J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 2-3-, * * Comparative Study Between Respiratory Gated Conventional 2-D Plan and 3-D Conformal Plan for Predicting Radiation Hepatitis Sang-wook Lee, MD, Gwi Eon Kim, MD, Kap Soo Chung, PhD*, Chang Geol Lee, MD, Jinsil Seong MD and Chang Ok Suh, MD Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Department of Radiology *, Seoul Health College, Seoul, Korea Purpose : To evaluate influences associated with radiation treatment planning obtained with the patient breathing freely Material and Methods : We compared reduction or elimination of planning target volume (PTV) margins with 2-D conventional plan with inclusion of PTV margins associated with breathing with 3-D conformal therapy The respiratory non gated 3-D conformal treatment plans were compared with respiratory gated conventional 2-D plans in 4 patients with hepatocellular carcinomas Isodose distribution, dose statistics, and dose volume histogram (DVH) of PTVs were used to evaluate differences between respiratory gated conventional 2-D plans and respiratory non gated 3-D conformal treatment plans In addition, the risk of radiation exposure of surrounding normal liver and organs are evaluated by means of DVH and normal tissue complication probabilities (NTCPs) Results : The vertical movement of liver ranged 2-3 cm in all patients We found no difference between respiratory gated 2-D plans and 3-D conformal treatment plans with the patients breathing freely Treatment planning using DVH analysis of PTV and the normal liver was used for all patients DVH and calculated NTCP showed no difference in respiratory gated 2-D plans and respiratory non gated 3-D conformal treatment plans Conclusion : Respiratory gated radiation therapy was very important in hepatic tumors because radiation induced hepatitis was dependent on remaining normal liver volume Further investigational studies for respiratory gated radiation treatment combined with 3-D conformal treatment are required Key Words : 3-D conformal therapy, Hepatocellular carcinoma
1) 3-18, 19) 3-2, 3), 21),,,, I 131 Lipiodol 3-2-3 cm, 12), 4-8) 9-13) 30 Gy, 35 Gy 22, 23), 10,14) (respiratory gated radiation therapy)3-12, 15-17), 12, 13) 2-, (respiratory gated conventional radiation therapy), 4 (box technique), 3 3- (respiratory non gated 3-D conformal, radiation therapy), 3-,
J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 1 1996 1 2-19965 3-4 7 8 8 cm, 11 cm 5 8, 7 cm 6 7, 3 4 cm 26) 3- (Pinnacle 3, ADAC co, USA) 2, cm 2-3 cm 5-10,, 24) (Fig 1) 55 Gy Liver Boundary 0 border 1 border 2 borders PTV Fig 1 Classification of tumor location in the liver surface 3-, 3- normal tissue complication probability (NTCP) 3 (simulation) (isocenter) 25) 2-3 mm ICRU 50 (planning target volume) 27) setup (Fig 2), (Beam s eye view) 5 (wedge) 3- (pencil beam) (convolution algorithm)
Liver Motion by Breathing PTV Breathing Margins CTV +SE,, 4 NTCP NTCP LymanNTCP 28) (3) (3) n (volume effect) n S- NTCP (1) Fig 2 Planning target volume (PTV) expansions for patient breathing applied to the superior and inferior borders of the clinical target volume (CTV), with already includes PTV margins for setup error (SE) NTCP= { 1} over { SQRT { 2 pi } } INT _{ t}^{ -INF } t CDOT exp (- { t}^{2 }/2)dt (1) v= { V} /{ { V}_{ref } } (2) TD (v)= { TD (1)} CDOT { { v}^{-n} } (3) t= { (D- { TD}_{50 } (v)) }/{ (m CDOT { TD}_{50 } (v)) } (4) S- (biological index) TD (1), TD (v) 2 (v) (clinical target volume, CTV) TD 50 (1) setup 5 50% TD 50 (v) 3 v 50% (2) v, Vref diffuse disease power law n 12)
J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 (fitted) { v}_{ eff} = DELTA { v}_{max }+ DELTA { v}_{1 } { (D_1}/ D_max) }^{1/n }+DELTA { v}_{2 } { (D_2/ D_ max ) }^{1/n } + TD 50 (v) (4) V_eff SUM left{v_i (D_i / D_ref )^1/n right}(6) t (4)m (5) (6) - S- TD 50 29) (2) v v (3) n, m, TD 50 (1) TD 50 (v) TD 50 (v), v, m (4) (4) t vd t (1)t NTCP v D 17) TD 50 (1)Emami 40Gy m Burman 33) 015 n Lawrence, 069 NTCP NTCP 30) Linear interpolation 31, Effective volume 32) NTCP Effective volume 31) 2- Effective volume x (D ref) (D max) y V eff Veff 1 15) D ref V eff 1 vi Di power law D max veff (5) 31) 12) n 2-3- 3-3- 5 1 (coplanar),,,,
J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998, 1 (Volumetric Analysis) 2 (PTV: planning terget volume) (Fig 3) 301cc 2-100% 95%, 301cc 3% (Table 1) 2 2-3- (Fig 4) 1 2 3 4 2-1 3 3 200 cgy 4 2-1712 cgy 3-1835 cgy 3-2- 3-
J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 123 cgy 5% 95% (D 95)1725 cgy1975 cgy 3-, (D 05)
95% (Table 3), (Fig 5) 1 2-95% (Table 2) 3, 2 4 2-3 3-2-,
J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 NTCP (Table 4) 1 3-2 4 2-3 3-2- Fig 6 30% 1 3 2-30-35 Gy () 9-11), 12, 13, 15, 16, 34) 29) 10, 14) 16, 27)
2-3cm, 12% NTCP 15% 35) 22, 23) 36) 3-,, 19, 25) 2-3cm,, setup 37) 3-3- Michigan 2-3cm 12) 3-3-, 38) 20) 3-, 2-3- 4- (box) 25) 2-3- () 3% 2- NTCP 3-3- 18) NTCP,
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J Korean Soc Ther Radiol Oncol : Vol 16, No 4, December, 1998 = = *,