The impact of avoidance sectors on knowledge-based planning for esophageal cancer treatment

IF 1.7 4区医学 Q4 ONCOLOGY

Medical Dosimetry Pub Date : 2026-03-01 Epub Date: 2025-10-11 DOI:10.1016/j.meddos.2025.09.004

Vishruta Dumane Ph.D., D.A.B.R. , Victoria Olsen B.S., C.M.D. , Ting Jiang B.S., C.M.D. , Tyler Hwang B.S., C.M.D. , Regina Yu B.S., C.M.D. , Maria P. Dimopoulos Ph.D., M.B.A., R.T.(T)(A.R.R.T.)

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引用次数: 0

Abstract

To build a knowledge-based treatment planning model using RapidPlan for esophageal cancer in the upper, mid and lower thoracic sites while comparing the performance of the model with and without the use of avoidance sectors. Plans from 45 patients with esophageal tumors requiring treatment in the upper (8), middle (15) and lower (22) thoracic regions were selected for training. Prescribed dose ranged from 41.4Gy to 56Gy (1.8-2 Gy/fraction) with simultaneous integrated boost (SIB). Clinical plans were re-planned without the use of avoidance sectors. Plans with reduced V105%(cc) to the planning target volume (PTV) while meeting criteria for organs at risk (OARs) were chosen to build the model. The model was validated on 23 plans by comparing the clinical plan to the RapidPlan with and without the use of avoidance sectors. RapidPlan without avoidance sectors reduced the V105%(cc) by 100.1 cc (p< 0.001), compared to the clinical plan, while also reducing the maximum dose. The lung V5 Gy was increased by 5.5% on average (p = 0.02). Doses to the heart, stomach, kidney, large bowel, small bowel and the spinal cord were not compromised. Using avoidance sectors with RapidPlan did not improve plan homogeneity or coverage over the clinical plan, while increasing the V20 Gy to the lungs by 2.8% (p = 0.01). Mean heart dose was increase by 1.1 Gy (p = 0.04), while kidney V18Gy (%) and spinal cord maximum were increased by 7.2% (p = 0.02) and 3.8 Gy respectively (p = 0.01). Volume of the prescription dose outside the PTV was lower by as much as 67 cc while using RapidPlan without avoidance sectors compared to the clinical plan and conformity index (CI) was improved by 7%-8% compared to the clinical plan. Using avoidance sectors worsened the CI by 3%-5% compared with the CP. The RapidPlan model configured for upper, mid and lower thoracic regions without the use of avoidance sectors significantly reduces volumes of the higher doses in the target and therefore potential likelihood of esophageal toxicity without excessively increasing lung dose.

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回避部门对食管癌治疗知识规划的影响。

目的：应用RapidPlan建立基于知识的上、中、下胸椎食管癌治疗计划模型，并比较模型在使用和不使用回避扇区时的效果。从45例需要在上(8)、中（15）和下（22）胸区进行治疗的食管肿瘤患者中选择方案进行训练。处方剂量范围为41.4Gy至56Gy （1.8-2 Gy/分数），同时集成增强（SIB）。重新规划临床计划，不使用回避区。选择V105%（cc）低于规划目标体积（PTV），同时满足危险器官（OARs）标准的方案建立模型。通过将临床计划与RapidPlan在使用和不使用回避扇区的情况下进行比较，对23个计划进行了模型验证。与临床计划相比，无回避区的RapidPlan将V105%（cc）降低了100.1 cc (p< 0.001)，同时也降低了最大剂量。肺V5 Gy平均升高5.5% （p = 0.02）。对心脏、胃、肾、大肠、小肠和脊髓的剂量没有损害。与RapidPlan一起使用回避区并没有改善计划的同质性或临床计划的覆盖率，但使肺部的V20 Gy增加了2.8% （p = 0.01）。心脏平均剂量增加了1.1 Gy (p = 0.04)，肾脏V18Gy（%）和脊髓最大值分别增加了7.2% （p = 0.02）和3.8 Gy （p = 0.01）。与临床计划相比，使用无回避扇区的RapidPlan时，处方剂量PTV外的体积降低了67 cc，符合性指数（CI）比临床计划提高了7%-8%。与CP相比，使用回避区使CI恶化了3%-5%。在不使用回避区的情况下，为上、中、下胸椎区域配置的RapidPlan模型显著减少了目标中较高剂量的体积，因此在不过度增加肺剂量的情况下，潜在的食管毒性可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Dosimetry 医学-核医学

CiteScore

2.40

自引率

0.00%

发文量

审稿时长

34 days

期刊介绍： Medical Dosimetry, the official journal of the American Association of Medical Dosimetrists, is the key source of information on new developments for the medical dosimetrist. Practical and comprehensive in coverage, the journal features original contributions and review articles by medical dosimetrists, oncologists, physicists, and radiation therapy technologists on clinical applications and techniques of external beam, interstitial, intracavitary and intraluminal irradiation in cancer management. Articles dealing primarily with physics will be reviewed by a specially appointed team of experts in the field.