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A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

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Chinese Medical Journal 2016年第12期129卷 1447-1454页

作者： Ming Li Gao-Feng Li Xiu-Yu Hou Hong Gao Yong-Gang Xu Ting Zhao Department of Radiation Oncology Beijing Hospital 8eijing 100730 China

Background： Image-guided radiation therapy （IGRT） is the preferred method for curative treatment of localized prostate cancer, which could improve disease outcome and reduce normal tissue toxicity reaction. 1GRT using cone-beam computed tomography （CBCT） in combination with volumetric-modulated arc therapy （VMAT） potentially allows smaller treatment margins and dose escalation to the prostate. The aim of this study was to compare the difference of dos^metric diffusion in conventional IGRT using 7-field, step-and-shoot intensity-modulated radiation therapy （IMRT） and hypofractionated IGRT using VMAT for patients with localized prostate cancer. Methods： We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT （n = 12） or VMAT （n = 12） for prostate cancer between November 2013 and October 2015. Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator. Offline planning was performed using the daily treatment images registered with simulation computed tomography （CT） images. A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study. Dose distributions were recalculated on CBCT images registered with the planning CT scanner. Results： Compared with 7-field, step-and-shoot IMRT, VMAT plans resulted in improved planning target volume （PTV） D95% （7663.17 ± 69.57 cGy vs. 7789.17± 131.76 cGy, P 〈 0.001）. VMAT reduced the rectal D25 （P 〈 0.001）, D35 （P 〈 0.001）, and D50 （P 〈 0.001）, bladder V50 （P 〈 0.001）, D25 （P = 0.002）, D35 （P = 0.028）, and D50 （P = 0.029）. However, VMAT did not statistically significantly reduce the rectal V50, compared with 7-field, step-and-shoot IMRT （25.02 ± 5.54% vs. 27.43 ±8.79%, P - 0.087）. Conclusions： To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivere

关键词： Hypofractionated Radiotherapy Image-guided Radiotherapy Prostate Cancer Treatment Planning volumetric-modulatedarc therapy

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