同时整合增强和保护的胰腺癌立体定向全身放射治疗规划基准研究：DEGRO/DGMP 立体定向放射治疗和放射外科工作组的结果。
Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas with Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery.
发表日期：2024 Aug 31
作者：
C Moustakis, O Blanck, M Grohmann, D Albers, D Bartels, B Bathen, G R Borzì, S Broggi, A Bruschi, M Casale, A Delana, P Doolan, F Ebrahimi Tazehmahalleh, S Fabiani, M D Falco, R Fehr, M Friedlein, S Gutser, A Hamada, T Hancock, J Köhn, C Kornhuber, T Krieger, U Lambrecht, S Lappi, E Moretti, A Mirus, T Muedder, S Plaude, B Polvika, V Ravaglia, R Righetto, G Rinaldin, H Schachner, A Scaggion, P Schilling, P Szeverinski, E Villaggi, M Walke, L Wilke, P Winkler, N H Nicolay, H T Eich, E Gkika, T B Brunner, D Schmitt
来源：
Int J Radiat Oncol
摘要：
PTV 和 OAR 的接近或重叠对胰腺癌 SBRT (PACA) 提出了重大挑战。这项国际治疗计划基准研究调查了 PACA SBRT 中的同时集成增强 (SIB) 和保护 (SIP) 概念是否可以提高和协调计划质量。所需目标剂量的多参数规范（GTVD50%、GTVD99%、PTVD95%、PTV0 .5cc），两种处方剂量为 GTVD50%=5×9.2Gy（46Gy）和 GTVD50%=8×8.25Gy（66Gy），OAR 限值根据 3 名 PACA 患者的计划 CT 和轮廓进行分布。在第一阶段，使用评分系统对计划进行排名，以比较 GTV/PTV 和 OAR 之间的权衡。在第 2 阶段，针对最具挑战性的病例和处方进行了重新规划，并在小组讨论后提供了专用的 SIB 和 SIP 轮廓以供优化。对于所有 3 个病例和两个阶段的合并，来自 5 个国家的 42 个机构使用通用方法生成了 292 个计划可用的治疗计划系统。仅 76% 和 74% 的规划者执行 GTVD50% 处方时，5 次和 8 次分次的误差在 2% 以内。 GTVD99% 的目标基本实现，而 OAR 和目标剂量之间的平衡在约 50% 的计划中显示出类似 SIB/SIP 的初始优化策略。对于计划排名，5 分和 8 分分别被罚 149 分和 217 分，表明有改进的可能性。在第 2 阶段，95% 的规划者执行了 GTVD50% 处方，误差在 2% 以内，并且 GTVD99% 和 OAR 剂量得到了更好的协调，分数处罚明显减少。 19 名规划者中有 14 名提高了他们的计划等级，其中 9 名至少提高了 2 个等级。专用的 SIB/SIP 概念与多参数处方和约束相结合可以为 PACA SBRT 带来整体协调和高质量的治疗计划。经过小组共识和培训后，多中心临床试验中的标准化 SIB/SIP 治疗计划似乎是可行的。版权所有 © 2024。由 Elsevier Inc. 出版。
The proximity or overlap of PTV and OAR poses a major challenge in SBRT of pancreatic cancer (PACA). This international treatment planning benchmark study investigates whether Simultaneously Integrated Boost (SIB) and Protection (SIP) concepts in PACA SBRT can lead to improved and harmonized plan quality.A multiparametric specification of desired target doses (GTVD50%, GTVD99%, PTVD95%, PTV0.5cc) with two prescription doses of GTVD50%=5×9.2Gy (46Gy) and GTVD50%=8×8.25Gy (66Gy) and OAR limits were distributed with planning CT and contours from 3 PACA patients. In phase 1, plans were ranked using a scoring system for comparison of trade-offs between GTV/PTV and OAR. In phase 2, re-planning was performed for the most challenging case and prescription with dedicated SIB and SIP contours provided for optimization after group discussion.For all 3 cases and both phases combined, 292 plans were generated from 42 institutions in 5 countries using commonly available treatment planning systems. The GTVD50% prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTVD99% goal was mostly reached, while the balance between OAR and target dose showed initial SIB/SIP-like optimization strategies in about 50% of plans. For plan ranking, 149 and 217 score penalties were given for 5 and 8 fractions, pointing to improvement possibilities. For phase 2, the GTVD50% prescription was performed by 95% of planners within 2% and GTVD99% as well as OAR doses were better harmonized with notable less score penalties. Fourteen of 19 planners improved their plan rank, 9 of them by at least 2 ranks.Dedicated SIB/SIP concepts in combination with multiparametric prescriptions and constraints can lead to overall harmonized and high treatment plan quality for PACA SBRT. Standardized SIB/SIP treatment planning in multicenter clinical trials appears feasible after group consensus and training.Copyright © 2024. Published by Elsevier Inc.