DOI QR코드

DOI QR Code

The Effect of Dose Distribution under Treatment Techniques on Cerebrospinal Irradiation

뇌 및 척수조사시 치료기법의 변화가 선량분포에 미치는 영향

  • Lee, Seungchul (Department of Radiation Oncology, Catholic univ. of korea Uijeongbu Hospital) ;
  • Kim, Youngjae (Department of Radiologic Technology, Daegu Health College)
  • 이승철 (가톨릭대학교 의정부성모병원) ;
  • 김영재 (대구보건대학교 방사선과)
  • Received : 2016.01.03
  • Accepted : 2016.01.30
  • Published : 2016.01.30

Abstract

This study tries to evaluate the usefulness CSI treatment. Compare the standard technique and simple technique, using the volume region of a high dose of Field joints (hot spot) or low dose regions (cold Spot). In patients who agreed to this study, obtain CT image using CT simulator skull to pelvis region. Standard Technique were performed on the movement of the joint radiation field range and simple technique has set a treatment plan to secure the radiation field range and analyzed treatment planning. Under analysis standard technique occurred the area of the high dose(Hot Spot) for the area overlapping the field and simple technique showing a uniform doses. CI indices of standard technique and simple technique was 1.6~3, 1.6~1.87, CN indices was 0.32~0.53, 0.46~0.51 and HI indices was 0.11~0.33, 0.2~0.26. Therefore, adjacent to part of the dose distribution junction more equally than simple technique compared to the Standard Technique. Compare the dose distribution patterns using CI, CN, HI indices, showed a uniform dose distribution in the simple technique. so, simple technique was determined appropriate treatment the CSI.

본 연구에서는 CSI 치료시 Standard Technique과 Simple Technique을 비교하여 조사야 접합부의 고선량(hot spot) 또는 저선량(cold spot)이 발생되는 부위의 체적을 분석하고 이에 따른 방사선 치료 유용성을 평가하고자 한다. 연구 목적에 동의한 환자를 대상으로 CT Simulator를 이용하여 환자의 두개부에서 골반부 까지 영상을 획득하였다. Standard Technique 의 경우 조사야 접합부의 이동을 실시하며 Simple Technique은 접합부에서 조사야를 고정하여 치료계획을 수립 후 분석하였다. 분석결과 Standard Technique의 경우에는 조사야 접합부분에 대한 고선량(hot spot)의 영역이 발생 되었으며, Simple Technique은 Standard 기법 보다 선량이 균등하게 나타났다. Standard Technique 과 Simple Technique의 CI 지수는 각 1.6~3, 1.6~1.87, CN의 경우는 0.32~0.53, 0.46~0.51, HI는 0.11~0.33, 0.2~0.26의 분포를 나타났다. 즉, 인접 조사야가 접합하는 조사야 부분의 선량 분포는 Standard Technique에 비해 균등하게 나타났으며, CI, CN, HI 지수를 비교한 결과 Simple Technique에서 균등한 선량 분포가 나타나 CSI 치료에서 Simple Technique의 적용은 적합하다고 판단된다.

