PDF(Sci-hub)
Abstract：
OBJECTIVE: Our goal was to compare conformal 3D (C3D) radiotherapy (RT), modulated intensity RT (IMRT), and volumetric modulated arc therapy (VMAT) planning techniques in treating pituitary adenomas.
BACKGROUND: RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR).
METHODS: We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI).
RESULTS: Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF.
CONCLUSIONS: Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.
BACKGROUND: RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR).
METHODS: We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI).
RESULTS: Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF.
CONCLUSIONS: Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.
摘要：
■我们的目标是比较适形3D（C3D）放射治疗（RT），调制强度RT（IMRT），和体积调制电弧疗法（VMAT）计划技术治疗垂体腺瘤。
■RT对治疗垂体腺瘤很重要。治疗计划的进步允许更高的辐射剂量，而影响风险器官（OAR）的风险较小。
■我们对接受外部束放射治疗的垂体腺瘤患者进行了为期5年的回顾性审查（带有展平滤光片的C3D，平整无过滤器[FFF]，IMRT,和VMAT）。我们比较了剂量-体积直方图数据。对于OAR,我们记录了D2%,最大值,和平均剂量。对于计划目标体积(PTV)，我们注册了V95%,V107%,D95%,D98%,D50%,D2%,最小剂量,合格指数(CI)，和同质性指数(HI)。
■58例垂体腺瘤患者被纳入。目标体积覆盖率对于所有技术都是可接受的。HI值为0.06,IMRT;0.07,VMAT;0.08,C3D;和0.09,C3DFFF(p<0.0001)。VMAT和IMRT提供了最佳的靶体积一致性(CI,分别为0.64和0.74;p<0.0001)。VMAT对光学通路产生的剂量最低，镜头,还有耳蜗.颈部在极端弯曲的位置表明，它有助于主要通过VMAT进行规划，只允许使用一个弧线并实现所需的一致性。缩短治疗时间,同时允许使用C3D对危险器官进行更大的保护，C3DFFF.
■我们的结果证实，使用IMRT在垂体腺瘤中的EBRT，VMAT,C3D,C3FFF为目标提供足够的覆盖。具有单弧或不完整弧的VMAT更好地符合所需的剂量测定目标，如目标覆盖率和正常结构剂量限制，以及更短的治疗时间。颈部极端弯曲可能有利于更好地保护有风险的器官的治疗计划。当其他治疗技术不可用时,具有极度颈部屈曲的C3D是合适的治疗选择。
■RT对治疗垂体腺瘤很重要。治疗计划的进步允许更高的辐射剂量，而影响风险器官（OAR）的风险较小。
■我们对接受外部束放射治疗的垂体腺瘤患者进行了为期5年的回顾性审查（带有展平滤光片的C3D，平整无过滤器[FFF]，IMRT,和VMAT）。我们比较了剂量-体积直方图数据。对于OAR,我们记录了D2%,最大值,和平均剂量。对于计划目标体积(PTV)，我们注册了V95%,V107%,D95%,D98%,D50%,D2%,最小剂量,合格指数(CI)，和同质性指数(HI)。
■58例垂体腺瘤患者被纳入。目标体积覆盖率对于所有技术都是可接受的。HI值为0.06,IMRT;0.07,VMAT;0.08,C3D;和0.09,C3DFFF(p<0.0001)。VMAT和IMRT提供了最佳的靶体积一致性(CI,分别为0.64和0.74;p<0.0001)。VMAT对光学通路产生的剂量最低，镜头,还有耳蜗.颈部在极端弯曲的位置表明，它有助于主要通过VMAT进行规划，只允许使用一个弧线并实现所需的一致性。缩短治疗时间,同时允许使用C3D对危险器官进行更大的保护，C3DFFF.
■我们的结果证实，使用IMRT在垂体腺瘤中的EBRT，VMAT,C3D,C3FFF为目标提供足够的覆盖。具有单弧或不完整弧的VMAT更好地符合所需的剂量测定目标，如目标覆盖率和正常结构剂量限制，以及更短的治疗时间。颈部极端弯曲可能有利于更好地保护有风险的器官的治疗计划。当其他治疗技术不可用时,具有极度颈部屈曲的C3D是合适的治疗选择。
