膀胱癌的辅助放疗：以回肠导管疏通为重点的剂量学研究

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2024-10-09 DOI:10.1016/j.clon.2024.10.006

S. Goyal , K. Periasamy , T. Dey , P. Vias , G. Trivedi , G. Ghera , R. Madan , H. Prashar , D. Khosla , R. Mavuduru , G.S. Bora

{"title":"膀胱癌的辅助放疗：以回肠导管疏通为重点的剂量学研究","authors":"S. Goyal , K. Periasamy , T. Dey , P. Vias , G. Trivedi , G. Ghera , R. Madan , H. Prashar , D. Khosla , R. Mavuduru , G.S. Bora","doi":"10.1016/j.clon.2024.10.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction.</div></div><div><h3>Methods and materials</h3><div>Computed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant.</div></div><div><h3>Results</h3><div>The median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry.</div></div><div><h3>Conclusions</h3><div>Ileal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103654"},"PeriodicalIF":3.2000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Adjuvant Radiotherapy in Bladder Cancers: A Dosimetric Study Focusing on Ileal Conduit Sparing\",\"authors\":\"S. Goyal , K. Periasamy , T. Dey , P. Vias , G. Trivedi , G. Ghera , R. Madan , H. Prashar , D. Khosla , R. Mavuduru , G.S. Bora\",\"doi\":\"10.1016/j.clon.2024.10.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>To compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction.</div></div><div><h3>Methods and materials</h3><div>Computed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant.</div></div><div><h3>Results</h3><div>The median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry.</div></div><div><h3>Conclusions</h3><div>Ileal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.</div></div>\",\"PeriodicalId\":10403,\"journal\":{\"name\":\"Clinical oncology\",\"volume\":\"37 \",\"pages\":\"Article 103654\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0936655524004199\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0936655524004199","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的比较在根治性膀胱切除术和 IC 重建后计划接受辅助放疗 (RT) 的前瞻性队列患者中不同治疗技术的回肠导管 (IC) 和其他危险器官 (OAR) 剂量测量。方法和材料获得了 20 名接受辅助 RT 的患者的计算机断层扫描（CT）数据集，并使用指定的模拟方案（包括延迟 CT 以识别 IC）对目标体积（原发和结节）和 OAR（包括 IC、输尿管-回肠吻合口和回肠造口）进行前瞻性划分。为每位患者生成了三个RT计划，剂量为54灰度（Gy），分27次进行（PTV V95% >95%）：带（3DCRT_S）和不带（3DCRT_N）造口屏蔽的三维适形放射治疗（3DCRT），以及容积调制弧治疗（VMAT），并为 VMAT 计划指定了 OAR 限制（IC：Dmax<54Gy, V50Gy <20cc）。根据已发表的文献，还对其他盆腔 OAR（肠、直肠、股骨头）进行了限制。对计划的目标覆盖范围和 OAR 剂量进行了评估；特别是 IC 和回肠造口）。采用方差分析检验比较达到剂量的中位数，P 值为 0.05 时具有统计学意义。结果 IC 容量的中位数为 63.34 (55.29-82.93) cc。95%的患者 IC 头端位于 L5 或 L4 椎体水平，80%的患者 IC 尾端位于 S2 或 S3 椎体水平。相比之下，回肠造口的范围从头颅的 L4 或 L5 椎体水平（100%）到尾部的 L5 水平（80%）。3DCRT_N 和 VMAT 方案的 PTV V95% 相似，而 3DCRT_S 方案在回肠造口屏蔽区域的 PTV V95% 明显较低（99.95% vs 99.01% vs 96.29%，p < 0.01）。3DCRT_N (38.81 cc) 和 3DCRT_S (35.62 cc) 的 IC V50Gy 中位数相当，而 VMAT 计划的 IC V50Gy 中位数明显较低（17.05 cc，p < 0.01）。三种方案的 IC Dmax 没有明显差异。另一方面，当比较 3DCRT_N、3DCRT_S 和 VMAT 方案的回肠造口剂量时，Dmean 值相当（11.93 Gy vs 7.41 Gy vs 9.54 Gy，p = 0.06），而 Dmax 值在 3DCRT_N 方案中明显较高，在 VMAT 方案中最低（35.32 Gy vs 27.57 Gy vs 24.22 Gy，p <0.01）。在输尿管-回肠吻合口、肠道和直肠剂量测定方面，VMAT 方案明显优于 3DCRT 方案。在不影响 PTV 覆盖范围的情况下，使用 VMAT 保留 IC 是可行的。通过降低吻合口和粘膜并发症的风险，VMAT的剂量学优势有望使需要较高盆腔RT剂量和结节RT的患者受益。临床获益应在前瞻性方案中进行评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Adjuvant Radiotherapy in Bladder Cancers: A Dosimetric Study Focusing on Ileal Conduit Sparing

Purpose

To compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction.

Methods and materials

Computed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant.

Results

The median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry.

Conclusions

Ileal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.