容積旋轉調強放射治療技術在頭頸部腫瘤的應用_West China Medical Journal

Authors：

 申芹 ^1,2 ,  陳念永 ¹ , 李光俊 ¹

1. ;
2. ;

Corresponding?author：

陳念永, Email: n_ychen@hotmail.com

Keywords：

容積旋轉調強放射治療; 頭頸部腫瘤; 放射物理學

DOI：

10.7507/1002-0179.201600442

Video：

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容積旋轉調強放射治療（VMAT）技術作為一種新型的放射治療（放療）技術，通過照射過程中機架連續旋轉，連續改變劑量率、機架位置和多葉準直器葉片位置等，實現不同射野方向上的射束強度調整。其最大優勢在于能達到與傳統調強放療技術相似或更好劑量分布的同時，大大提高了治療效率。但作為新興技術，完整的VMAT執行方案還有待開發，現有的臨床數據相當有限。頭頸部腫瘤因其復雜的解剖結構，對放療計劃質量要求甚高，該文旨在對VMAT在頭頸部腫瘤的應用作一綜述，以期為VMAT在頭頸部腫瘤的臨床實施提供循證依據。

Citation： 申芹, 陳念永, 李光俊. 容積旋轉調強放射治療技術在頭頸部腫瘤的應用. West China Medical Journal, 2016, 31(9): 1614-1617. doi: 10.7507/1002-0179.201600442 Copy

