目的:这项研究的目的是评估多标准优化是否可以限制放射治疗计划中的操作者之间的差异,并评估该方法是否可以有助于目标体积覆盖和减少头颈部癌症的强度调节根治性放射治疗的风险器官。
方法:我们对20例口咽或口腔鳞状细胞癌患者进行了回顾性分析。我们对使用Precision®软件制作的手动计划进行了比较剂量学研究,与使用多准则优化方法(RayStation®)提出的计划进行比较。我们评估了前六名患者的操作员间可重复性,以及使用多标准优化方法节省处于危险中的器官的剂量学贡献。
结果:年龄中位数为69岁,大多数病变是口咽癌(65%),35%的病变为T3期。首先,我们获得了每个患者在每个器官水平的四次操作员测量结果之间的高度相似性.组内相关系数大于0.85。第二,我们观察到对侧腮腺有显著的剂量学益处,同侧和对侧咬肌,同侧和对侧翼状肌以及喉部(P<0.05)。对于对侧腮腺,多标准优化和手动计划之间的平均剂量差为-2.0Gy(P=0.01)。关于喉部,两种方案的平均剂量差为-4.6Gy(P<0.001)。
结论:多标准优化是一种可重复的技术,比手动优化更快。它允许有危险器官的剂量学优势,特别是对于那些通常不考虑手动剂量测定。这可能导致生活质量的提高。
OBJECTIVE: The purpose of this study was to assess if multicriteria optimization could limit interoperator variability in radiation therapy planning and assess if this method could contribute to target volume coverage and sparing of organ at risk for intensity-modulated curative radiation therapy of head and neck cancers.
METHODS: We performed a retrospective analysis on 20 patients treated for an oropharyngeal or oral cavity squamous cell carcinoma. We carried out a comparative dosimetric study of manual plans produced with Precision® software, compared with the plans proposed using the multicriteria optimization method (RayStation®). We assessed interoperator reproducibility on the first six patients, and dosimetric contribution in sparing organs at risk using the multicriteria optimization method.
RESULTS: Median age was 69 years, most lesions were oropharyngeal carcinoma (65%), and 35% lesions were stage T3. First, we obtained a high degree of similarity between the four operator measurements for each patient at the level of each organ. Intraclass correlation coefficients were greater than 0.85. Second, we observed a significant dosimetric benefit for contralateral parotid gland, homolateral and contralateral masseter muscles, homolateral and contralateral pterygoid muscles and for the larynx (P<0.05). For the contralateral parotid gland, the mean dose difference between the multicriteria optimization and manual plans was -2.0Gy (P=0.01). Regarding the larynx, the mean dose difference between the two plans was -4.6Gy (P<0.001).
CONCLUSIONS: Multicriteria optimization is a reproducible technique and faster than manual optimization. It allows dosimetric advantages on organs at risk, especially for those not usually taken into consideration in manual dosimetry. This may lead to improved quality of life.