[국내논문]International Spine Radiosurgery Consortium Consensus Guidelines에 따른 Spine Stereotactic Radiosurgery에서 IMRT와 VMAT의 비교연구 Comparison of IMRT and VMAT Techniques in Spine Stereotactic Radiosurgery with International Spine Radiosurgery Consortium Consensus Guidelines원문보기
정위적 체부 방사선치료(Stereotactic Body Radiation Therapy, SBRT)는 척추 전이암을 치료하는데 있어서 점점 증가하고 있다. 표적 종양의 급격한 선량 변화와 등선량 분포를 얻기 위해서, 세기조절방사선치료(Intensity-modulated radiation therapy, IMRT)와 체적변조회전치료(Volumetric-modulated arc therapy, VMAT)는 척추 방사선수술에 있어서 필수적인 치료기법이다. 이 연구의 목적은 표적 종양을 위한 International Spine Radiosurgery (ISRC) Consortium의 consensus guideline으로 그려진 표적에 있어서 IMRT와 VMAT의 치료기법을 질적으로 비교하고자 한다. 경부, 흉부, 요추 부위에 종양치료를 받은 3명의 환자를 선택 하였다. 표적 종양은 ISRC의 consensus guideline을 바탕으로 정의 하였다. $T_B$는 vertebral body만 포함하였고, $T_{BPT}$는 vertebral body, pedicle, transverse process를 포함하였다. 그리고 $T_{ST}$는 spinous process와 transverse process를 포함하여 그렸다. Maximum spinal cord선량은 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 12.46 Gy, 12.17 Gy, 11.36 Gy였고, IMRT, RA1, RA2에서 각각 11.81 Gy, 12.19 Gy, 11.99 Gy였다. 평균 감소(90%~50%) 선량 거리 (mm)는 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 3.5 mm, 3.3 mm, 3.9 mm였고, IMRT, RA1, RA2에서 각각 3.7 mm, 3.7 mm, 3.3 mm였다. 가장 복잡한 $T_{BPT}$의 경우에서 IMRT, RA1, RA2의 conformity index는 각각 0.621, 0.761, 0.817 이었고, rDHI는 0.755, 0.796, 0.824 였다. IMRT와 VMAT 모두 척추 정위적 방사선수술에서 표적 종양에 급격한 선량 변화와 등선량 분포를 전달하였다. 그러나 표적 종양이 vertebral body, pedicle, transverse process를 포함한다면, IMRT 치료기법은 VMAT 치료기법과 비교해서 conformity index 측면에서 불충분하였다. 그럼에도 불구하고, IMRT 치료기법은 RA1, RA2와 비교해서 대부분의 영역에서 maximum spinal cord 선량을 줄이는데 더 효과적이었다.
정위적 체부 방사선치료(Stereotactic Body Radiation Therapy, SBRT)는 척추 전이암을 치료하는데 있어서 점점 증가하고 있다. 표적 종양의 급격한 선량 변화와 등선량 분포를 얻기 위해서, 세기조절방사선치료(Intensity-modulated radiation therapy, IMRT)와 체적변조회전치료(Volumetric-modulated arc therapy, VMAT)는 척추 방사선수술에 있어서 필수적인 치료기법이다. 이 연구의 목적은 표적 종양을 위한 International Spine Radiosurgery (ISRC) Consortium의 consensus guideline으로 그려진 표적에 있어서 IMRT와 VMAT의 치료기법을 질적으로 비교하고자 한다. 경부, 흉부, 요추 부위에 종양치료를 받은 3명의 환자를 선택 하였다. 표적 종양은 ISRC의 consensus guideline을 바탕으로 정의 하였다. $T_B$는 vertebral body만 포함하였고, $T_{BPT}$는 vertebral body, pedicle, transverse process를 포함하였다. 그리고 $T_{ST}$는 spinous process와 transverse process를 포함하여 그렸다. Maximum spinal cord선량은 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 12.46 Gy, 12.17 Gy, 11.36 Gy였고, IMRT, RA1, RA2에서 각각 11.81 Gy, 12.19 Gy, 11.99 Gy였다. 평균 감소(90%~50%) 선량 거리 (mm)는 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 3.5 mm, 3.3 mm, 3.9 mm였고, IMRT, RA1, RA2에서 각각 3.7 mm, 3.7 mm, 3.3 mm였다. 가장 복잡한 $T_{BPT}$의 경우에서 IMRT, RA1, RA2의 conformity index는 각각 0.621, 0.761, 0.817 이었고, rDHI는 0.755, 0.796, 0.824 였다. IMRT와 VMAT 모두 척추 정위적 방사선수술에서 표적 종양에 급격한 선량 변화와 등선량 분포를 전달하였다. 그러나 표적 종양이 vertebral body, pedicle, transverse process를 포함한다면, IMRT 치료기법은 VMAT 치료기법과 비교해서 conformity index 측면에서 불충분하였다. 그럼에도 불구하고, IMRT 치료기법은 RA1, RA2와 비교해서 대부분의 영역에서 maximum spinal cord 선량을 줄이는데 더 효과적이었다.
Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential...
Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, $T_{BPT}$ and $T_{ST}$ depending on sectors involved; $T_B$ (vertebral body only), $T_{BPT}$ (vertebral body+pedicle+transverse process), and $T_{ST}$ (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Eacg tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for $T_B$, $T_{BPT}$ and $T_{ST}$ sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for $T_B$, $T_{BPT}$, and $T_{ST}$ sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target $T_{BPT}$ sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.
Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, $T_{BPT}$ and $T_{ST}$ depending on sectors involved; $T_B$ (vertebral body only), $T_{BPT}$ (vertebral body+pedicle+transverse process), and $T_{ST}$ (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Eacg tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for $T_B$, $T_{BPT}$ and $T_{ST}$ sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for $T_B$, $T_{BPT}$, and $T_{ST}$ sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target $T_{BPT}$ sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.
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제안 방법
All of the plans for IMRT technique in this study were composed of fixed-gantry 7 fields with angles of 105°, 130°, 155°, 180°, 205°, 230° and 255°, with a collimator angle of 45°.
27) concluded that partial volume tolerance of spinal cord is at least 10 Gy to 10% of the spinal cord volume (defined as 6 mm above and below the spine radiosurgery target), Computed Tomography (CT) images were acquired with a slice thickness of 2 mm. Each case was retrospectively re-planned to compare dosimetric characteristics between IMRT and RapidARC techniques with prescription of an 18 (Gy) single fraction at 6 MV photon energies.
In this study, we qualitatively compared the quality of plans using IMRT and VMAT techniques in spine stereotactic radiosurgery with 18 Gy single fraction. Both IMRT and VMAT techniques deliver high conformal dose distributions to tumor distributions of TB, TBPT and TST, while satisfying the tolerance of spinal cord specified in the AAPM TG-101 report and partial volume tolerance reported by Ryu et al.
IMRT and RA2 techniques were highly efficient in reducing V10 (%) of the partial volume tolerance. Increasing the number of the arc made, while sparing the critical organs near the target volume from spinal cord V10 (%), results of the RA1 and RA2 techniques.
Novalis Tx (Varian Medical Systems, CA, USA and BrainLAB, Feldkirchen, Germany) linear accelerator system with HD-120 MLC (High Definition Multi Leaf Collimator, 64 inner leaves with 2.5 mm and 56 outer leaves with 5 mm) was used to compare the dosimetric difference of the IMRT and VMAT techniques. Also, the eclipseⓇ (8.
대상 데이터
Three patients treated with spinal tumor of cervical, thoracic, or lumbar region at our institution were selected for this study. As Ryu et al.
이론/모형
All of the plans for IMRT technique in this study were composed of fixed-gantry 7 fields with angles of 105°, 130°, 155°, 180°, 205°, 230° and 255°, with a collimator angle of 45°. Radiation treatment delivery method was selected for the sliding window. The dose-volume constraints for the tumor in the IMRT optimization were 18.
성능/효과
3. The 3D dose max in TB, TBPT and TST regions were 109.1%, 110.6% and 109.1% for the RA1 technique and 108.5%, 110.7% and 108.5% for the RA2 technique, respectively. On the other hand, the respective values were 107.
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