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2.	劉平, 胡春宏. 頭頸部惡性腫瘤的同步放化療研究進展[J]. 腫瘤研究與臨床, 2000, 4(4):284-286.
3.	于金明, 邢力剛. 頭頸部腫瘤放射治療研究進展[J]. 耳鼻咽喉-頭頸外科, 2003, 10(2):118-123.
4.	Tham IW, Hee SW, Yeo RM, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the National cancer centre Singapore experience[J]. Int J Radiat Oncol Biol Phys, 2009, 75(5):1481-1486.
5.	Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J]. Int J Radiat Oncol Biol Phys, 2004, 60(5):1440-1450.
6.	Ezzell GA, Galvin JM, Low D, et al. Guidance document on delivery, treatment planning, and clinical implementation of IMRT:report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee[J]. Med Phys, 2003, 30(8):2089-2115.
7.	Hoogeman MS, Nuyttens JJ, Levendag PC, et al. Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging[J]. Int J Radiat Oncol Biol Phys, 2008, 70(2):609-618.
8.	Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers[J]. Int J Radiat Oncol Biol Phys, 2006, 65(1):1-7.
9.	郭蕊, 孫穎, 黃劭敏, 等. 鼻咽癌容積旋轉調強放療與常規靜態調強放療的劑量學對比研究[J]. 中山大學學報:醫學科學版, 2012, 33(6):835-840, 855.
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11.	Takahashi S. Conformation radiotherapy. Rotation techniques as applied to radiography and raditherapy of cancer[J]. Acta Radiol Diagn (Stockh), 1965(Suppl 242):1.
12.	Yu CX, Li XA, Ma L, et al. Clinical implementation of intensity-modulated arc therapy[J]. Int J Radiat Oncol Biol Phys, 2002, 53(2):453-463.
13.	Yu CX, Tang G. Intensity-modulated arc therapy:principles, technologies and clinical implemention[J]. Phys Med Biol, 2011, 56(5):31-54.
14.	Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J]. Med Phys, 2008, 35(1):310-317.
15.	Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy:a review of current literature and clinical use in practice[J]. Br J Radiol, 2011, 84(17):967-996.
16.	Amendola BE, Amendola M, Perez N, et al. Volumetric-modulated arc therapy with RapidArc(^?):An evaluation of treatment delivery efficiency[J]. Rep Pract Oncol Radiother, 2013, 18(6):383-386.
17.	Lee TF, Ting HM, Chao PJ, et al. Dual arc volumetric-modulated arc radiotherapy (VMAT) of nasopharyngeal carcinomas:a simultaneous integrated boost treatment plan comparison with intensity-modulated radiotherapies and single arc VMAT[J]. Clin Oncol (R Coll Radiol), 2012, 24(3):196-207.
18.	Verbakel WF, Cuijpers JP, Hoffmans D, et al. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer:a comparative planning and dosimetric study[J]. Int J Radiat Oncol Biol Phys, 2009, 74(1):252-259.
19.	Vanetti E, Clivio A, Nicolini G, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx:a treatment planning comparison with fixed field IMRT[J]. Radiother Oncol, 2009, 92(1):111-117.
20.	Johnston M, Clifford S, Bromley R, et al. Volumetric-modulated arc therapy in head and neck radiotherapy:a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma[J]. Clin Oncol (R Coll Radiol), 2011, 23(8):503-511.
21.	Holt A, Van Gestel D, Arends MP, et al. Multi-institutional comparison of volumetric modulated arc therapy vs. intensity-modulated radiation therapy for head-and-neck cancer:a planning study[J]. Radiat Oncol, 2013, 8:26.
22.	Orlandi E, Giandini T, Iannacone E, et al. Radiotherapy for unresectable sinonasal cancers:dosimetric comparison of intensity modulated radiation therapy with coplanar and non-coplanar volumetric modulated arc therapy[J]. Radiother Oncol, 2014, 113(2):260-266.
23.	Alvarez-Moret J, Pohl F, Koelbl O, et al. Evaluation of volumetric modulated arc therapy (VMAT) with Oncentra MasterPlan^? for the treatment of head and neck cancer[J]. Radiat Oncol, 2010, 5:110.
24.	Rao M, Yang W, Chen F, et al. Comparison of elekta VMAT with helical tomotherapy and fixed field IMRT:plan quality, delivery efficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
25.	唐正中, 吳愛東, 錢立庭, 等. 鼻咽癌靜態IMRT與VMAT同步加量放療劑量學比較[J]. 安徽醫科大學學報, 2014, 49(8):1164-1167.
26.	吳昊, 韓樹奎, 孫艷, 等. 局部進展期鼻咽癌快速旋轉調強與固定野動態調強放療的劑量學比較[J]. 中華放射腫瘤學雜志, 2010, 19(5):410-413.
27.	徐壽平, 王連元, 戴相昆, 等. 螺旋斷層放療系統原理及其應用[J]. 醫療衛生裝備, 2008, 29(12):100-102.
28.	Lu SH, Cheng JC, Kuo SH, et al. Volumetric modulated arc therapy for nasopharyngeal carcinoma:a dosimetric comparison with TomoTherapy and step-and-shoot IMRT[J]. Radiother Oncol, 2012, 104(3):324-330.
29.	Clemente S, Wu B, Sanguineti G, et al. SmartArc-based volumetric modulated arc therapy for oropharyngeal cancer:a dosimetric comparison with both intensity-modulated radiation therapy and helical tomotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 80(4):1248-1255.
30.	Broggi S, Perna L, Bonsignore F, et al. Static and rotational intensity modulated techniques for head-neck cancer radiotherapy:a planning comparison[J]. Phys Med, 2014, 30(8):973-979.
31.	Bertelsen A, Hansen CR, Johansen J, et al. Single arc volumetric modulated arc therapy of head and neck cancer[J]. Radiother Oncol, 2010, 95(2):142-148.
32.	Guckenberger M, Richter A, Krieger T, et al. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?[J]. Radiother Oncol, 2009, 93(2):259-265.
33.	Ning ZH, Mu JM, Jin JX, et al. Single arc volumetric-modulated arc therapy is sufficient for nasopharyngeal carcinoma:a dosimetric comparison with dual arc VMAT and dynamic MLC and step-and-shoot intensity-modulated radiotherapy[J]. Radiat Oncol, 2013, 8:237.
34.	Qiu JJ, Chang Z, Wu QJ, et al. Impact of volumetric modulated arc therapy technique on treatment with partial breast irradiation[J]. Int J Radiat Oncol Biol Phys, 2010, 78(1):288-296.
35.	Ezzell GA, Burmeister JW, Dogan N, et al. IMRT commissioning:multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119[J]. Med Phys, 2009, 36(11):5359-5373.
36.	Webb S, Mcquaid D. Some considerations concerning volume-modulated arc therapy:a stepping stone towards a general theory[J]. Phys Med Biol, 2009, 54(14):4345-4360.

