Dosimetric Comparison of 3D-CRT, IMRT, IMAT and Helical Tomotherapy for Thoracic Esophageal Carcinoma

Abstract

In this study, we compared the dose-volume parameters for treatment of thoracic esophageal cancer with treatment plans for 3D-CRT, IMRT, IMAT and HT. 15 thoracic esophagus patients who were treated in our clinic between 2017-2018 years were selected. PTV volumes were between 205 and 445.4 cc with an average of 355.2 cc. 3D-CRT, IMRT, IMAT and HT radiotherapy plans were created for each patient using the same contours and the same dose planning prescription. Total dose of 50.4 Gy for all patients was planed with 180 cGy dose per a fraction in total 28 fractions. For PTV; when the four treatment techniques were compared, HI values were 3D-CRT 0.84 ± 0.0, IMRT 0.57 ± 0.05, IMAT 0.06 ± 0.013, HT 0.08 ± 0.03 (p <0.05). CI values were found for 3D-CRT as 1.84 ± 0.2, for IMRT as 1.25 ± 0.05, for IMAT as 1.19 ± 0.04, for HT as 1.2 ± 0.06 (p <0.05). IMRT and IMAT techniques provided better OAR protection compared to other techniques in all lung and heart comparisons. The lowest doses for Dmax and D1% of Spinal Cord were provided by HT technique. We found that IMRT, IMAT and HT techniques have lower critical organ doses than 3D-CRT technique for treating torasic esophageal cancer. Considering the current evidence of the relationship between radiation-induced cardiac toxicity in the literature and the dose-volume parameters after treatment for esophageal cancer in our study, we can say that dose plans are better for IMRT and IMAT plans than 3D-CRT and HT in terms of lung and heart doses.

Keywords

• Esophageal carcinoma,3D-CRT,IMRT,IMAT,HT

Torasik Özofagus Karsinomunda 3D-CRT, IMRT, IMAT ve Helical Tomoterapinin Dozimetrik Karşılaştırması

Abstract

Bu çalışmada, torasik özofagus kanserinin tedavisi için 3D-CRT, IMRT, IMAT ve HT tedavi planlarının doz-hacim parametrelerini karşılaştırdık. Çalışma için kliniğimizde 2017-2018 yılları arasında tedavi edilen 15 torasik özofagus hastası seçildi. PTV hacimleri 205 cc ile 445.4 cc arasındaydı ve ortalama değer 355,2 cc idi. Her hasta için aynı konturları ve aynı doz planlama reçetesini kullanarak 3D-CRT, IMRT, IMAT ve HT radyoterapi planları oluşturuldu. Her bir plan için, toplam 28 fraksiyon ile fraksiyon başına 180 cGy doz ile toplamda 50,4 Gy'lik bir doz uygulanmıştır. PTV için; dört tedavi tekniği karşılaştırıldığında HI değerleri 3D-CRT için 0,84 ± 0,0, IMRT için 0,57 ± 0,05, IMAT için 0,06 ± 0,013 ve HT için 0,08 ± 0,03 (p <0.05) bulundu. CI değerleri için ise 3D-CRT için 1,84 ± 0,2, IMRT için 1,25 ± 0,05, IMAT için 1,19 ± 0,04 ve HT için 1,2 ± 0.06 (p <0,05) vardı. IMRT ve IMAT teknikleri, tüm akciğer ve kalp dozu karşılaştırmalarında, diğer tekniklere kıyasla daha iyi OAR koruması sağlamıştır. Omurilik Dmax ve D1% dozları için en düşük dozlar HT tekniği ile sağlanmıştır. IMRT, IMAT ve HT tekniklerinin torasik özofagus kanserini tedavi etmek için 3D-CRT tekniğinden daha düşük kritik organ dozlarına sahip olduğunu bulduk. Çalışmamızda özofagus kanseri tedavisinden sonra radyasyona bağlı kardiyak toksisite ile doz-hacim parametreleri arasındaki ilişkinin literatürdeli mevcut kanıtları da göz önüne alındığında, IMRT ve IMAT planları için doz planlarının 3D-CRT ve HT'den akciğer ve kalp dozları açısından daha iyi olduğunu söyleyebiliriz.

Keywords

• Özofagus kanseri,3D-CRT,IMRT,IMAT,HT

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