Progress in Medical Physics (한국의학물리학회지:의학물리)

Korean Society of Medical Physics (한국의학물리학회)
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Comparison of Dose Distribution in Spine Radiosurgery Plans: Simultaneously Integrated Boost and RTOG 0631 Protocol

척추뼈전이암 환자의 체부정위방사선치료계획 비교: 동시통합추가치료법 대 RTOG 0631 프로토콜

  • Park, Su Yeon (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Dongryul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hee Chul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jin Sung (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jong Sik (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin, Eun Hyuk (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hye Young (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Sang Hoon (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Youngyih (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 박수연 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 오동렬 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 박희철 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 김진성 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 김종식 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 신은혁 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 김혜영 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 정상훈 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 한영이 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실)
  • Received : 2014.08.18
  • Accepted : 2014.09.18
  • Published : 2014.09.30
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Abstract

In this study, we compared dose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans were performed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord and other normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.

척추뼈전이암 환자를 대상으로 본원의 동시통합추가치료법(SIB)과 RTOG 0631 프로토콜에 따른 체부정위방사선치료계획을 세우고, 선량분포를 비교하였다. 간암 원발인 척추 뼈 전이암 환자 5명을 대상으로 전산화단층촬영 영상과 자기공명영상(T1, T2)를 바탕으로 영상융합을 시행하였다. 본원에서 시행하는 SIB방법은 영상에서 보이는 종양을 GTV로 설정하고, GTV를 포함한 전체 척추체부(entire vertebral body, VB)를 CTV1로 정의하였고 GTV에 18 Gy CTV1에 10 Gy를 1회 처방하였다. RTOG 0631 프로토콜 방법은 GTV의 침윤 정도에 따라 주변부의 추근, 좌우 횡돌기 및 극돌기 등을 선택적으로 포함하여 CTV2로 정의하였고 18 Gy 1회 처방하여 체부정위방사선치료계획을 시행하였다. 선량체적화 결과값을 선량-체적 히스토그램을 통해 분석한 결과, 두 방법 모두 표적에 대하여 처방 선량을 만족하였으며, 척수 및 정상 장기에 대하여는 SIB방법이 RTOG 0631프로토콜보다는 낮은 값을 보였다. 또한, 전체 VB의 조사선량분포를 정량화한 결과, RTOG 0631프로토콜에서도 SIB방법과 동일한 처방선량 허용치 85%이상을 포함하는 것으로 나타났다. 하지만 정상 장기에 대한 선량은 RTOG 0631 프로토콜에 따른 치료 방법이 높은 편이었다. 주변부 장기의 부작용이 우려되는 임상적 상황의 경우 조사 체적이 적은 SIB방법이 좋은 선택이 될 수 있을 것이다. 결론적으로 SIB방법이나 RTOG 0631 프로토콜에 따른 표적체적 설정을 통한 체부정위방사선치료계획 모두 유사한 결과를 보였으며, 향후 다양한 연구를 통해 종양제어확률 및 부작용 확률의 차이를 분석해야 할 것이다.

Keywords

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