Lokalize prostat kanserli hastalarda yoğunluk ayarlı radyoterapi (IMRT) tekniği kullanılarak standart optimizasyon yöntemi ile çok kriterli optimizasyon (MCO) yönteminin karşılaştırılması

Öz

Bu çalışmada, prostat kanserli hastalar için RayStation tedavi planlama sisteminde çok kriterli optimizasyon (MCO) yöntemi kullanılarak yoğunluk ayarlı radyasyon tedavisi (IMRT) uygulamasını değerlendirmek amaçlandı. Çalışmaya daha önce IMRT ile tedavi edilen toplam 10 ardışık prostat kanseri hastası dahil edildi ve MCO modalitesi kullanılarak yeniden planlandı. Plan kalitesi, risk altındaki organlar (OAR) ve planlama hedef hacminin (PTV) uygunluk indeksi (CI) ve homojenlik indeksi (HI) kullanılarak analiz edildi ve karşılaştırıldı. PTV tabanlı IMRT planlaması ile doz yükseltme, özellikle yüksek doz alanlarında, yüksek OAR dozları ile yakından bağlantılıydı. HI ve CI her iki modalite için benzer olmasına rağmen, IMRT ile karşılaştırıldığında MCO için ortalama monitör birimlerinde belirgin bir düşüş saptandı (P < 0.05). MCO planı, belirgin şekilde mesane ve femur başı için daha iyi koruyucu etkiler gösterdi (P < 0.05). MCO yönteminin IMRT yöntemine göre toplam planlama süresini kısalttığı görülmüştür (P < 0.01). Bulgularımız, MCO'nun plan kalitesini iyileştirdiğini ve PTV kapsamı ve OAR koruması açısından prostat kanseri için üstün bir modalite olduğunu göstermiştir.

Anahtar Kelimeler

• Yoğunluk ayarlı radyasyon tedavisi
• Çok kriterli optimizasyon
• Plan kalitesi
• Prostat kanseri.

Comparison of standard optimization method and multicriteria optimization (MCO) method using intensity-modulated radiotherapy (IMRT) technique for patients with localized prostate cancer

Öz

This study aimed to evaluate the implementation of intensity-modulated radiation therapy (IMRT) using multicriteria optimization (MCO) in the RayStation treatment planning system for patients with prostate cancer. A total of 10 consecutive prostate cancer patients previously treated by IMRT were included in this study and re-planned using the MCO modality. The plan quality was analyzed and compared using the conformity index (CI) and homogeneity index (HI) of the dose sparing of organs at risk (OAR) and planning target volume (PTV). Dose–escalation with PTV-based IMRT planning was closely connected with elevated OAR doses, particularly in high-dose areas. Although HI and CI were similar for both modalities, we detected a marked decrease in mean monitor units for MCO when compared to IMRT (P < 0.05). The MCO-plan showed markedly better bladder and femoral heads sparing effects (P<0.05). It has been found that the MCO method shortens the total planning time compared to the IMRT method (P < 0.01). Our findings showed that MCO improved plan quality and was the superior modality for prostate cancer in terms of PTV coverage and OAR sparing.

Anahtar Kelimeler

• Intensity-modulated radiation therapy
• Multicriteria optimization
• Plan quality
• Prostate cancer.

Kaynakça

1. Batumalai, V., Jameson, M. G., Forstner, D. F., Vial, P., & Holloway, L. C. (2013). How important is dosimetrist experience for intensity modulated radiation therapy? A comparative analysis of a head and neck case. Practical radiation oncology, 3(3), e99–e106.
2. Bauman, G., Rumble, R. B., Chen, J., Loblaw, A., Warde, P., & Members of the IMRT Indications Expert Panel (2012). Intensity-modulated radiotherapy in the treatment of prostate cancer. Clinical oncology (Royal College of Radiologists (Great Britain)), 24(7), 461–473.
3. Bodensteiner D. (2018). RayStation: External beam treatment planning system. Medical dosimetry: official journal of the American Association of Medical Dosimetrists, 43(2), 168–176.
4. Bohsung, J., Gillis, S., Arrans, R., Bakai, A., De Wagter, C., Knöös, T., Mijnheer, B. J., Paiusco, M., Perrin, B. A., Welleweerd, H., & Williams, P. (2005). IMRT treatment planning:- a comparative inter-system and inter-centre planning exercise of the ESTRO QUASIMODO group. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology, 76(3), 354–361.
5. Breedveld, S., Storchi, P. R., & Heijmen, B. J. (2009). The equivalence of multi-criteria methods for radiotherapy plan optimization. Physics in medicine and biology, 54(23), 7199–7209.
6. Cotrutz, C., Lahanas, M., Kappas, C., & Baltas, D. (2001). A multiobjective gradient-based dose optimization algorithm for external beam conformal radiotherapy. Physics in medicine and biology, 46(8), 2161–2175.
7. Craft, D. L., Halabi, T. F., Shih, H. A., & Bortfeld, T. R. (2006). Approximating convex pareto surfaces in multiobjective radiotherapy planning. Medical physics, 33(9), 3399–3407.
8. Craft, D. L., Hong, T. S., Shih, H. A., & Bortfeld, T. R. (2012). Improved planning time and plan quality through multicriteria optimization for intensity-modulated radiotherapy. International journal of radiation oncology, biology, physics, 82(1), e83–e90.

