Značaj simulacije četvorodimenzionalnom kompjuterizovanom tomografijom u radioterapiji lokalno uznapredovalog karcinoma pluća: uticaj na smanjenje planiranog ciljnog volumena

  • Slavica Marić International Medical Centers Banja Luka – Affidea (IMC/Affidea), Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Petar Janjić International Medical Centers Banja Luka – Affidea (IMC/Affidea), Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Borut Bosančić University of Banja Luka, Faculty of Agriculture, Department of Biometrics, Institute of Genetic Resources, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Milan Mijailović University of Kragujevac, Faculty of Medical Sciences, Department of Radiology, Kragujevac, Serbia
  • Snežana Lukić University of Kragujevac, Faculty of Medical Sciences, Department of Radiology, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP210520096M
Ključne reči: adenokarcinom;, karcinom, planocelularni;, tomografija, kompjuterizovana, četvorodimenzionalna;, pluća, neoplazme;, radioterapija.

Sažetak


 

Uvod/Cilj. Simulacija putem četvorodimenzionalne kompjuterizovane tomografije (4D KT) je važan segment savremene radioterapije karcinoma pluća. Konvencionalna trodimenzionalna (3D) simulacija uz slobodno disanje (free-breathing – FB) je statična sa limitiranim informacijama o respiratornim pokretima koji mogu produkovati nepreciznosti u procesu delineacije i planiranju radioterapije. Cilj ove studije bio je da se uradi poređenje ciljnih volumena definisanih na 3D KT simulaciji vs. 4D KT simulaciji i uticaja na planirani ciljni volumen (PCV), imajući u vidu da je


smanjeni PCV uz preciznu pokrivenost primarnog tumora od izuzetne važnosti. Urađena je kvantifikacija pokreta primarnog tumora (gross tumor volume – GTV) tokom 4D KT simulacije duž tri ose: Z-superoinferiornu (SI), X-mediolateralnu (ML), Y-anteroposteriornu (AP). Metode. U ovoj retrospektivnoj studiji evaluirano je 20 pacijenata sa dijagnozom lokalno uznapredovalog karcinoma pluća i indikacijom za radikalnu radioterapiju. Prema institucionalnom protokolu uradjena je 3D KT i 4D KT simulacija FB za svakog pacijenta. Zatim je urađeno volumetrijsko poređenje volumena definisanih putem 3D KT vs. 4D KT: GTV 3D vs. unutrašnji GTV (UGTV) 4D i PCV 3D vs. unutrašnji PCV (UPCV) 4D. Poređenje pomeranja GTV u fazi FB (GTV FB), fazi 0 (GTV 0), fazi 50 (GTV 50) i fazi projekcije maksimalnog intenziteta, maximum intensity projection (GTV MIP) urađeno je tako da je GTV FB uzet kao bazična vrednost. Evaluacija je urađena za sve tri ose. Rezultati. Izmerene vrednosti volumena GTV 3D vs. UGTV 4D bile su 63,15 cm3 vs. 85,51 cm3 (p < 0,001). UGTV 4D je bio značajno veći u odnosu na GTV 3D (p < 0,001). Srednja vrednost ekvivalentnog sfernog dijametra (ESD) za PCV 3D vs. UPCV 4D bila je 8,44 cm vs. 7,82 cm (p < 0,001), srednja vrednost volumena PCV 3D vs. UPCV 4D bila je 352,70 cm3 vs. 272,78 cm3 (p < 0,001). PCV 3D je bio značajno veći u poređenju UPCV 4D (p < 0,001). Utvrđena je i statistički značajna razlika (p < 0,05) u odstupanju GTV u odnosu na Z osovinu između gornjeg i donjeg lobusa. Zaključak. Delineacija bazirana na 4D KT simulaciji daje mogućnost redukcije PCV u poređenju sa 3D simulacijom i čini važan preduslov za visoko kvalitetan i precizan radioterapijski tretman.

Biografija autora

Slavica Marić, International Medical Centers Banja Luka – Affidea (IMC/Affidea), Banja Luka, Republic of Srpska, Bosnia and Herzegovina

radioterapija, radijacioni onkolog

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Objavljeno
2023/01/04
Broj časopisa
Vol. 79 Br. 12 (2022): Vojnosanitetski pregled
Rubrika
Originalni članak