Research Article
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Akciğer Radyoterapisinde SBRT ve IMRT Tekniklerinin İncelenmesi: Dozimetrik Çalışma

Year 2021, Volume 3, Issue 3, 113 - 117, 01.11.2021
https://doi.org/10.38175/phnx.961871

Abstract

Amaç: Çalışmamızda Accuray marka Tomoterapi cihazının volo tedavi planlama sistemiyle akciğer kanserinde Stereotaktik Beden Radyoterapisi (SBRT) ve Yoğunluk Ayarlı Radyoterapi (IMRT) teknikleri kullanılarak elde edilen doz dağılımlarının ve çevre dozların karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Doz ölçümü için 7 hastanın Bilgisayarlı Tomografi (BT) görüntüleri üç boyutlu konturlama yazlım sistemi (MIM) konturluma istasyonuna aktarılmıştır. Tedavi başlamadan önce çekilmiş bilgisayarlı tomografi görüntüleri, network sistemi yardımıyla üç boyutlu konturlama sistemine aktarılarak,hastanın tümör ve kritik organları belirlenmiştir. BT görüntüsü üzerinden hedef hacim; planlanan hedef hacim (PTV) sağ veya sol akciğer, kritik organlar; kalp,kosta, özefagus, medulla, bilateral akciğer (her iki akciğer) belirlenerek Tomotheraphy Volo Planlama Sistemi’ne aktarılmıştır. Çalışmada sanal olarak oluşturulan akciğer tümörleri 1 cm, 3 cm ve 5 cm olacak şekilde oluşturulmuştur. Akciğer tümör boyutları değişirken eş zamanlı olarak tomoterapi cihazının kesit (jaw) alanı da 1 cm, 2.5 cm ve 5 cm olacak şekilde değiştirilerek her bir tümör boyutunda SBRT ve IMRT teknikleri için denenmiştir. PTV dozu 60 Gy ve 3 fraksiyon olacak şekilde tedavi planları oluşturulmuştur.
Bulgular: Yapılan çalışma sonucunda Akciğer kanserinin tedavisinde karşılaştırılan SBRT ve IMRT tekniklerinden 1 cm’lik tümör boyutunda 1 cm’lik jaw , 2.5 cm’lik jaw ve 5 cm’lik jaw için ve 5 cm’lik tümör boyutunda kullanılan 1 cm’lik jaw için PTV max, D95 değerleri ve kritik organ olan bilateral akciğer max değerleri üzerinde SBRT lehine anlamlı bir farklılık saptanmıştır (p<0.05). 3 cm’lik tümör boyutunda kullanılan 1 cm’lik, 2.5 cm’lik ve 5 cm’lik jaw alanlarında ve 5 cm’lik tümör boutunda kullanılan 2,5 ve 5 cm’lik jaw alanlarında karşılaştırılan tedavi yöntemleri için PTV max ve bilateral akciğer max değerleri üzerinde yapılan istatistiksel analiz sonucunda SBRT lehine anlamlı bir farklılık saptanmıştır.(p<0,05)Tedavi sürelerinde ise 1 cm’lik tümör boyutunda kullanılan 1 cm’lik jaw alanında istatistiksel analiz sonucunda IMRT lehine anlamlı bir farklılık saptanmıştır (p<0,05) ve diğer kritik organlar için ise anlamlı bir farklılık saptanmamıştır (p>0,05).
Sonuç: Sonuç olarak, 1 cm, 3 cm ve 5 cm’lik tümör boyutlarında kullanılan 1 cm, 2.5 cm ve 5 cm kesit (jaw) alanlarına göre her iki teknikte kritik organları korumuştur. Fakat SBRT tekniğinin hedef hacim (PTV) ve her iki akciğer açısından daha iyi sonuçlar verdiği görülmüştür.