Keywords

References

  1. E. Bouffet J.L. Bernard, D. Frappaz, J.C. Gentet, H. Roche, P. Tron, C. Carrie, C. Raybaud, A. Joannard, C. Lapras, M. Choux, M. Carton, L. Aimard, T. Philip, M. Brunat-Mentigny, "M4 protocol for cerebellar medulloblastoma : supratentorial radiotherapy may not be avoided," International Journal of Radiation Oncology, Biology, Physics No. 24, pp. 79-85, 1992.
  2. William M. Wara, Quynh-Thu X. Le, Penny K. Sneed, David A. Larson, Michael D. Prados, Victor A. Levin, Michael S.B. Edwards, Michael D. Weil, "Pattern of recurrence of medulloblastoma after low-dose craniospinal radiotherapy," International Journal of Radiation Oncology, Biology Physics, No. 30, pp. 551-556, 1994. https://doi.org/10.1016/0360-3016(92)90940-J
  3. Edward C. Halperin, Louis S. Constine, Nancy J. Tarbell , "Pediatric radiation oncology. 5th ed," Philadelphia: Lippincott Williams & Wil-kins 2011.
  4. Rajan B1, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M.Craniopharyngioma: a long-term results following limited surgery and radiotherapy", Radiationtherapy and oncology, No. 26, pp. 1-10, 1993. https://doi.org/10.1016/0167-8140(93)90019-5
  5. Merchant TE1, Kiehna EN, Kun LE, Mulhern RK, Li C, Xiong X, Boop FA, Sanford RA., "Phase II trial of conformal radiation the-rapy for pediatric patients with craniopharyngioma and corre-lation of surgical factors and radiation dosimetry with change in cognitive function", Journal of Neurosurg 104, 2006.
  6. Merchant TE1, Kiehna EN, Sanford RA, Mulhern RK, Thompson SJ, Wilson MW, Lustig RH, Kun LE., "Craniopharyngioma: the St. Jude Children's Research Hospital experience 1984-2001", International Journal of Radiation Oncology, Biology, Physics No. 53, pp. 533-542, 2002. https://doi.org/10.1016/S0360-3016(02)02799-2
  7. EC Halperin, LS Constine, NJ Tarbell, LE Kun, "Pediatric radiation oncology. 5th ed", Philadelphia: Lippincott Williams & Wil-kins; 2011.
  8. Stella Hetelekidis, Patrick D Barnes, May L Tao, Edwin G Fischer, Lindsey Schneider, R.Michael Scott, Nancy J Tarbell, "20-year experience in childhood cranio-pharyngioma", International Journal of Radiation Oncology, Biology, Physics, No. 27, pp. 189-195, 1993.
  9. Patrick R. M. Thomas, Melvin Deutsch, James L. Kepner, James M. Boyett, Jeffrey Krischer, Patricia Aronin, Leland Albright, Jeffrey C. Allen, Roger J. Packer, Rita Linggood, Raymond Mulhern, James A. Stehbens, James Langston, Philip Stanley, Patricia Duffner, Lucy Rorke, Joel Cherlow, Henry S. Friedman, Jonathan L. Finlay, Teresa J. Vietti and Larry E. Kun, "Low-sta-ge medulloblastoma: final analysis of trial comparing stan-dard-dose with reduced-dose neuraxis irradiation", Journal of Clinical Oncology, No. 18, pp. 3004-3011, 2000. https://doi.org/10.1200/JCO.2000.18.16.3004
  10. Roger J. Packer, Joel Goldwein, H. Stacy Nicholson, L. Gilbert Vezina, Jeffrey C. Allen, M. Douglas Ris, Karin Muraszko, Lucy B. Rorke, William M. Wara, Bruce H. Cohen and James M. Boyett, "Treatment of children with medulloblastomas with reduced dose craniospinal radiation therapy and adjuvant chemo-the rapy: a Children's Cancer Group Study", Journal of Clinical Oncology No. 17, pp. 2127-2136, 1999. https://doi.org/10.1200/JCO.1999.17.7.2127
  11. Suzanne L. Wolden, Ira J. Dunkel, Mark M. Souweidane, Laura Happersett, Yasmin Khakoo, Karen Schupak, David Lyden and Steven A. Leibel, "Patterns of failure using a conformal radiation therapy tumor bed boost for me-dulloblastoma", Journal of Clinical Oncology, No. 21, pp. 3079-3083, 2003. https://doi.org/10.1200/JCO.2003.11.140
  12. Thomas E. Merchant, Larry E. Kun, Matthew J. Krasin, Dana Wallace, Murali M. Chintagumpala, Shiao Y. Woo, David M. Ashley, Maree Sexton, Stewart J. Kellie, Verity Ahern, Amar Gajjar, "Multi-institution prospective trial of reduced-dose cranio-spinal irradiation (23.4 Gy) followed by conformal posterior fossa(36 Gy) and primary site irradiation (55.8 Gy) and dose-intensive chemotherapy for average-risk medulloblastoma," International Journal of Radiation Oncology, Biology Physics, No. 70, pp. 782-787, 2008. https://doi.org/10.1016/j.ijrobp.2007.07.2342
  13. Thomas E Merchant, Chenghong Li, Xiaoping Xiong, Larry E Kun, Frederic A Boop, Robert A Sanford, "A onformal radiotherapy after surgery for paediatric epen-dymoma: a prospective study," Lancet Oncology No. 10, pp. 258-266, 2009. https://doi.org/10.1016/S1470-2045(08)70342-5
  14. MJ Lee. HJ Jung, "The Result of Radiation Therapy of Nasopharyngeal Carcinoma," International Journal of Radiation Oncology, Vol. 21 No. 4, pp. 269-275, 2003.
  15. Ann J. Mc Cunniff, Mark J. Liang. "Radiation tolerance of the cervical spinal cord," International Journal of Radiation Oncology, Vol. 16, No. 3, pp. 675-678, 1988.
  16. John C. Probert, Bruce R. Parker, "The effects of radiation therapy on bone growth", Radiology, No. 114, pp. 155-162, 1975. https://doi.org/10.1148/114.1.155
  17. J H Silber, P S Littman, A T Meadows, "Stature loss following skeletal irradiation for childhood cancer," Journal of Clinical Oncology, No. 8 pp. 304-312, 1990. https://doi.org/10.1200/JCO.1990.8.2.304
  18. Margaret A. Tucker, Giulio J. D'Angio, John D. Boice, Jr., Sc.D., Louise C. Strong, Frederick P. Li, Marilyn Stovall, M.S., Betty J. Stone, Daniel M. Green, Fabrizio Lombardi, William Newton, Robert N. Hoover, Joseph F. Fraumeni, Jr,"The Late Effects Study Group. Bone sarcomas linked to radiotherapy and chemotherapy in children," The New England Journal of Medicine, No. 317, pp. 588-593, 1987. https://doi.org/10.1056/NEJM198709033171002
  19. N.J Tarbell, P Mauch, R.D Gelber, H.J Weinstein, "Sex differences in risk of second malignant tumours after Hodgkin's disease in childhood," Lancet oncology, No. 341, pp. 1428-1432, 1993.