强度调节质子治疗治疗复杂多发性脑膜瘤的有效性：剂量学和放射生物学与螺旋断层治疗对神经系统风险的比较研究

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-05-26 DOI:10.1016/j.clon.2025.103877

G. Singh , D. Sharma , S. Gayen , G. Krishnan , U. Krishna , G. Aishwarya , J. Mary Mathew , R. Jalali

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引用次数: 0

摘要

目的：本研究通过引入一种新的、强大的强度调节质子治疗（IMPT）计划，并评估其相对于螺旋断层治疗（HT）的剂量学和放射生物学结果，解决了在多发性脑膜瘤（MM）放射治疗中保留危险神经器官（OARs）的挑战。方法使用24例MM患者的sct和MRI数据集生成相互竞争的IMPT和HT计划。IMPT采用5个静态场的定点分配策略，考虑2-3 mm的设置和2%的范围不确定性，对CTV-sum进行了稳健优化，而HT则对PTV-sum进行了优化。中位处方剂量为50.2 GyRBE，分为28个馏分。结果每例患者分离ctv数为2 ~ 9个，靶体积分别为27.69 ~ 1153.61 cc （CTV-sum）和62.5 ~ 1415.25 cc （PTV-sum）。HT和IMPT最坏情况下CTV-sum的D95%的平均±SD剂量差（-0.58±0.57 GyRBE, p = 0.03）在临床上是可以接受的。Dmean与PTV-sum差异无统计学意义（p = 0.06），但IMPT组D2%明显高于HT组（p = 0.006）。IMPT显著降低了大多数桨的Dmax和Dmean (p <；0.05)，正常脑组织整体剂量降低(p <；0.0001)，比高温高1.37-6.97倍。NTCP显著降低(p <；晶状体、眼睛、脑干、视神经和耳蜗的差异均为0.05)。结论：与HT相比，simpt确保了强大的目标覆盖，同时显著降低了几种桨的Dmax， Dmean和NTCP。其对正常脑组织的整体剂量降低可能有利于再照射和降低第二次癌症风险。

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Effectiveness of Intensity Modulate Proton Therapy in Managing Complex Multiple Meningiomas: A Dosimetric and Radiobiological Comparative Study with Helical Tomotherapy on Neurological Risk

Purpose

This study addresses the challenges of sparing neurological organs at risk (OARs) in radiation therapy for multiple meningiomas (MM) by introducing a novel, robust intensity-modulated proton therapy (IMPT) plan and assessing its dosimetric and radiobiological outcomes relative to helical tomotherapy (HT).

Methods

CT and MRI datasets from 24 MM patients were used to generate competing IMPT and HT plans. IMPT employed a spot-assignment strategy with five static fields and was robustly optimized for CTV-sum, considering 2–3 mm setup and 2% range uncertainty, while HT was optimized on PTV-sum. The median prescribed dose was 50.2 GyRBE in 28 fractions.

Results

The number of isolated CTVs per patient ranged from 2 to 9, with total target volumes of 27.69–1153.61 cc (CTV-sum) and 62.5–1415.25 cc (PTV-sum). The mean±SD dose difference in D_95% between PTV-sum in HT and CTV-sum in the IMPT worst-case scenario (-0.58 ± 0.57 GyRBE, p = 0.03) was clinically acceptable. While D_mean to PTV-sum showed no significant difference (p = 0.06), D2% was significantly higher in IMPT (p = 0.006) than in HT. IMPT significantly reduced both D_max and D_mean for most OARs (p < 0.05) and lowered integral dose to normal brain tissue (p < 0.0001) by a factor of 1.37–6.97 compared to HT. Significant NTCP reductions (p < 0.05) were observed for the lenses, eyes, brainstem, optic nerves, and cochlea.

Conclusions

IMPT ensures robust target coverage while significantly lowering D_max, D_mean, and NTCP for several OARs compared to HT. Its reduced integral dose to normal brain tissue may benefit re-irradiation and lower second cancer risk.

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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.