锥束在线适应性放射治疗：治疗胃黏膜相关淋巴组织淋巴瘤的一种有前景的方法？

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-02-01 DOI:10.1016/j.adro.2024.101692

Xinran Zhong PhD , Mahbubur Rahman PhD , Ambrosia Simmons MD, PhD, Xingzhe Li MD, Malgorzata Kozak MD, Neil Desai MD, Robert Timmerman MD, Andrew Godley PhD, Bin Cai PhD, David Parsons PhD, Kiran A. Kumar MD, Mu-Han Lin PhD

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引用次数: 0

摘要

目的：每日在线适应性放射治疗（oART）为治疗边缘缩小的胃粘膜相关淋巴组织（MALT）淋巴瘤提供了机会。本研究报告了我们基于锥束计算机断层扫描（CBCT）的日常oART治疗胃MALT淋巴瘤憋气和缩小边缘的早期经验。方法和材料：采用基于cbct的oART系统治疗10例患者。根据每日CBCT调整危险器官（OARs）和临床靶体积（CTV）。计划目标体积（PTV）由CTV计算，CTV边缘为0.5 ~ 0.7 cm，并伴有屏气。在预计划阶段比较多种光束安排，以确保最小的监测单位（MU），以确保患者舒适度和屏气再现性。对10例患者的108个分数进行PTV、CTV覆盖率和Paddick符合性指数（CI）的比较。使用调整方案和预方案之间的相对百分比差异比较MU、Paddick CI和梯度指数。报告了预计划、调整计划和计划计划中9例患者106个部分的桨叶剂量。记录并报告9例患者93个治疗组临床工作流程各步骤的时间统计。结果：在所有患者的治疗过程中，PTV体积从-37.1%变化到90.5%（11.7%±18.5%）。由于在保持相似的OAR剂量的同时，PTV和CTV覆盖率更高，因此选择适应方案作为每个部分的治疗方案。调整计划和预定计划的PTV和CTV覆盖率分别为VRx = 95.0%±0.3%和64.1±19.6%,VRx = 99.9±0.1%和74.0%±22.2%。适应方案的MU、Paddick CI和梯度指数平均分别为计划前值的4.1%、0.4%和-4.2%。控制台的自适应工作流程和医生时间分别为25±7和19±6分钟。结论：基于cbct的oART系统具有所提出的工作流程，可以在合理的时间内使用更小的PTV边缘治疗胃MALT淋巴瘤患者，同时保持良好的目标覆盖率，从而获得一致的适应计划质量。这种方法可以扩展到更大的胃肠道患者队列。

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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Cone Beam Online Adaptive Radiation Therapy: A Promising Approach for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma?

Purpose

Daily online adaptive radiation therapy (oART) opens the opportunity to treat gastric mucosa-associated lymphoid tissue (MALT) lymphoma with a reduced margin. This study reports our early experience of cone beam computed tomography (CBCT)-based daily oART treating gastric MALT lymphoma with breath-hold and reduced margins.

Methods and Materials

Ten patients were treated on a CBCT-based oART system. Organs at risk (OARs) and the clinical target volume (CTV) were adjusted based on the daily CBCT. Planning target volume (PTV) was derived from the CTV with a 0.5 to 0.7 cm margin with breath-hold. Multiple beam arrangements were compared during the preplanning phase to ensure minimal monitor unit (MU) for patient comfort and breath-hold reproducibility. For 108 fractions from the 10 patients, the PTV, CTV coverage, and Paddick conformity index (CI) were compared between the adapted and scheduled plans. The MU, Paddick CI, and gradient index were compared using relative percentage differences between the adapted plans and preplans. The OAR doses from 106 fractions across 9 patients were reported for the preplans, adapted plans, and scheduled plans. The time statistics for each step of the clinical workflow were recorded and reported for 93 treatment fractions from 9 patients.

Results

The PTV volume varied from −37.1% to 90.5% (11.7% ± 18.5%) throughout treatments across all patients. The adapted plan was chosen as the treatment plan for each fraction because of superior PTV and CTV coverage while maintaining a similar OAR dose. The PTV and CTV coverage for the adapted and scheduled plans was V_Rx = 95.0% ± 0.3% versus 64.1 ± 19.6% and V_Rx = 99.9 ± 0.1% versus 74.0% ± 22.2%, respectively. The adapted plans’ MU, Paddick CI, and gradient index were, on average, 4.1%, 0.4%, and −4.2% of the preplan values, respectively. The console's adaptive workflow and physician time were 25 ± 7 and 19 ± 6 minutes, respectively.

Conclusion

A CBCT-based oART system with the proposed workflow is feasible for treating patients with gastric MALT lymphoma using a reduced PTV margin while maintaining excellent target coverage within a reasonable time, resulting in consistent adapted plan quality. This approach can be expanded to a larger cohort of gastrointestinal patients.

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.