Comparison of Treatment Plans with Multileaf Collimators of different Leaf Width

Leaf width가 다른 다엽 콜리메터에 의한 치료계획 비교

Purpose: To compare desimetrically intensity-modulated radiotherapy treatment plans with commercially available multileaf collimators (MLCs) of different leaf width for intracranial lesions. Materials and Methods: Twelve patients with intracranial lesions were treated with BrainLAB's micro-MLCs (mMLCs) and performed with the BrainSCAN ver. 5.2 planning software. They were replanned using the Varian 120 and 80 MLCs. These collimators have minimum leaf width of 3 mm, 5 mm and 10 mm at isocenter, respectively. PTV was $3.3~339.2\textrm{cm}^3$ and the number of beams was 3~7. These three plans were compared with respect to the uniformity and the conformity indices, doses to critical organ and normal tissue. Results: For the uniformity index of the planning target volume (PTV), there were no statistically significant differences between mMLCs and 120 MLCs (p=0.057) and between 120 MLCs and 80 MLCs (p=0.388). However, there was a difference between mMLCs and 80 MLCs (p<0.001). Maximum target dose to the PTV showed no dependency with respect to the leaf width. On the contrary, there were statistically significant differences in the conformity indices between mMLCs and 120 MLCs (p=0.003), between mMLCs and 80 MLCs (p=0.003) and between 120 MLCs and 80 MLCs (p=0.003). The volume of brainstem irradiated to $\geq$70% dose and to $\geq$50% dose was increased as the leaf width of MLCs increased. In particular, the volume of normal tissue irradiated is obviously changed for different leaf width. Volumetric increments for MLCs with leaf widths of 5 mm and 10 mm were 6.3% and 23.2% to the normal tissue irradiated to $\geq$50% dose, and 8.7% and 32.7% to the normal tissue irradiated to $\geq$70% dose, respectively, compared to the volume for MLCs with leaf width of 3 mm. Conclusions: The uniformity index and maximum target dose to the PTV showed no dependency with respect to leaf width of MLCs. However, the conformity index was improved as the leaf width decreased. For the sparing of normal brain tissue, treatment plans with MLCs of 3 mm leaf width is more effective, compared to ones with MLCs of 5 mm and 10 mm leaf widths.

목적: Leaf width가 다른 다엽 콜리메터(MLCs)를 이용, 두개내 병변에 관하여 각각의 세기조절방사선치료(IMRT) 계획을 수립하여, 이를 선량학적으로 비교하였다. 재료 및 방법: BrainSCAN ver. 5.2. 소프트웨어를 사용하여 micro-MLC로 이미 치료가 수행된 12명의 환자를 Varian사의 120 MLC와 80 MLC로 다시 치료계획하였으며 이 다엽 콜리메터들은 중심에서의 leaf width가 각각 3 mm, 5 mm, 10 mm이다. 이 때, 계획용 표적체적은 3.3～339.2 cc였고, 조사된 빔의 수는 3～7개이다. 이들을 uniformity Index, conformity index, 결정장기와 정상조직 내 선량으로 서로 비교하였다. 결과: 계획용 표적체적의 uniformity Index경우, mMLCs와 120 MLCs 사이에서 (p=0.057) 120 MLCs와 80 MLCs 사이에서(p=0.388) 통계적으로 차이가 없었다. 그러나 mMLCs와 80 MLCs 사이에서 차이를 보였다(p<0.001). 계획용 표적체적에 대한 최대 목표선량은 leaf width와 연관성이 없었다. 반면에, conformity Index의 경우는 mMLCs와 120 MLCs (p=0.003), mMLCs와 80 MLCs (p=0.003), 50 MLCs와 120 MLCs (p=0.003) 사이에서 통계적인 차이를 보였다. 처방선량의 70%와 50% 이상 조사되는 뇌간의 부피는 다엽 콜리메터의 leaf width가 증가함에 따라 증가하였다. 특히, leaf width의 변화에 따라 방사선에 조사되는 정상 뇌조직의 부피가 분명하게 변하였다. Leaf width가 3 mm인 다엽 콜리메터와 비교하였을 때, leaf width가 5 mm, 10 mm인 다엽 콜리메터의 부피 증가는 처방선량의 50% 이상 조사되는 정상조직의 경우, 각각 6.3%, 23.2%였고, 처방선량의 70% 이상 조사되는 정상조직의 경우, 각각 8.7%, 32.7%였다. 결론: 계획용 표적체적의 uniformity Index와 최대 목표선량은 leaf width와 연관성이 없었다. 그렇지만 conformity Index 는 leaf width가 감소함에 따라 향상되었다. 두개내 병변 치료시, 정상 뇌조직의 보존에 있어 leaf width 5 mm, 10 mm인 다엽 콜리메터를 이용한 치료계획보다 leaf width 3 mm인 다엽 콜리메터를 이용한 치료계획이 보다 효과적임을 알 수 있었다.