References

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  • Timmerman RD, Paulus R, Pass HI, Gore EM, Edelman MJ, Galvin J, et al. Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol 2018;4(9):1263-1266. doi: 10.1001/jamaoncol.2018.1251.
  • Zheng M. Classification and Pathology of Lung Cancer. Surgical Oncology Clinics of North America. 2016;25(3):447-68. doi: 10.1016/j.soc.2016.02.003.
  • Flehinger BJ, Kimmel M, Melamed MR. The Effect of Surgical Treatment on Survival from Early Lung Cancer. Implications for screening. Chest. 1992;101(4):1013-8. doi: 10.1378/chest.101.4.10131
  • Webb S.“Intensity-modulated radiation therapy Medical Science Series”, IOP. Publishing Ltd. Bristol, UK. 2001.
  • Peñagarícano JA, Yan Y, Corry P, Moros E, Ratanatharathorn V. Retrospective Evaluation of Pediatric Cranio-Spinal Axis Irradiation Plans with the Hi-ART Tomotherapy System. Technology in Cancer Research & Treatment. 2007;6(4):355-60.doi: 10.1177/153303460700600413.
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  • Baumann M, Cordes N, Haase M, Zips D. Molekuler Cancer and Radiation Biology. Principles and Practice of Radiation Oncology (5th ed). Lippincott Williams & Wilkins; 2008. pp. 109-121.
  • Galvin JM, Ezzell G, Eisbrauch A, Yu C, Butler B, Xiao Y, et al. Implementing IMRT in clinical practice: A joint document of the American Society for Therapeutic Radiology and Oncology and the American Association of Physicist in Medicine. Int. J. Radiat. Oncol. Biol. Phys. 2004;58(5):1616–1634.
  • Gillette EL, McChesney SL, Hoopes PJ.1985. Isoeffect curves for radiation-induce cardiomyopathy in the dog. Int J Radiat Oncol Biol Phys. 1985;11(12):2091-7. doi: 10.1016/0360-3016(85)90089-6.
  • Aras S, İkizceli T, Aktan M. Dosimetric Comparison of Three-Dimensional Conformal Radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy Techniques (IMRT) with Radiotherapy Dose Simulations for Left-Sided Mastectomy Patients. Eur J Breast Health. 2019;15(2):85-89.
  • Schultheiss TE, Higgins EM, El-Mahdi HM. The latent period in radiation myelopathy. Int J Radiat Oncol Biol Phys. 1984;10:1109-15
  • Gregory MMV, Kevin S, Chandana R, Stephen G, Matthew K, Edward C, Toufik D. Intensity- modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. Int J Radiat Oncol Biol Phys. 2010;77(2):344-9. doi: 10.1016/j.ijrobp.2009.05.004
  • Ashleigh W, Andre K, Adria N, Jordan M,Danielle L. Lung SBRT: dosimetric and delivery comparison of Rapid Arc, TomoTherapy, and IMRT. Journal of Applied Clinical Medical Physics. 2013;14(4):4065. doi: 10.1120/jacmp.v14i4.4065
  • Kissick MW, Fenwick J, James JA, Jeraj R, Kapatoes JM, Keller H, et al. The helical tomotherapy thread effect. Medical Physics. 2005 May;32(5):1414-23. doi: 10.1118/1.1896453.

Investigation of SBRT and IMRT Techniques in Lung Radiotherapy: A Dosimetric Study

Year 2021, Volume 3, Issue 3, 113 - 117, 01.11.2021
https://doi.org/10.38175/phnx.961871

Abstract

Objective: In our study, we aimed to compare the dose distrubutions of Accuray brand TomoTherapy device Volo treatment planning system lung stereoactic body radiation therapy (SBRT) and intensity-adjusted radiation therapy in cancer dose distributions obtained using (IMRT) techniques and environmental doses.
Matetial and Method: Computed Tomography (CT) images of 7 patients were transferred to the MIM contouring station for dose measurement. CT target volume via image; PTV right or left lung ,critical organs: heart, costa,esophagus, medulla, bilateral lung transferred to planning system. Lung tumors created virtually. In study 1 cm tumor of the size it is formed to be cm,3 cm and 5 cm. Spouse as lungtumor sizes change.in time, the cross-section (jaw) area of the TomoTherapy device will also be 1 cm, 2.5 cm and 5 cm it has been modified and tested for SBRT and IMRT techniques at each tumor size.
Results: PTV dose treatment plans have been established to be 60 Gy and 3 fractions. The study 1 cm tumor of the size SBRT and IMRT techniques compared to the treatment of lung cancer as a result for 1 cm jaw, 2.5 cm jaw and 5 cm jaw in cm tumor size and 5 cm tumor PTV max, D95 values for 1 cm jaw used in size and bilateral, which is the critical organs. A significant difference in lung max values was found in favor of SBRT (p<0.05). 3 cm tumor size used in 1 cm, 2.5 cm and 5 cm jaw areas and 5 cm treatment compared to 2.5 and 5 cm jaw areas used in cm tumor bouts statistics on ptv max and bilateral lung max values at the end of the analysis, an agreed difference was found in favor of the SBRT (p<0.05) during treatment periods. At the end of statistical analysis in 1 cm jaw area used in 1 cm tumor size a significant difference in favor of IMRT has been identified.(p<0.05) and no significant differences were found for other critical organs (p > 0.05).
Conclusion: As a result, 1 cm, 3 cm and 5 cm tumor sizes used in 1 cm, 2.5 cm and 5 cm section (jaw) areas according to both techniques preserved critical organs. But the SBRT technique showed better results in terms of target volume (PTV) and both lungs.

