骨盆立体定向消融放疗再照射的剂量积累

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-05-09 DOI:10.1016/j.clon.2025.103861

F. Slevin , C. O'Hara , J. Entwisle , J. Lilley , M. Nix , C. Thompson , M. Tyyger , A.L. Appelt , L.J. Murray

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引用次数: 0

摘要

尽管再照射的使用越来越多，但我们对正常组织适当剂量限制的理解仍然有限。这与多疗程累积剂量评估的主要不确定性有内在联系。本研究旨在：i)回顾性评估骨盆立体定向消融放疗（SABR）再照射患者的正常组织累积剂量，考虑解剖变化和碎片大小效应；ii)产生安全正常组织累积剂量的初步数据。材料和方法对56例骨盆根治或新辅助放疗后局部复发的骨盆SABR再照射患者进行分析。原始治疗计算机断层扫描（CT）扫描变形地登记到再照射CT；靶体积、危险器官（OARs）和剂量分布从原始解剖转移到再照射扫描。原始和再照射剂量分布被转换成2 gy当量剂量（EQD2）。使用基于可变形图像配准（DIR）的剂量总和和/或每个桨叶的最大剂量总和（D0.5 cc）计算累积剂量。评估再照射后2年的严重毒性事件。结果大多数患者为前列腺癌（85.7%），盆腔淋巴结复发（75%）以单一靶体积（91.1%）治疗，处方剂量为30 Gy，分5次（90.3%）。初始和再照射之间的中位时间为53个月（四分位数间距[IQR]: 36-79）。根据DIR，观察到EQD2对直肠的累积剂量高达82.8 Gy，对膀胱的累积剂量为110.2 Gy，对结肠的累积剂量为69.8 Gy，对骶丛的累积剂量为101.4 Gy，对血管的累积剂量为108.1 Gy。根据D0.5 cc的总和，小肠的累积剂量高达111.9 Gy。未观察到可归因于再照射的严重毒性事件。本研究证明了对先前接受盆腔SABR再照射的患者进行正常组织累积剂量的按体素解剖和放射生物学上适当的三维评估的可行性。没有毒性事件可归因于所提供的累积剂量或再照射剂量。

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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Dose Accumulation for Pelvic Stereotactic Ablative Radiotherapy Reirradiation

Aims

Despite the increasing use of reirradiation, our understanding of appropriate normal tissue dose constraints remains limited. This is intrinsically tied to major uncertainties concerning evaluation of cumulative doses from multiple treatment courses. This study aimed to: i) retrospectively evaluate cumulative normal tissue doses in patients treated with pelvic stereotactic ablative radiotherapy (SABR) reirradiation, taking account of anatomical change and fraction size effects, and ii) produce preliminary data regarding safe cumulative normal tissue doses.

Materials and methods

Fifty-six patients treated with pelvic SABR reirradiation for locoregional recurrence after prior radical or (neo)adjuvant radiotherapy in the pelvis were included. Original-treatment computed tomography (CT) scans were deformably registered to the reirradiation CTs; and target volumes, organs at risk (OARs), and dose distributions were transferred from the original anatomy to the reirradiation scan. Original and reirradiation dose distributions were converted into equivalent dose in 2-Gy fractions (EQD2). Cumulative doses were calculated using deformable image registration (DIR)–based dose summation and/or summed maximum doses (D0.5 cc) for each OAR. Severe toxicity events up to 2 years post reirradiation were evaluated.

Results

Most patients had prostate cancer (85.7%) and were treated for pelvic nodal recurrence (75%) with a single target volume (91.1%) using a prescription dose of 30 Gy in 5 fractions (90.3%). The median time between original and reirradiation was 53 months (interquartile range [IQR]: 36-79). Based on DIR, cumulative doses in EQD2 of up to 82.8 Gy for the rectum, 110.2 Gy for the bladder, 69.8 Gy for the colon, 101.4 Gy for the sacral plexus, and 108.1 Gy for the vessels were observed. Based on summed D0.5 cc, cumulative doses of up to 111.9 Gy were delivered to the small bowel. No severe toxicity events which could be attributed to reirradiation were observed.

Conclusions

This study has demonstrated feasibility of per-voxel anatomically and radiobiologically appropriate 3-dimensional evaluation of cumulative normal tissue doses in patients previously treated with pelvic SABR reirradiation. No toxicity events could be attributed to the cumulative or reirradiation doses delivered.

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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.