Journal of Radiation Protection and Research

The Korean Association for Radiation Protection (대한방사선방어학회)
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Optimal Radiation Port Arrangements for Hepatic Tumor using 3-dimensional Conformal Radiotherapy Planning

3차원입체조형방사선치료 계획 시 간종괴의 위치에 따른 최적 조사 방향의 결정

  • Lee, Ik-Jae (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Seong, Jin-Sil (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Shim, Su-Jung (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Jeong, Kyoung-Keun (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Cho, Kwang-Hwan (Department of Radiation Oncology, Sunchunhyang University College of Medicine)
  • 이익재 (연세대학교 의과대학 방사선종양학과) ;
  • 성진실 (연세대학교 의과대학 방사선종양학과) ;
  • 심수정 (연세대학교 의과대학 방사선종양학과) ;
  • 정경근 (연세대학교 의과대학 방사선종양학과) ;
  • 조광환 (순천향대학교 의과대학 방사선종양학과)
  • Published : 2006.12.30
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Abstract

The purpose of this study was to investigate the optimal beam arrangements for hepatic tumors, according to the location of the hepatic tumor and its relationship to organs at risk (OARs). The virtual gross tumor volumes were divided into four groups according to the Couinaud's classification. Several plans were made for each virtual target, and these plans were compared for the normal tissue complication probabilities (NTCP). For group I, NTCP improved as the number of the beam ports increased. However, plans with more than 5 ports had little advantage. For group II, plans with the beam directions from the anterior side showed better results. Group III contained many OARs near the target, which placed restrictions on the beam-directions. Multi-directional plans yielded a higher dose to the OARs than a simple two-port plan using right anterior oblique and posterior beam (RAO/PA). For group IV, a simple RAO/PA port plan was adequate for protection of remaining liver. NTCP can significantly vary between radiotherapy plans when the location of the tumor and its neighboring OARs are taken into consideration. The results in this study of optimal beam arrangements could be a useful set of guidelines for radiotherapy of hepatic tumors.

본 연구는 간암 환자의 방사선치료 시에 정상 조직과 간암의 위치에 따른 적절한 조사방향을 찾고자 하였다. 간암의 위치는 Couinaud에 의한 분류법을 이용하여 4군으로 나누었고, 각 군의 용적을 가상의 표적 용적으로 정해서 여러 개의 방사선 치료계획을 세워 정상조직합병증발생률(normal tissue complication probability, NTCP)을 비교하였다. 그룹 I에서는 조사 수를 늘릴수록 정상간의 NTCP가 감소되었으나 6개 이상부터는 일정하였다. 그룹 II에서는 PA(posterior to anterior) 조사가 추가 되었을 때 정상간의 NTCP가 증가하였다. 그룹 III는 표적용적 주변에 정상조직이 많아 조사 방향의 설정에 어려움이 있었고 여러 방향에서의 조사 보다는 RAO(right anterior oblique)와 PA를 이용한 2개의 조사만이 시행되었을 때 정상 간의 NTCP가 가장 낮았다. 그룹 IV에서도 RAO와 PA의 2개 조사로 이루어진 치료계획에서 정상 간의 NTCP 가 가장 낮았다. 본 연구를 통해 간암의 방사선 치료계획 시 간암의 위치와 정상조직의 위치에 따라 NTCP 가 다양하게 나타남을 알 수 있었고, 간암의 방사선치료 계획 시 최적 조사 방향의 설정을 통해 임상적으로 방사선치료를 적용하는 데 유용한 지침이 될 수 있을 것으로 생각된다.

Keywords

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