利用虚拟四维体积调制弧线治疗系统优化肺癌立体定向放射治疗中呼吸运动的边缘适应。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-09-11 DOI:10.1016/j.clon.2025.103934

D. Kawahara , H. Masuda , T. Wada , M. Kishi , T. Katsuta , N. Imano , Y. Murakami

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引用次数: 0

摘要

目的：本研究应用先前开发的四维（4D）剂量计算方法，使用虚拟四维计算机断层扫描（v4DCT）来评估和优化肺立体定向全身放射治疗（SBRT）中最佳裕度（OM）的使用。具体而言，我们评估了来自不同处方等剂量水平的OM的临床可行性及其对靶覆盖和正常组织保留的影响。材料和方法：体积调制弧线治疗（VMAT）计划是使用一个带有虚拟肺肿瘤的全身幻影来创建的。治疗计划确保95%的计划目标体积（PTV）被70%、75%和80%的处方等剂量线覆盖。假设自由呼吸生成v4DCT图像。四维放射治疗（v4DRT）剂量代表所有呼吸期的累积剂量。剂量学内缘（DIM）定义为确保肿瘤总体积（GTV） D100%和D99%覆盖的最大振幅。根据70%至80%等剂量计划对GTV的平均剂量和对危险器官（OARs）的剂量确定OM。结果：考虑到呼吸运动，DIM比传统的边缘大2.0 ~ 2.6倍。在呼吸运动条件下，实现优化的边缘导致正常肺组织的V20Gy显著降低。此外，距离PTV 0.5 ~ 2.0 cm处的最大剂量下降幅度较大。70%和75%等剂量方案的OM比80%等剂量方案的常规PTV边际减少了55%至62%。结论：本研究提出了一种边缘处方肺SBRT的OM。该方法在保持目标剂量覆盖和降低桨叶暴露的同时，将呼吸运动幅度降低了55%至62%。

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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Optimisation of Margin Adaptation for Respiratory Motion in Lung Cancer Stereotactic Body Radiation Therapy Using Virtual Four-dimensional Volumetric Modulated Arc Therapy System Radiotherapy

Aim

This study applies a previously developed four-dimensional (4D) dose calculation method using virtual four-dimensional computed tomography (v4DCT) to evaluate and optimise the use of an optimal margin (OM) in lung stereotactic body radiation therapy (SBRT). Specifically, we assess the clinical feasibility of an OM derived from different prescription isodose levels and its impact on target coverage and normal tissue sparing.

Materials and Methods

Volumetric modulated arc therapy (VMAT) plans were created using a whole-body phantom with a virtual lung tumour. Treatment planning ensured that 95% of the planning target volume (PTV) was covered by the prescription isodose lines for 70%, 75%, and 80%. v4DCT images were generated assuming free breathing. The four-dimensional radiotherapy (v4DRT) dose represented the accumulated dose across all respiratory phases. The dosimetric internal margin (DIM) was defined as the maximum amplitude ensuring D_100% and D_99% coverage of the gross tumour volume (GTV). The OM was determined based on the average dose to the GTV and the dose to organs at risk (OARs) for the 70% to 80% isodose plans.

Results

The DIM was determined to be 2.0 to 2.6 times larger than the conventional margin accounting for respiratory motion. Implementation of the optimised margin resulted in a significant reduction of the V_20Gy for normal lung tissue under respiratory motion conditions. Additionally, the maximum dose at distances of 0.5 to 2.0 cm from the PTV showed a reduction with larger amplitudes. The OM with 70% and 75% isodose plan achieved a 55% to 62% reduction compared to the conventional PTV margin with 80% isodose plan.

Conclusion

This study proposes an OM for lung SBRT with marginal prescription. This approach reduced the respiratory motion margin by 55% to 62% while maintaining target dose coverage and lowering OAR exposure.

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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.