论文标题

碳离子疗法的范围减小:使用放射性离子束的潜在优势

Range margin reduction in carbon ion therapy: potential benefits of using radioactive ion beams

论文作者

Sokol, Olga, Cella, Laura, Boscolo, Daria, Horst, Felix, Oliviero, Caterina, Pacelli, Roberto, Palma, Giuseppe, De Simoni, Micol, Conson, Manuel, Caroprese, Mara, Weber, Ulrich, Graeff, Christian, Parodi, Katia, Durante, Marco

论文摘要

尤其是重离子的放射疗法,特别是12C梁,是癌症治疗中最先进的形式之一。但是,尖锐的剂量梯度和在目标区域中的高生物学有效性使它们成为治疗深处和放射耐药性肿瘤的理想工具,但同时对范围预测的小误差敏感。将安全边缘添加到肿瘤体积中,以减轻这些不确定性并确保其均匀的覆盖范围,但是在照射期间,它们会导致对周围健康组织的不可避免的损害。为了充分利用尖锐的布拉格峰的好处,为建立所谓图像引导的放射疗法的精确范围验证方法做出了巨大的努力。尽管正电子发射断层扫描在12C离子治疗中广泛用于此目的,但低计数率,生物冲洗率和活性分布的广泛形状仍将其精度限制在几毫米上。取而代之的是,直接用于治疗的放射性光束将产生改善的信号,并与剂量下降更紧密匹配,并有可能在体内光束范围监测中精确。我们已经进行了一项治疗计划研究,以估算放射性11C梁处理能够减少范围不确定性对肿瘤接近临界器官的可能影响。我们证明,(i)11C离子的灭灭图原则上可以反映患者剂量分布的毫米变化,(ii)(ii)与11C梁的治疗计划的结果在满足风险的限制的限制方面显着改善,与12C计划相比,与串行范围更少的严重毒性相比,(III)的限制可能会降低,并且(III)的差异较小。治疗。

Radiotherapy with heavy ions, in particular, 12C beams, is one of the most advanced forms of cancer treatment. Sharp dose gradients and high biological effectiveness in the target region make them an ideal tool to treat deep-seated and radioresistant tumors, however, at the same time, sensitive to small errors in the range prediction. Safety margins are added to the tumor volume to mitigate these uncertainties and ensure its uniform coverage, but during the irradiation they lead to unavoidable damage to the surrounding healthy tissue. To fully exploit the benefits of a sharp Bragg peak, a large effort is put into establishing precise range verification methods for the so-called image-guided radiotherapy. Despite positron emission tomography being widely in use for this purpose in 12C ion therapy, the low count rates, biological washout, and broad shape of the activity distribution still limit its precision to a few millimeters. Instead, radioactive beams used directly for treatment would yield an improved signal and a closer match with the dose fall-off, potentially enabling precise in vivo beam range monitoring. We have performed a treatment planning study to estimate the possible impact of the reduced range uncertainties, enabled by radioactive 11C beams treatments, on sparing critical organs in the tumor proximity. We demonstrate that (i) annihilation maps for 11C ions can in principle reflect even millimeter shifts in dose distributions in the patient, (ii) outcomes of treatment planning with 11C beams are significantly improved in terms of meeting the constraints for the organs at risk compared to 12C plans, and (iii) less severe toxicities for serial and parallel critical organs can be expected following 11C treatment with reduced range uncertainties, compared to 12C treatments.

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