文章：

评估肠道气体变化对儿童质子治疗中Wilms瘤的影响

Evaluating the Impact of Bowel Gas Variations for Wilms’ Tumor in Pediatric Proton Therapy

原文发布日期：2 February 2024

DOI: 10.3390/cancers16030642

类型: Article

开放获取: 是

英文摘要：

(1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms’ tumor patients. (2) Methods: Thirteen patients with Wilms’ tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient’s right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms’ tumor.

摘要翻译： 

(1) 背景：质子治疗作为一种精确的放射治疗方式，其疗效易受肠道内容物变化的影响。本研究旨在确定能够最大限度减少治疗计划质量偏差的最优机架角度，从而提升Wilms瘤患者质子治疗的安全性与有效性。(2) 方法：纳入SJWT21临床试验的13例Wilms瘤患者接受质子治疗。通过每日锥形束计算机断层扫描（CBCT）系统监测肠道气体变化，分析每日CBCT图像中识别的气腔结构，构建每日验证计划并测量水等效路径长度（WEPL）变化。通过最差情境模拟确定最安全的束流角度。(3) 结果：研究发现靶区剂量最大降幅（ΔD100%）达8.0%，对应WEPL变化（ΔWEPL）为11.3 mm。靶区剂量平均降幅（mean ΔD100%）为2.8%（标准差3.2%），平均ΔWEPL为3.3 mm（标准差2.7 mm）。最差情境分析表明，110°至310°范围内朝向患者右后方照射的机架束流角度可最小化WEPL差异。(4) 结论：本研究系统评估了儿童Wilms瘤质子治疗中肠道气体变异对治疗计划精度及质子射程不确定性的影响。

原文链接：

Evaluating the Impact of Bowel Gas Variations for Wilms’ Tumor in Pediatric Proton Therapy