Baş boyun kanserli hastaların tedavisinde adaptif radyoterapinin dozimetrik olarak değerlendirilmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Amaç: Radyoterapi tedavileri süresince tümördeki küçülmenin yanı sıra kilo değişimine maruz kalan nazofarenks ve larenks kanseri tanılı hastalara farklı zaman dilimlerinde uygulanan adaptif radyoterapi (ART) tedavilerinin hangi zaman diliminde ve kaç kere uygulanması gerektiğinin araştırılması. Yöntem: Radyoterapi tedavileri süresince tümördeki küçülmenin yanı sıra kilo değişimine maruz kalan 30 baş-boyun kanserli hastaya (18'i nazofarenks ca, 12'si larenks ca) ilk tedavi BT taramasından sonra, 10., 15., 20. ve 25. tedavi günlerinde ART planlaması uygulanmıştır. İlk tedavi planı doz dağılımı referans alınarak 4 ayrı ART planlaması için 16 farklı ART plan senaryosuna ait ağırlıklı kümülatif toplam doz dağılımı hesaplanmıştır. Her bir ART plan senaryosu ile ilk plan istatistiksel sonuçlar eşliğinde boxplot ile dozimetrik olarak değerlendirilmiştir. Bulgular: Kilo değişimlerinde tüm tedavi süresince yaklaşık olarak ortalama %10'a yakın bir düşüş saptanmıştır. Her iki hasta grubu için incelenen her üç hedef yapıda da adaptif plan sayısının azalmasına bağlı olarak PTV Coverage ve PTV C.I. için azalış, PTV H.I. için ise artış görülmüştür. İncelenen her iki hasta grubu için kritik organ grafiklerinde spinal kord haricindeki kritik organlarının hiçbiri için adaptif plan senaryolarında plan kabul kriterlerinin dışında bir değer görülmemiştir. Sonuç: Çalışma sonucunda kilo değişimi yaşayan hastalarda hem hedef yapılar hem de kritik organlar için 10. tedavi günü ile 25. tedavi günleri aralığında en az 2 adaptif radyoterapi yapılması önerilebilir. Ancak değerlendirme grafiklerinden de anlaşılacağı üzere her bir hasta kendi içerisinde uç değişimler gösterebilmektedir. Bu nedenle her hafta kilo kontrolü eşliğinde (Cone Beam Computed Tomography) CBCT görüntüleri incelenerek ciddi değişim saptanması durumunda adaptif plan sayısı artırılabilir. Bu çalışma sonuçları tedavisi sırasında kuşku duyduğumuz değerlendirme kriterleri için bir rehber niteliğindedir.
Objective: To investigate in which time period and how many times adaptive radiotherapy (ART) treatments should be applied in different time periods to patients with head and neck cancer diagnosed with nasopharynx and larynx who are exposed to weight change during radiotherapy treatments. Method: ART was used in 30 head and neck cancer patients (18 with nasopharynx diagnosis, 12 with larynx diagnosis) who were exposed to weight changes during radiotherapy on days on the 10th, 15th, 20th, and 25th treatment days, after the first treatment CT scan. Taking the initial treatment plan dose distribution as a reference, the weighted cumulative total dose distribution of 16 different ART plan scenarios was calculated for 4 separate ART treatments. Each ART plan scenario and the first plan were evaluated dosimetrically with a boxplot accompanied by statistical results. Results: An average decrease of approximately 10% was detected in weight changes throughout the entire treatment period. In all three target structures examined for both patient groups, a decrease was observed for PTV Coverage and PTV C.I. and an increase for PTV H.I. due to the decrease in the number of adaptive plans. In the critical organ graphs for both patient groups studied, no value outside the plan acceptance criteria was observed in the adaptive plan scenarios for any of the critical organs except the spinal cord. Conclusion: As a result of the study, it can be recommended to perform at least 2 adaptive radiotherapy sessions between the 10th and 25th treatment days for both target structures and critical organs in patients experiencing weight change. However, as can be seen from the evaluation graphs, each patient may show extreme changes within themselves. For this reason, (Cone Beam Computed Tomography) CBCT images can be examined every week with weight control and the number of adaptive plans can be increased if serious changes are detected.The results of this study serve as a guide for the evaluation criteria that we have doubts about during treatment.
Objective: To investigate in which time period and how many times adaptive radiotherapy (ART) treatments should be applied in different time periods to patients with head and neck cancer diagnosed with nasopharynx and larynx who are exposed to weight change during radiotherapy treatments. Method: ART was used in 30 head and neck cancer patients (18 with nasopharynx diagnosis, 12 with larynx diagnosis) who were exposed to weight changes during radiotherapy on days on the 10th, 15th, 20th, and 25th treatment days, after the first treatment CT scan. Taking the initial treatment plan dose distribution as a reference, the weighted cumulative total dose distribution of 16 different ART plan scenarios was calculated for 4 separate ART treatments. Each ART plan scenario and the first plan were evaluated dosimetrically with a boxplot accompanied by statistical results. Results: An average decrease of approximately 10% was detected in weight changes throughout the entire treatment period. In all three target structures examined for both patient groups, a decrease was observed for PTV Coverage and PTV C.I. and an increase for PTV H.I. due to the decrease in the number of adaptive plans. In the critical organ graphs for both patient groups studied, no value outside the plan acceptance criteria was observed in the adaptive plan scenarios for any of the critical organs except the spinal cord. Conclusion: As a result of the study, it can be recommended to perform at least 2 adaptive radiotherapy sessions between the 10th and 25th treatment days for both target structures and critical organs in patients experiencing weight change. However, as can be seen from the evaluation graphs, each patient may show extreme changes within themselves. For this reason, (Cone Beam Computed Tomography) CBCT images can be examined every week with weight control and the number of adaptive plans can be increased if serious changes are detected.The results of this study serve as a guide for the evaluation criteria that we have doubts about during treatment.
Açıklama
25.12.2024 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır.
Anahtar Kelimeler
Fizik ve Fizik Mühendisliği, Physics and Physics Engineering, Radyasyon Onkolojisi
