Дозиметрическая оценка различных методик сочетанной лучевой терапии больных раком шейки матки

Abstract

Purpose: Carrying out dosimetric investigation of possibility to replace a traditional combined radiation therapy of cervical cancer by combinations only external irradiation, without change of total course dose and number of fractions. Material and Methods: Eleven patients with a diagnosis of cervical cancer (stages T2bNxM0 and T3NxM0) who received a course of combined radiotherapy (CRT) have been considered in this study. The combination of dose delivery techniques 3D-CRT + high dose rate brachytherapy (HDR) was used as a basic one. The following fractionation regimes for CRT were simulated: external beam RT (EBRT) of the first stage – total dose 50 Gy and fraction dose 2 Gy (25 fractions), the second stage – total dose 28 Gy and fraction dose 7 Gy (4 fractions). Total CRT course dose was 89.7 Gy EQD2. Dosimetric planning of EBRT using conventional radiography and 3D-CRT has been carried out using XIO dosimetry planning system. Dosimetric planning of first-stage EBRT and second-stage EBRT using the VMAT technique has been performed in the Monaco dosimetry planning system. HDR of the second stage has been planned using the HDRplus dosimetric planning system for the Multisource HDR unit with a 60Co source. Results: Coverage of the clinical volume of the tumor using HDR, on average, was equal to 95 % of the prescribed dose at 91.8 % of the volume, 110 % of the dose – 75.7 % of the volume. 60Co + VMAT results in the coverage level 95 % of the dose at 97.1 % of the volume and 110 % of the dose at 2.1 % of the volume. 3D-CRT + VMAT provide the coverage level of 95 % of the dose at 98 % of the volume and 110 % of the dose at 2.6 % of the volume. Using the combination VMAT + VMAT allows achieving the average coverage of the target at the level of 98 % of the dose at 97 % of the volume, 110 % of the dose at 8.8 % of the volume. The maximum dose per volume of the organs at risk equal to 2 cm3 did not exceed their tolerant levels both for the bladder and for the rectum. Conclusion: At present, there is a technical possibility to replace the second stage of CRT cervical cancer by EBRT using the VMAT technique. Implementation of the VMAT technique allows to increase the uniformity of irradiated volume coverage comparing with traditional HDR. While using VMAT technique the tolerant levels of organs at risk are not exceeded.