Hodgkin lenfoma tanılı hastalarda farklı alan ışınlamalarında 3 boyutlu konformal radyoterapi (3b-krt), tomoterapi ve volumetrik ayarlı ark terapi (vmat) planlama tekniklerinin dozimetrik karşılaştırılması
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Date
2017-10-12
Authors
Erdoğan, Pınar
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada, radyoterapi almış Hodgkin Lenfoma tanılı 19 hastanın 3B-KRT, HT ve VMAT tekniklerinde IFRT ve INRT alanlarına 20 Gy ile 30 Gy radyasyon dozu verildiğinde, hedef hacimlerin ve riskli organların almış olduğu dozların dozimetrik olarak incelenmesi amaçlanmıştır. Uludağ Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda tedavi edilmiş hastaların arşiv materyali, planlama sisteminden retrospektif olarak temin edilmiştir. IFRT ve INRT alanları için PTV'ler oluşturulmuş ve bu PTV'lere 30Gy ile 20Gy olmak üzere iki farklı doz tanımlanmıştır. Tedavi planlamalarında 3B-KRT için, tedavi planlama sistemi olarak CMS XIO TPS ve algoritma olarak Convolution; HT için, TPS olarak Tomoterapi Hi-Art TPS ve algoritma olarak Convolution/Superposition; VMAT için, TPS olarak Monaco 5.1 TPS ve algoritma olarak Monte Carlo kullanılmıştır. Sanal planlar, PTV'ler ve riskli organlar ( kalp, akciğer, meme, karotis arter ve spinal kord) için doz dağılımları ve DVH kullanılarak karşılaştırılmıştır. İstatiksel analiz için SPPS 22 programında Kruskal-Wallis ve One-Way ANOVA testleri kullanılmıştır. 3B-KRT tekniğinde tüm hastalarda AP-PA alan, boyun tutulumu olan hastalarda da ek olarak karşılıklı lateral alanlar kullanılmıştır. HT için FW 2.5 cm, MF 2.5 ve PF 0.287 olarak belirlenmiştir. VMAT planlarında aksilla tutulumu olan hastalarda tam ark, aksilla tutulumu olmayanlarda B-VMAT tercih edilmiştir. Yapılan çalışma sonucunda IFRT'den INRT'ye geçmek riskli organların aldığı radyasyon dozu miktarını önemli ölçüde azaltmıştır. Aynı şekilde hedef hacme tanımlanan dozda düşüş olduğunda yüksek dozlara benzer sonuçlar vermiş, riskli organların aldığı dozlarda düşüşler elde edilmiştir. HT ve VMAT tekniklerinde daha homojen ve konformal doz dağılımları elde edilmiştir. 3B-KRT tekniğinde düşük doz saçılmalarında en iyi değerler elde edilmiştir
In this study, we aimed to examine doses of target volumes and doses of risky organs when doses of 20 Gy to 30 Gy of radiation were given to IFRT and INRT fields in 3D-CRT, tomotherapy and VMAT techniques of 19 patients with Hodgkin lymphoma who had radiotherapy. The archive material of patients treated in Uludag University Medical Faculty Radiation Oncology Department was retrospectively provided from the planning system. PTVs were created for IFRT and INRT fields and two different doses were defined for these PTVs, 30 Gy to 20 Gy. For treatment planning, CMS XIO TPS as the treatment planning system and Convolution as the algorithm for 3D-CRT; Tomotherapy Hi-Art TPS as TPS and Convolution / Superposition as algorithm for HT; for VMAT, Monaco 5.1 TPS was used as TPS and Monte Carlo was used as the algorithm. Virtual plans were compared using PTVs' and risky organs' (heart, lung, breast, carotis artery and spinal cord) dose distributions and DVH. Kruskal-Wallis and One-Way ANOVA tests were used in the SPSS 22 program for statistical analysis. In 3D-CRT technique, for all patients AP-PA field and also patients with neck involvement, additional lateral fields were used. For HT, FW was set to 2.5 cm, MF 2.5 ve PF 0.287. In VMAT plans, B-VMAT was preferred in patients with axillary involvement and full arc was preferred in patients without axilla involvement. As a result of the study, passing from IFRT to INRT significantly reduced the amount of radiation received by risky organs. Likewise, when the dose defined to target volume decreased, it gave similar results to the higher doses, resulting in reductions in the doses taken by the risky organs. More homogeneous and conformal dose distributions were obtained in HT and VMAT techniques. The best values were obtained in low dose scattering with 3D-CRT technique.
In this study, we aimed to examine doses of target volumes and doses of risky organs when doses of 20 Gy to 30 Gy of radiation were given to IFRT and INRT fields in 3D-CRT, tomotherapy and VMAT techniques of 19 patients with Hodgkin lymphoma who had radiotherapy. The archive material of patients treated in Uludag University Medical Faculty Radiation Oncology Department was retrospectively provided from the planning system. PTVs were created for IFRT and INRT fields and two different doses were defined for these PTVs, 30 Gy to 20 Gy. For treatment planning, CMS XIO TPS as the treatment planning system and Convolution as the algorithm for 3D-CRT; Tomotherapy Hi-Art TPS as TPS and Convolution / Superposition as algorithm for HT; for VMAT, Monaco 5.1 TPS was used as TPS and Monte Carlo was used as the algorithm. Virtual plans were compared using PTVs' and risky organs' (heart, lung, breast, carotis artery and spinal cord) dose distributions and DVH. Kruskal-Wallis and One-Way ANOVA tests were used in the SPSS 22 program for statistical analysis. In 3D-CRT technique, for all patients AP-PA field and also patients with neck involvement, additional lateral fields were used. For HT, FW was set to 2.5 cm, MF 2.5 ve PF 0.287. In VMAT plans, B-VMAT was preferred in patients with axillary involvement and full arc was preferred in patients without axilla involvement. As a result of the study, passing from IFRT to INRT significantly reduced the amount of radiation received by risky organs. Likewise, when the dose defined to target volume decreased, it gave similar results to the higher doses, resulting in reductions in the doses taken by the risky organs. More homogeneous and conformal dose distributions were obtained in HT and VMAT techniques. The best values were obtained in low dose scattering with 3D-CRT technique.
Description
Keywords
Hodgkin lenfoma, Tomoterapi, VMAT, 3B-KRT, Hodgkin lymphoma, Tomotherapy
Citation
Erdoğan, P. (2017). Hodgkin lenfoma tanılı hastalarda farklı alan ışınlamalarında 3 boyutlu konformal radyoterapi (3b-krt), tomoterapi ve volumetrik ayarlı ark terapi (vmat) planlama tekniklerinin dozimetrik karşılaştırılması. Yayınlanmamış yüksek lisans tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.