1. Shah JP, Lydiatt W. Treatment of cancer of the head and neck[J]. CA Cancer J Clin, 1995, 45:352-368.
2. 劉平, 胡春宏. 頭頸部惡性腫瘤的同步放化療研究進展[J]. 腫瘤研究與臨床, 2000, 4(4):284-286.
3. 于金明, 邢力剛. 頭頸部腫瘤放射治療研究進展[J]. 耳鼻咽喉-頭頸外科, 2003, 10(2):118-123.
4. Tham IW, Hee SW, Yeo RM, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the National cancer centre Singapore experience[J]. Int J Radiat Oncol Biol Phys, 2009, 75(5):1481-1486.
5. Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J]. Int J Radiat Oncol Biol Phys, 2004, 60(5):1440-1450.
6. Ezzell GA, Galvin JM, Low D, et al. Guidance document on delivery, treatment planning, and clinical implementation of IMRT:report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee[J]. Med Phys, 2003, 30(8):2089-2115.
7. Hoogeman MS, Nuyttens JJ, Levendag PC, et al. Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging[J]. Int J Radiat Oncol Biol Phys, 2008, 70(2):609-618.
8. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers[J]. Int J Radiat Oncol Biol Phys, 2006, 65(1):1-7.
9. 郭蕊, 孫穎, 黃劭敏, 等. 鼻咽癌容積旋轉調強放療與常規靜態調強放療的劑量學對比研究[J]. 中山大學學報:醫學科學版, 2012, 33(6):835-840, 855.
10. Bzdusek K, Friberger H, Eriksson K, et al. Development and evaluation of an efficient approach to volumetric arc therapy planning[J]. Med Phys, 2009, 36(6):2328-2339.
11. Takahashi S. Conformation radiotherapy. Rotation techniques as applied to radiography and raditherapy of cancer[J]. Acta Radiol Diagn (Stockh), 1965(Suppl 242):1.
12. Yu CX, Li XA, Ma L, et al. Clinical implementation of intensity-modulated arc therapy[J]. Int J Radiat Oncol Biol Phys, 2002, 53(2):453-463.
13. Yu CX, Tang G. Intensity-modulated arc therapy:principles, technologies and clinical implemention[J]. Phys Med Biol, 2011, 56(5):31-54.
14. Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J]. Med Phys, 2008, 35(1):310-317.
15. Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy:a review of current literature and clinical use in practice[J]. Br J Radiol, 2011, 84(17):967-996.
16. Amendola BE, Amendola M, Perez N, et al. Volumetric-modulated arc therapy with RapidArc(^?):An evaluation of treatment delivery efficiency[J]. Rep Pract Oncol Radiother, 2013, 18(6):383-386.
17. Lee TF, Ting HM, Chao PJ, et al. Dual arc volumetric-modulated arc radiotherapy (VMAT) of nasopharyngeal carcinomas:a simultaneous integrated boost treatment plan comparison with intensity-modulated radiotherapies and single arc VMAT[J]. Clin Oncol (R Coll Radiol), 2012, 24(3):196-207.
18. Verbakel WF, Cuijpers JP, Hoffmans D, et al. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer:a comparative planning and dosimetric study[J]. Int J Radiat Oncol Biol Phys, 2009, 74(1):252-259.
19. Vanetti E, Clivio A, Nicolini G, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx:a treatment planning comparison with fixed field IMRT[J]. Radiother Oncol, 2009, 92(1):111-117.
20. Johnston M, Clifford S, Bromley R, et al. Volumetric-modulated arc therapy in head and neck radiotherapy:a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma[J]. Clin Oncol (R Coll Radiol), 2011, 23(8):503-511.
