PDF(Pubmed)
Abstract：
UNASSIGNED: Uveal melanoma (UM) is the most common primary ocular malignancy. We compared fractionated stereotactic radiotherapy (SRT) with proton therapy, including toxicity risks for UM patients.
UNASSIGNED: For a total of 66 UM patients from a single center, SRT dose distributions were compared to protons using the same planning CT. Fourteen dose-volume parameters were compared in 2-Gy equivalent dose per fraction (EQD2). Four toxicity profiles were evaluated: maculopathy, optic-neuropathy, visual acuity impairment (Profile I); neovascular glaucoma (Profile II); radiation-induced retinopathy (Profile III); and dry-eye syndrome (Profile IV). For Profile III, retina Mercator maps were generated to visualize the geographical location of dose differences.
UNASSIGNED: In 9/66 cases, (14 %) proton plans were superior for all dose-volume parameters. Higher T stages benefited more from protons in Profile I, especially tumors located within 3 mm or less from the optic nerve. In Profile II, only 9/66 cases resulted in a better proton plan. In Profile III, better retina volume sparing was always achievable with protons, with a larger gain for T3 tumors. In Profile IV, protons always reduced the risk of toxicity with a median RBE-weighted EQD2 reduction of 15.3 Gy.
UNASSIGNED: This study reports the first side-by-side imaging-based planning comparison between protons and SRT for UM patients. Globally, while protons appear almost always better regarding the risk of optic-neuropathy, retinopathy and dry-eye syndrome, for other toxicity like neovascular glaucoma, a plan comparison is warranted. Choice would depend on the prioritization of risks.
UNASSIGNED: For a total of 66 UM patients from a single center, SRT dose distributions were compared to protons using the same planning CT. Fourteen dose-volume parameters were compared in 2-Gy equivalent dose per fraction (EQD2). Four toxicity profiles were evaluated: maculopathy, optic-neuropathy, visual acuity impairment (Profile I); neovascular glaucoma (Profile II); radiation-induced retinopathy (Profile III); and dry-eye syndrome (Profile IV). For Profile III, retina Mercator maps were generated to visualize the geographical location of dose differences.
UNASSIGNED: In 9/66 cases, (14 %) proton plans were superior for all dose-volume parameters. Higher T stages benefited more from protons in Profile I, especially tumors located within 3 mm or less from the optic nerve. In Profile II, only 9/66 cases resulted in a better proton plan. In Profile III, better retina volume sparing was always achievable with protons, with a larger gain for T3 tumors. In Profile IV, protons always reduced the risk of toxicity with a median RBE-weighted EQD2 reduction of 15.3 Gy.
UNASSIGNED: This study reports the first side-by-side imaging-based planning comparison between protons and SRT for UM patients. Globally, while protons appear almost always better regarding the risk of optic-neuropathy, retinopathy and dry-eye syndrome, for other toxicity like neovascular glaucoma, a plan comparison is warranted. Choice would depend on the prioritization of risks.
摘要：
■葡萄膜黑色素瘤（UM）是最常见的原发性眼部恶性肿瘤。我们比较了分次立体定向放射治疗（SRT）与质子治疗，包括UM患者的毒性风险。
■对于来自单个中心的66名UM患者，使用相同的计划CT将SRT剂量分布与质子进行比较。以每分2-Gy当量剂量(EQD2)比较14个剂量-体积参数。评估了四种毒性特征：黄斑病变，视神经病变,视力损害（概况I）;新生血管性青光眼（概况II）;辐射诱发的视网膜病变（概况III）;和干眼综合征（概况IV）。对于剖面III，生成视网膜墨卡托图以可视化剂量差异的地理位置。
■在9/66例中，（14％）质子计划对于所有剂量体积参数均优于。更高的T阶段受益于剖面I中的质子，尤其是距视神经3mm以内的肿瘤。在简介II中，只有9/66例导致了更好的质子计划。在简介III中，更好的视网膜体积节省总是可以用质子实现的，T3肿瘤的增益更大。在剖面IV中，质子总是降低毒性风险,RBE加权EQD2的中位数降低15.3Gy.
■这项研究报告了UM患者的质子和SRT之间的首次基于并排成像的计划比较。全球范围内,虽然质子在视神经病变的风险方面似乎总是更好，视网膜病变和干眼综合征,其他毒性，如新生血管性青光眼，有必要进行计划比较。选择将取决于风险的优先次序。
■对于来自单个中心的66名UM患者，使用相同的计划CT将SRT剂量分布与质子进行比较。以每分2-Gy当量剂量(EQD2)比较14个剂量-体积参数。评估了四种毒性特征：黄斑病变，视神经病变,视力损害（概况I）;新生血管性青光眼（概况II）;辐射诱发的视网膜病变（概况III）;和干眼综合征（概况IV）。对于剖面III，生成视网膜墨卡托图以可视化剂量差异的地理位置。
■在9/66例中，（14％）质子计划对于所有剂量体积参数均优于。更高的T阶段受益于剖面I中的质子，尤其是距视神经3mm以内的肿瘤。在简介II中，只有9/66例导致了更好的质子计划。在简介III中，更好的视网膜体积节省总是可以用质子实现的，T3肿瘤的增益更大。在剖面IV中，质子总是降低毒性风险,RBE加权EQD2的中位数降低15.3Gy.
■这项研究报告了UM患者的质子和SRT之间的首次基于并排成像的计划比较。全球范围内,虽然质子在视神经病变的风险方面似乎总是更好，视网膜病变和干眼综合征,其他毒性，如新生血管性青光眼，有必要进行计划比较。选择将取决于风险的优先次序。