References

  • Haasbeek CJ, Slotman BJ, Senan S. Radiotherapy for lung cancer: clinical impact of recent technical advances. Lung Cancer. 2009;64(1):1–8.
  • Wang J, Olag J, Ultmann RE. 1999. Assessment of pulmonary complications after lung resection. Ann Thorac Surgery. 1999;67(5):1444-7. doi: 10.1016/s0003-4975(99)00255-6.
  • Khan FM. The Physics of Radiation Therapy. Lippincott Williams & Wilkins, Philadelphia, USA; 2003.
  • Field JK. Selection and validation of new lung cancer markers for the molecular pathological assessment of individuals with a high risk of developing lung cancer. In: Brambilla C, Brambilla E. (Editors). Lung tumors fundamental biology and clinical management. New York: Marcel Dekker Inc; 1999. pp. 287-302.
  • Chang JY, Bradley JD, Govindan R, Komaki R. Lung. In: Perez CA, Brady LW, editors. Principles and Practice of Radiation Oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1076–109.
  • Timmerman RD, Paulus R, Pass HI, Gore EM, Edelman MJ, Galvin J, et al. Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol 2018;4(9):1263-1266. doi: 10.1001/jamaoncol.2018.1251.
  • Zheng M. Classification and Pathology of Lung Cancer. Surgical Oncology Clinics of North America. 2016;25(3):447-68. doi: 10.1016/j.soc.2016.02.003.
  • Flehinger BJ, Kimmel M, Melamed MR. The Effect of Surgical Treatment on Survival from Early Lung Cancer. Implications for screening. Chest. 1992;101(4):1013-8. doi: 10.1378/chest.101.4.10131
  • Webb S.“Intensity-modulated radiation therapy Medical Science Series”, IOP. Publishing Ltd. Bristol, UK. 2001.
  • Peñagarícano JA, Yan Y, Corry P, Moros E, Ratanatharathorn V. Retrospective Evaluation of Pediatric Cranio-Spinal Axis Irradiation Plans with the Hi-ART Tomotherapy System. Technology in Cancer Research & Treatment. 2007;6(4):355-60.doi: 10.1177/153303460700600413.
  • Erkan T, Melek NY, Cem O, Ali AY. Prevention of acute radiation-induced esophagitis with glutamine in non-small cell lung cancer patients treated with radiotherapy: evaluation of clinical and dosimetric parameters. Lung Cancer. 2009;63(3):393-9. doi: 10.1016/j.lungcan.2008.06.015.
  • Baumann M, Cordes N, Haase M, Zips D. Molekuler Cancer and Radiation Biology. Principles and Practice of Radiation Oncology (5th ed). Lippincott Williams & Wilkins; 2008. pp. 109-121.
  • Galvin JM, Ezzell G, Eisbrauch A, Yu C, Butler B, Xiao Y, et al. Implementing IMRT in clinical practice: A joint document of the American Society for Therapeutic Radiology and Oncology and the American Association of Physicist in Medicine. Int. J. Radiat. Oncol. Biol. Phys. 2004;58(5):1616–1634.
  • Gillette EL, McChesney SL, Hoopes PJ.1985. Isoeffect curves for radiation-induce cardiomyopathy in the dog. Int J Radiat Oncol Biol Phys. 1985;11(12):2091-7. doi: 10.1016/0360-3016(85)90089-6.
  • Aras S, İkizceli T, Aktan M. Dosimetric Comparison of Three-Dimensional Conformal Radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy Techniques (IMRT) with Radiotherapy Dose Simulations for Left-Sided Mastectomy Patients. Eur J Breast Health. 2019;15(2):85-89.
  • Schultheiss TE, Higgins EM, El-Mahdi HM. The latent period in radiation myelopathy. Int J Radiat Oncol Biol Phys. 1984;10:1109-15
  • Gregory MMV, Kevin S, Chandana R, Stephen G, Matthew K, Edward C, Toufik D. Intensity- modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. Int J Radiat Oncol Biol Phys. 2010;77(2):344-9. doi: 10.1016/j.ijrobp.2009.05.004
  • Ashleigh W, Andre K, Adria N, Jordan M,Danielle L. Lung SBRT: dosimetric and delivery comparison of Rapid Arc, TomoTherapy, and IMRT. Journal of Applied Clinical Medical Physics. 2013;14(4):4065. doi: 10.1120/jacmp.v14i4.4065
  • Kissick MW, Fenwick J, James JA, Jeraj R, Kapatoes JM, Keller H, et al. The helical tomotherapy thread effect. Medical Physics. 2005 May;32(5):1414-23. doi: 10.1118/1.1896453.

Details

Primary Language English
Subjects Oncology
Journal Section Research Articles
Authors

Elif ATEŞ (Primary Author)
0000-0002-4150-186X
Türkiye

Publication Date November 1, 2021
Application Date July 3, 2021
Acceptance Date July 15, 2021
Published in Issue Year 2021, Volume 3, Issue 3

Cite

AMA Ateş E. Investigation of SBRT and IMRT Techniques in Lung Radiotherapy: A Dosimetric Study. Phnx Med J. 2021; 3(3): 113-117.

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