前列腺放射治疗中减少神经血管束剂量的挑战与机遇

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-04-09 DOI:10.1016/j.ctro.2025.100959

Victor J. Brand , Linda Rossi , Maaike T.W. Milder , Femke E. Froklage , Alison C. Tree , Mischa S. Hoogeman , Luca Incrocci

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Non-NVB sparing (non-NVBsparing) plans and NVB sparing plans in two settings were generated: (1) uncompromised NVB sparing (u-NVBsparing; maintaining target coverage) (2) and compromised NVB sparing (c-NVBsparing; allowing target underdosage). Coplanar and non-coplanar beam arrangements were compared. U-NVBsparing was compared to non-NVBsparing. C-NVBsparing plans were visualized in Pareto fronts. Statistical significance (p-value < 0.05) was determined by Wilcoxon signed-rank test. Results: u-NVBsparing compared to non-NVBsparing plans showed statistically significant median reductions in NVB D0.1 cc (38.9 vs 42.6 Gy for coplanar; 38.9 vs 43.3 Gy for non-coplanar) and Dmean (25.6 vs 30.0 Gy for coplanar; 24.7 vs 30.2 Gy for noncoplanar). Further lowering NVB D0.1 cc in c-NVBsparing plans clearly correlated to lower target coverage. Non-coplanar c-NVBsparing plans maintained significantly higher target coverages for similar NVB D0.1 cc values, compared to coplanar plans. 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引用次数: 0

摘要

背景与目的：前列腺癌放射治疗（PCa）后神经血管束（NVB）的辐射损伤与勃起功能障碍有关。使用共面和非共面自动治疗计划的NVB节约在两种情况下提出：(1)不影响目标覆盖，(2)允许目标覆盖折衷。材料和方法：20例既往治疗的局限性PCa患者。基于MRI-CT匹配，回顾性地划定NVB。所有治疗计划（5 × 7.25 Gy）均采用Erasmus-iCycle（内部自动治疗计划算法）自动生成。Non-NVB sparing （non-NVBsparing）计划和NVBsparing计划在两种设置下生成：(1)uncompromise NVBsparing (u-NVBsparing)；维持目标覆盖)(2)和受损的NVB保存（c-NVBsparing）；允许目标剂量不足)。比较了共面和非共面光束的排列方式。将U-NVBsparing与non-NVBsparing进行比较。C-NVBsparing计划在Pareto前线可视化。统计学意义(p-value <；0.05)，经Wilcoxon sign -rank检验。结果：与非nvbsparing方案相比，u-NVBsparing方案中位NVB D0.1 cc(共面组38.9 Gy vs 42.6 Gy；非共面38.9 Gy vs 43.3 Gy)和Dmean(共面25.6 Gy vs 30.0 Gy；非共面为24.7 Gy vs 30.2 Gy)。在c-NVBsparing方案中，进一步降低NVB D0.1 cc与较低的目标覆盖率明显相关。与共面方案相比，非共面c-NVBsparing方案在相似的NVB D0.1 cc值下保持了显著更高的目标覆盖率。结论：在不影响目标覆盖的情况下保留NVB是可行的。与共面NVB保留计划相比，非共面NVB保留计划没有发现临床相关的益处，尽管总体上有统计学优势。NVB的进一步节省是以目标覆盖率为代价的，为此，帕累托前沿可以用作临床实践中的工具。

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Challenges and opportunities to minimize the dose in the neurovascular bundles during prostate radiotherapy

Background and purpose: Radiation damage to the neurovascular bundles (NVB) has been linked to erectile dysfunction after prostate cancer radiotherapy (PCa). NVB sparing using coplanar and non-coplanar automated treatment planning is presented here in two settings: (1) without compromising target coverage, (2) allowing target coverage compromise. Material and methods: 20 previously treated patients with localized PCa. Based on a MRI-CT match, the NVB were retrospectively delineated. All treatment plans (5 × 7.25 Gy) were automatically generated using Erasmus-iCycle (in-house automated treatment planning algorithm). Non-NVB sparing (non-NVBsparing) plans and NVB sparing plans in two settings were generated: (1) uncompromised NVB sparing (u-NVBsparing; maintaining target coverage) (2) and compromised NVB sparing (c-NVBsparing; allowing target underdosage). Coplanar and non-coplanar beam arrangements were compared. U-NVBsparing was compared to non-NVBsparing. C-NVBsparing plans were visualized in Pareto fronts. Statistical significance (p-value < 0.05) was determined by Wilcoxon signed-rank test. Results: u-NVBsparing compared to non-NVBsparing plans showed statistically significant median reductions in NVB D0.1 cc (38.9 vs 42.6 Gy for coplanar; 38.9 vs 43.3 Gy for non-coplanar) and Dmean (25.6 vs 30.0 Gy for coplanar; 24.7 vs 30.2 Gy for noncoplanar). Further lowering NVB D0.1 cc in c-NVBsparing plans clearly correlated to lower target coverage. Non-coplanar c-NVBsparing plans maintained significantly higher target coverages for similar NVB D0.1 cc values, compared to coplanar plans. Conclusion: NVB sparing without compromising target coverage is feasible. No clinically relevant benefit was found for non-coplanar compared to coplanar NVB sparing plans, although overall statistically superior. Further sparing of the NVB comes at the cost of target coverage, for which a Pareto front could be used as a tool in clinical practise.

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