Dosimetric advantages of a novel X-Ray/γ-Ray integrated radiotherapy platform in cervical carcinoma: A comparative treatment planning study

IF 2.7 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Physica Medica-European Journal of Medical Physics Pub Date : 2025-09-19 DOI:10.1016/j.ejmp.2025.105098

Zhongfei Wang , Qinghui Yun , Te Zhang , Xiaohuan Sun , Wei Wang , Jie Duan , Liting Chen , Yue Gao , Ziqi An , Pengfei Zhang , Jian Zang , Lina Zhao

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Abstract

Purpose

This study evaluates the dosimetric benefits of TaiChi, a novel radiotherapy platform combining 6MV linac-based volumetric-modulated arc therapy (VMAT) and γ-ray stereotactic radiotherapy, for locally advanced cervical carcinoma (LACC) with pelvic lymph node metastases.

Methods

Twelve LACC cases were retrospectively analyzed, comparing TaiChi plans with conventional treatment plans. The prescribed doses were standardized at 50 Gy for the planning target volume (PTV) and 12.5 Gy for the PTVLn-a boost volume delivering focal dose escalation to metastatic lymph nodes.Conventional treatment plans were developed using the Varian Eclipse 13.5 treatment planning system (TPS) with VMAT techniques. In contrast, TaiChi plans were generated using the RTPRO TPS (OUR United Corp., China), leveraging the platform’s unique dual-modality capabilities: a 6MV linac-based VMAT plan was optimized for PTV coverage, while gamma knife was utilized for PTVLn dose escalation. A comprehensive dosimetric comparison was conducted to evaluate the system’s ability to simultaneously achieve PTVLn dose escalation and organs-at-risk (OARs) sparing.

Results

TaiChi achieved comparable PTVLn conformity (CI: 0.86 ± 0.06 vs. 0.87 ± 0.02, p = 0.299) but superior dose gradient (GI: 2.03 ± 0.27 vs. 2.21 ± 0.32, p < 0.001). Significant PTVLn dose escalation was observed with TaiChi: mean dose (68.58 ± 0.52 Gy vs. 63.55 ± 1.01 Gy, p < 0.001), D₉₈ (61.81 ± 0.55 Gy vs. 57.09 ± 1.70 Gy, p < 0.001), and D₂ (75.02 ± 1.61 Gy vs. 65.36 ± 2.74 Gy, p < 0.001). PTV D2 was moderately higher with TaiChi (64.11 ± 4.01 Gy vs. 62.17 ± 2.68 Gy, p = 0.04). OAR sparing improved significantly: bladder, rectum, and small intestine V45Gy decreased by 3.7 %, 5.1 %, and 3.9 %, respectively.

Conclusion

TaiChi’s synergistic X-ray/γ-ray approach enables safe dose escalation to metastatic nodes while reducing OAR exposure, potentially enhancing tumor control and toxicity outcomes for node-positive cervical carcinoma.

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新型x射线/γ射线综合放疗平台在宫颈癌治疗中的剂量学优势：一项比较治疗计划研究

目的：本研究评估太极治疗盆腔淋巴结转移的局部晚期宫颈癌（LACC）的剂量学益处。太极是一种新型放射治疗平台，结合6MV直线体积调节电弧治疗（VMAT）和γ射线立体定向放疗。方法回顾性分析12例LACC病例，比较太极治疗方案与常规治疗方案。计划靶体积（PTV）的标准剂量为50 Gy， ptvln的标准剂量为12.5 Gy，这是一种向转移性淋巴结传递局灶剂量递增的增强体积。采用Varian Eclipse 13.5治疗计划系统（TPS）和VMAT技术制定常规治疗计划。相比之下，太极计划是使用RTPRO TPS （OUR United Corp., China）生成的，利用该平台独特的双模态功能：基于6MV直线的VMAT计划优化了PTV覆盖范围，而伽玛刀则用于PTVLn剂量增加。进行了全面的剂量学比较，以评估该系统同时实现PTVLn剂量增加和保留危险器官（OARs）的能力。结果staichi达到了相当的PTVLn符合性（CI: 0.86±0.06比0.87±0.02,p = 0.299），但具有较好的剂量梯度（GI: 2.03±0.27比2.21±0.32,p < 0.001）。太极组PTVLn剂量显著升高：平均剂量（68.58±0.52 Gy vs. 63.55±1.01 Gy, p < 0.001）， D98(61.81±0.55 Gy vs. 57.09±1.70 Gy, p < 0.001), D2（75.02±1.61 Gy vs. 65.36±2.74 Gy, p < 0.001）。太极组PTV D2中度增高（64.11±4.01 Gy比62.17±2.68 Gy, p = 0.04）。OAR保留显著改善：膀胱、直肠和小肠V45Gy分别降低3.7%、5.1%和3.9%。结论太极的协同x射线/γ射线入路可以安全增加转移淋巴结的剂量，同时减少OAR暴露，潜在地增强肿瘤控制和淋巴结阳性宫颈癌的毒性结果。

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来源期刊

Physica Medica-European Journal of Medical Physics 生物-生物物理

CiteScore

6.80

自引率

14.70%

发文量

493

审稿时长

78 days

期刊介绍： Physica Medica, European Journal of Medical Physics, publishing with Elsevier from 2007, provides an international forum for research and reviews on the following main topics: Medical Imaging Radiation Therapy Radiation Protection Measuring Systems and Signal Processing Education and training in Medical Physics Professional issues in Medical Physics.