Lokal ileri evre serviks kanserlerinde yoğunluk ayarlı radyoterapi ve volumetrik ayarlı ark tedavinin dozimetrik karşılaştırılması

Berna Nalbant; Fatma Sert; Emin Tavlayan; Nezahat Olacak; Zeynep Özsaran

doi:10.19161/etd.414954

TR EN

Lokal ileri evre serviks kanserlerinde yoğunluk ayarlı radyoterapi ve volumetrik ayarlı ark tedavinin dozimetrik karşılaştırılması

Öz

Amaç: Radyokemoterapi lokal ileri evre serviks kanserinin tedavisinde standart yaklaşımdır. Amacımız, serviks kanseri tedavisinde modern tekniklerden yoğunluk ayarlı radyoterapi (YART) ve volumetrik ark terapi (VMAT) tekniklerini dozimetrik olarak karşılaştırmaktır.

Gereç ve Yöntem: Kliniğimizde tedavi edilmiş 10 lokal ileri evre serviks kanseri hastasının bilgisayarlı tomografi (BT)’leri kullanılmıştır. Hastalarda gross tümör hacmi (GTV), klinik tümör hacmi (CTVtm) ve lenf nodları (CTV lenf nodu) ve komşu risk altındaki organları konturlanmıştır. CTVtm ve CTV lenf nodlarına 1.5 cm sınır verilerek tedavi hacimleri oluşturulmuştur. Total doz 50.4 Gy olacak şekilde günlük 1.8 Gy fraksiyon dozu ile tedavi planlamaları yapılmıştır. İki teknik, Doz volüm histogramı, homojenite indeks (HI), konformite indeks (KI), monitör ünit (MU), segment sayısı değerlendirmeleri yapılmıştır.

Bulgular: İnce bağırsak için, 40 Gy doz alan hacim yüzdeliğinin YART tekniğinde medyan değeri %14.24 iken, VMAT tekniğinde %11.28 olarak hesaplanmıştır (p=0.022). VMAT tekniğinde %12.39 olarak hesaplanan femur başları 30 Gy doz alan hacim değerleri, YART tekniğinde ortanca değeri %7.80 olarak bulunmuştur (p=0.007). VMAT tekniği istatistiksel anlamlı seviye kısa sürede tamamlanırken, fraksiyon başına MU değeri anlamlı olarak fazla bulunmuştur. Her iki tedavi tekniğinin de HI ve KI değerleri açısından aralarında farklılık gösterilememiştir. Sonuç: Hasta konforuna ve cihaz performansına açısından VMAT tekniğinde kısa tedavi süresi avantaj olarak görülmektedir. Kliniğimizin mevcut cihaz durumuna göre her iki tedavi modeli de kullanılabilir

Anahtar Kelimeler

Radyoterapi,YART,serviks kanseri,VMAT,delta-4 fantom.

The dosimetric comparison of ıntensity modulated radiotherapy and volumetric arc therapy in locally advanced uterine cervix cancer

Abstract

Aim: The standard treatment approach for locally advanced stage uterine cervix cancer is radio-chemotherapy. New radiotherapy techniques provide appropriate dose distributions with maximum tumor dose and minimum organ at risk doses. We aim to compare intensity modulated radiotherapy (IMRT) and volumetric arc therapy techniques in the cervix cancer treatment.

Materials and Methods: Ten computed tomographies (CT) of treated patients were used. Gross tumor volume (GTV), clinical tumor volume (CTV) both for tumor and lymph nodes and organ at risks were contoured. Treatment volumes were created by adding 1.5 cm margins to CTV tumor and lymph nodes. Totally 50.4 Gy doses with 1.8 Gy daily fraction were applied. Two techniques were compared in terms of dose volume histograms, homogenity index (HI), conformity Index (CI), monitory unit (MU) and segment numbers.

Results: For intestines, V40 Gy were 14.24% and 11.28% with IMRT and VMAT, respectively (p=0.022). For femoral heads, V30 Gy were 7.8% and 12.39% with IMRT and VMAT, respectively (p=0.007). The duration time of treatment was significantly short but MU value for each fraction was significantly high with VMAT technique. On the other hand, there could not find any difference in terms of HI and CI between two techniques.

Conclusion: The shortness of treatment duration can be seen as an advantage in terms of both patient comfort and machine performance in VMAT technique. IMRT and VMAT can be preferred for the treatment of locally advanced cervix cancer by taking into the conditions of our department.

Keywords

Radiotherapy,IMRT,cervical cancer,VMAT,delta-4 phantom.

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Details

Primary Language

Turkish

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Berna Nalbant
0000-0003-0446-9597
Türkiye

Fatma Sert ^*
0000-0001-6052-8614
Türkiye

Emin Tavlayan
0000-0003-0177-1571
Türkiye

Nezahat Olacak
0000-0002-0700-0420
Türkiye

Zeynep Özsaran
0000-0003-4362-3542
Türkiye

Publication Date

June 1, 2018

Submission Date

February 23, 2017

Acceptance Date

May 15, 2017

Published in Issue

Year 2018 Volume: 57 Number: 2

DOI

https://doi.org/10.19161/etd.414954

IZ

https://izlik.org/JA69HE26NX

Cite

RIS / Bibtex

Vancouver

1.Berna Nalbant, Fatma Sert, Emin Tavlayan, Nezahat Olacak, Zeynep Özsaran. Lokal ileri evre serviks kanserlerinde yoğunluk ayarlı radyoterapi ve volumetrik ayarlı ark tedavinin dozimetrik karşılaştırılması. EJM. 2018 Jun. 1;57(2):82-7. doi:10.19161/etd.414954