis and clinical results of the simultaneous integrated boost (SIB) in intensity modulated radiotherapy (IMRT) for head and neck cancer. Critical Reviews in Oncology Hematol. 2010;73(2):111-125. doi: 10.1016/j.critrevonc.2009.03.003.

13. Hodapp N. ICRU Report 83: Prescribing, recording, and Reporting photon beam Intensity Modulated Radiation Therapy(IMRT). Strahlenther Onkol. 2012;188(1):97-9.

14. Jones D. ICRU Report 50: Prescribing, recording and reporting photon beam therapy. International Commission on Radiation Units and Measurements. Medical Physics. 1993.

15. Jones B, Dale RG, Finst P, Khaksar SJ. Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2000;47:1379–1384.

16. Melvin A. Some implications of linear-quadratic-linear radiation dose-response with regard to hypofractionation. Med. Phys. 2008;35:4161–4172.

17. Paddick I. A simple scoring ratio to index the conformity of radiosurgical treatment plans: Technical note. J Neurosurg. 2000;93(suppl 3):219-222.

18. Milosevic M, Gospodarowicz M, Jewett M, Bristow R, Haycocks T. Intensity-Modulated Radiation Therapy for lymph node metastases in bladder cancer; In Clinical Target Volumes In Conformal And Intensity Modulated Radiation Therapy. 2004:157-169.

19. Çelen YY, Kızılkaya HO. Difference of Simultaneous Integrated Boost Technique after Breast Conserving Surgery. European Journal of Science and Technology. 2020;19:578-87. doi: 10.31590/ejosat.719046

20. Nageeti T, Mahfouz M, Abdallah H, Algaoud M, Zatar R. Dosimetric comparison of simultaneous ıntegrated vs. sequential boost in radiotherapy for high grade gliomas. Cancer Ther Oncol Int J. 2019;15:68-71. doi: 10.19080/CTOIJ.2019.15.555907

21. Feng CH, Hasan Y, Kopec M. Hallaq H. Simultaneously integrated boost (SIB) spares OAR and reduces treatment time in locally advanced cervical cancer. Journal of Appl. Clin. Med. Phy. 2016;17(5):6123.

22. Li L, Xin Y, Cui H, Zhao X, Dang J, Li Y. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced drug-resistant gastrointestinal stromal tumors: a feasibility study. Front. Oncol. 2020;10.

23. Moamen A, Abo-Madyan Y, Jahnke L, Wenz F, Glatting G. Comparison of breast sequential and simultaneous integrated boost using the biologically effective dose volume histogram. Radiation Oncology. 2016:11-16. doi: 10.1186/s13014-016-0590-1.

24. Bakkal BH, Elmas O. Dosimetric comparison of organs at risk in 5 different radiotherapy plans in patients with preoperatively irradiated rectal cancer. Medicine (Baltimore). 2021;100(1):e24266. doi: 10.1097/MD.0000000000024266