Journal of the ICRU最新文献_第10页

11. Sources and Absorbed-Dose Calculation 11.来源和吸收剂量计算

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw014

引用次数: 0

Case 4: Cervical Cancer Stage IB1 Treated with 3D Conformal External Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Tandem/Ovoid High Dose Rate Brachytherapy 病例4：癌症IB1期宫颈癌采用三维适形外照射、联合化疗和放射治疗腔内串联/椭圆形高剂量率近距离治疗

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw021

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4. Brachytherapy Imaging for Treatment Planning 4. 用于治疗计划的近距离放射治疗成像

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru_ndw007

{"title":"4. Brachytherapy Imaging for Treatment Planning","authors":"","doi":"10.1093/jicru_ndw007","DOIUrl":"https://doi.org/10.1093/jicru_ndw007","url":null,"abstract":"Various imaging modalities have been used to stage patients with gynecologic cancers and are invaluable in assessing local, regional, and metastatic spread of disease. As cervical cancer is directly accessible on pelvic examination, clinical findings based on visual and digital examination, and documented on clinical diagrams, also remain essential. Plain radiographs, including chest x rays, barium enemas (BE), intravenous urography (IVU), skeletal surveys, and lymphangiography (LAG), as well as cystoscopy and rectal endoscopy, have long been mainstays of staging of cervical cancer and remain so in many parts of the world. Radiographs to guide both external-beam therapy and brachytherapy have been used nearly universally, but are limited by their inability to demonstrate the tumor and its extensions to many of the critical, adjacent abdomino-pelvic organs. Reliance on bony anatomy is not sufficient for treatment planning for cervical cancer (Finlay et al., 2006; McAlpine et al., 2004). More recently, three-dimensional (3D)-imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) have become the techniques of choice for external-beam and brachytherapy treatment planning, for monitoring response during treatment, and for post-treatment surveillance. Functional imaging, in particular positron-emission tomography (PET) combined with CT, and, recently functional MRI, play increasingly important roles. Ultrasound (US) has been replaced by MRI in the last two decades in the initial staging of patients, but it might have an essential role for image-guided intracavitary and interstitial gynecologic brachytherapy. The focus in the following will be on the role of clinical diagrams and imaging in treatment planning and response monitoring leading to adaptive therapy.","PeriodicalId":91344,"journal":{"name":"Journal of the ICRU","volume":"39 1","pages":"37 - 47"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81585333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prescribing, Recording, and Reporting Brachytherapy for Cancer of the Cervix 子宫颈癌近距离放疗的处方、记录和报告

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru_ndw027

C. Kirisits, C. Haie-meder, J. Lindegaard

引用次数: 152

Abstract 摘要

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw001

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12. Treatment Planning 12. 治疗计划

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru_ndw016

{"title":"12. Treatment Planning","authors":"","doi":"10.1093/jicru_ndw016","DOIUrl":"https://doi.org/10.1093/jicru_ndw016","url":null,"abstract":"This section summarizes the practical aspects of clinical treatment planning for intracavitary cervical brachytherapy. Treatment planning is based on the overall planning aim for the combined dose distributions of external-beam radiotherapy (EBRT) and brachytherapy. Based on information available at diagnosis, a schedule for EBRT and brachytherapy, their relative contribution to the overall EQD2 for defined target volumes, fractionation, and timing is defined. Due to regression of the primary tumor, the target volume for brachytherapy can diminish significantly during treatment. Therefore, adaptive treatment planning is based on a reassessment of tumor and target volumes before and possibly at the time of brachytherapy. Adaptations of the brachytherapy implant itself to the anatomical situation after weeks of EBRT are also an integral part of the optimized adaptive-treatment-planning procedure. Adaptation is possible at different levels of complexity, ranging from the minimum requirement of a detailed clinical examination to image-guided approaches simulating the implantation technique and geometry (preplanning). During implantation, further optimization of the implant can be obtained by intraoperative image guidance. The final implantation geometry in relation to target volumes and organs at risks (OARs) is determined with volumetric imaging or radiographic approximation with the applicator in place. A set of dose–volume constraints for the individual brachytherapy fractions must be available prior to the optimization of dwell positions and dwell times, taking into account the pre-defined overall planning aims as well as spatial distributions of absorbed dose from previous brachytherapy and/or external-beam fractions. The method to achieve reproducible and controlled absorbed dose distributions is to start the optimization process with standardized loading patterns for the active dwell positions. In an iterative process, the dwell positions and dwell times are adjusted until an acceptable compromise between target coverage and OAR constraints is achieved. Inverse optimization and graphically assisted dosedistribution shaping should be performed with care as the spatial distribution of over-dosed and underdosed spots within the treated volume is often changed substantially compared with the manual iterative procedure. Clinical experience and quantitative radiobiology has shown that dose–effect curves for toxicity in the pelvis can be steep depending on the OAR and the chosen endpoint (Bentzen, 1993; Georg et al., 2012; Perez et al., 1998; Petereit et al., 1999; Pourquier et al., 1982; 1987). Figure 8.1 illustrates an example of dose–volume correlations for late rectal morbidity in cervical cancer patients treated with MRI-based brachytherapy, where a steep dose–effect is evident, especially when D2cm3 is used as a descriptor of the cumulative dose of EBRT and brachytherapy EQD2 delivered to the rectum (Georg et al., 2009). Considering the sharp a","PeriodicalId":91344,"journal":{"name":"Journal of the ICRU","volume":"142 2","pages":"151 - 160"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/jicru_ndw016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72490273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

7. Radiobiological Considerations 7. 放射生物因素

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru_ndw011

{"title":"7. Radiobiological Considerations","authors":"","doi":"10.1093/jicru_ndw011","DOIUrl":"https://doi.org/10.1093/jicru_ndw011","url":null,"abstract":"Historically, variation in dose is kept to a minimum inside each CTV and planning target volume (PTV) in external-beam treatments, with the aim of achieving a homogeneous dose distribution with the dose varying between 95 % and 107 % of the prescribed dose (ICRU, 1993b; 2000). However, with new techniques [such as intensity-modulated radiation therapy (IMRT)], some dose inhomogeneity (dose painting) may be specifically planned (ICRU, 2010). For intracavitary brachytherapy (ICBT), the dose may be prescribed to a point but more typically to a CTV with a volume of 10 cm to 200 cm (Pötter et al., 2006). Dose to a CTV may be prescribed as a D98 or other dose–volume value or to other clinical volumes as discussed in Sections 5 and 6. Even in the smaller CTVs, the dose distribution is heterogeneous with relatively low doses near the margin of the CTV and two to three times greater dose rates and doses delivered immediately adjacent to the radioactive sources. The average dose and dose rate within the CTV is consequently much higher than the dose and dose rate at the periphery. In external beam therapy, because of dose–volume–effect relationships, these high doses would not be tolerated by normal tissues, given the larger volumes commonly exposed. A study by De Brabandere et al. (2008) shows that the GTV receives on average 146 % (108 % to 273 %) of the dose to the periphery of the CTV. Outside of the CTV, there is a steep decrease in dose rate and dose.","PeriodicalId":91344,"journal":{"name":"Journal of the ICRU","volume":"55 1","pages":"104 - 89"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79113770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

1. Introduction 1.简介

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw003

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6. Organs at Risk and Morbidity-Related Concepts and Volumes 6.风险器官和发病率相关概念和数量

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw010

引用次数: 1

12. Treatment Planning 12.治疗计划

Journal of the ICRU Pub Date : 2013-04-01 DOI: 10.1093/jicru/ndw016

引用次数: 0