9. Craft, D., Halabi, T., & Bortfeld, T. (2005). Exploration of tradeoffs in intensity-modulated radiotherapy. Physics in medicine and biology, 50(24), 5857–5868.
10. Craft, D., Halabi, T., Shih, H. A., & Bortfeld, T. (2007). An approach for practical multiobjective IMRT treatment planning. International journal of radiation oncology, biology, physics, 69(5), 1600–1607.
11. D'Amico, A. V., Whittington, R., Malkowicz, S. B., Schultz, D., Blank, K., Broderick, G. A., Tomaszewski, J. E., Renshaw, A. A., Kaplan, I., Beard, C. J., & Wein, A. (1998). Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA, 280(11), 969–974.
12. Ferlay, J., Colombet, M., Soerjomataram, I., Mathers, C., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F. (2019). Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International journal of cancer, 144(8), 1941–1953.
13. Feuvret, L., Noël, G., Mazeron, J. J., & Bey, P. (2006). Conformity index: a review. International journal of radiation oncology, biology, physics, 64(2), 333–342.
14. Haas, O. C., Burnham, K. J., & Mills, J. A. (1998). Optimization of beam orientation in radiotherapy using planar geometry. Physics in medicine and biology, 43(8), 2179–2193.
15. Hong, T. S., Craft, D. L., Carlsson, F., & Bortfeld, T. R. (2008). Multicriteria optimization in intensity-modulated radiation therapy treatment planning for locally advanced cancer of the pancreatic head. International journal of radiation oncology, biology, physics, 72(4), 1208–1214.
16. Lee, W. R., Dignam, J. J., Amin, M. B., Bruner, D. W., Low, D., Swanson, G. P., Shah, A. B., D'Souza, D. P., Michalski, J. M., Dayes, I. S., Seaward, S. A., Hall, W. A., Nguyen, P. L., Pisansky, T. M., Faria, S. L., Chen, Y., Koontz, B. F., Paulus, R., & Sandler, H. M. (2016). Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 34(20), 2325–2332.
17. Low, D. A., Harms, W. B., Mutic, S., & Purdy, J. A. (1998). A technique for the quantitative evaluation of dose distributions. Medical physics, 25(5), 656–661.
18. McGarry, C. K., Bokrantz, R., O'Sullivan, J. M., & Hounsell, A. R. (2014). Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning. Medical dosimetry: official journal of the American Association of Medical Dosimetrists, 39(3), 205–211.
19. Rawla P. (2019). Epidemiology of Prostate Cancer. World journal of oncology, 10(2), 63–89.
20. Teoh, J., Hirai, H. W., Ho, J., Chan, F., Tsoi, K., & Ng, C. F. (2019). Global incidence of prostate cancer in developing and developed countries with changing age structures. PloS one, 14(10), e0221775.
21. Thieke, C., Küfer, K. H., Monz, M., Scherrer, A., Alonso, F., Oelfke, U., Huber, P. E., Debus, J., & Bortfeld, T. (2007). A new concept for interactive radiotherapy planning with multicriteria optimization: first clinical evaluation. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology, 85(2), 292–298.
22. Thorwarth, D., Notohamiprodjo, M., Zips, D., & Müller, A. C. (2017). Personalized precision radiotherapy by integration of multi-parametric functional and biological imaging in prostate cancer: A feasibility study. Zeitschrift fur medizinische Physik, 27(1), 21–30.
23. Troeller, A., Yan, D., Marina, O., Schulze, D., Alber, M., Parodi, K., Belka, C., & Söhn, M. (2015). Comparison and limitations of DVH-based NTCP models derived from 3D-CRT and IMRT data for prediction of gastrointestinal toxicities in prostate cancer patients by using propensity score matched pair analysis. International journal of radiation oncology, biology, physics, 91(2), 435–443.
24. Wala, J., Craft, D., Paly, J., Zietman, A., & Efstathiou, J. (2013). Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning. Medical dosimetry: official journal of the American Association of Medical Dosimetrists, 38(3), 298–303.
25. Yu, T., Zhang, Q., Zheng, T., Shi, H., Liu, Y., Feng, S., Hao, M., Ye, L., Wu, X., & Yang, C. (2016). The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures. PloS one, 11(5), e0154499.
26. Zorlu, F., Zorlu, R., Divrik, R. T., Eser, S., & Yorukoglu, K. (2014). Prostate cancer incidence in Turkey: an epidemiological study. Asian Pacific journal of cancer prevention: APJCP, 15(21), 9125–9130.
27. Gay, H. A., Barthold, H. J., O'Meara, E., Bosch, W. R., El Naqa, I., Al-Lozi, R., Rosenthal, S. A., Lawton, C., Lee, W. R., Sandler, H., Zietman, A., Myerson, R., Dawson, L. A., Willett, C., Kachnic, L. A., Jhingran, A., Portelance, L., Ryu, J., Small, W., Jr, Gaffney, D., … Michalski, J. M. (2012). Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas. International journal of radiation oncology, biology, physics, 83(3), e353–e362.
28. Esen, K., & Demir Apaydın. F. (2020). Abdominal incelemelerde ileri BT teknikleri ve protokolleri. Türk Radyoloji Seminerleri 8, 21-37.