21. Holt A, Van Gestel D, Arends MP, et al. Multi-institutional comparison of volumetric modulated arc therapy vs. intensity-modulated radiation therapy for head-and-neck cancer:a planning study[J]. Radiat Oncol, 2013, 8:26.
22. Orlandi E, Giandini T, Iannacone E, et al. Radiotherapy for unresectable sinonasal cancers:dosimetric comparison of intensity modulated radiation therapy with coplanar and non-coplanar volumetric modulated arc therapy[J]. Radiother Oncol, 2014, 113(2):260-266.
23. Alvarez-Moret J, Pohl F, Koelbl O, et al. Evaluation of volumetric modulated arc therapy (VMAT) with Oncentra MasterPlan^? for the treatment of head and neck cancer[J]. Radiat Oncol, 2010, 5:110.
24. Rao M, Yang W, Chen F, et al. Comparison of elekta VMAT with helical tomotherapy and fixed field IMRT:plan quality, delivery efficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
25. 唐正中, 吳愛東, 錢立庭, 等. 鼻咽癌靜態IMRT與VMAT同步加量放療劑量學比較[J]. 安徽醫科大學學報, 2014, 49(8):1164-1167.
26. 吳昊, 韓樹奎, 孫艷, 等. 局部進展期鼻咽癌快速旋轉調強與固定野動態調強放療的劑量學比較[J]. 中華放射腫瘤學雜志, 2010, 19(5):410-413.
27. 徐壽平, 王連元, 戴相昆, 等. 螺旋斷層放療系統原理及其應用[J]. 醫療衛生裝備, 2008, 29(12):100-102.
28. Lu SH, Cheng JC, Kuo SH, et al. Volumetric modulated arc therapy for nasopharyngeal carcinoma:a dosimetric comparison with TomoTherapy and step-and-shoot IMRT[J]. Radiother Oncol, 2012, 104(3):324-330.
29. Clemente S, Wu B, Sanguineti G, et al. SmartArc-based volumetric modulated arc therapy for oropharyngeal cancer:a dosimetric comparison with both intensity-modulated radiation therapy and helical tomotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 80(4):1248-1255.
30. Broggi S, Perna L, Bonsignore F, et al. Static and rotational intensity modulated techniques for head-neck cancer radiotherapy:a planning comparison[J]. Phys Med, 2014, 30(8):973-979.
31. Bertelsen A, Hansen CR, Johansen J, et al. Single arc volumetric modulated arc therapy of head and neck cancer[J]. Radiother Oncol, 2010, 95(2):142-148.
32. Guckenberger M, Richter A, Krieger T, et al. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?[J]. Radiother Oncol, 2009, 93(2):259-265.
33. Ning ZH, Mu JM, Jin JX, et al. Single arc volumetric-modulated arc therapy is sufficient for nasopharyngeal carcinoma:a dosimetric comparison with dual arc VMAT and dynamic MLC and step-and-shoot intensity-modulated radiotherapy[J]. Radiat Oncol, 2013, 8:237.
34. Qiu JJ, Chang Z, Wu QJ, et al. Impact of volumetric modulated arc therapy technique on treatment with partial breast irradiation[J]. Int J Radiat Oncol Biol Phys, 2010, 78(1):288-296.
35. Ezzell GA, Burmeister JW, Dogan N, et al. IMRT commissioning:multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119[J]. Med Phys, 2009, 36(11):5359-5373.
36. Webb S, Mcquaid D. Some considerations concerning volume-modulated arc therapy:a stepping stone towards a general theory[J]. Phys Med Biol, 2009, 54(14):4345-4360.

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容積旋轉調強放射治療技術在頭頸部腫瘤的應用

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