| Autor: |
Abbott, EM, Young, R, Hale, C, MItchell, K, Falzone, N, Vallis, K, Kennedy, A |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Popis: |
Purpose Selective internal radiotherapy (SIRT) is administered to treat tumors of the liver and is generally well tolerated. While widely adopted for its therapeutic benefits, SIRT is rarely combined with external beam radiotherapy (EBRT) due to the complexity of the dosimetry resulting from the combination of treatments with distinct radiobiological effects. The purpose of this study was to establish a dosimetric framework for combining SIRT and EBRT using clinical experience derived from representative hepatocellular carcinoma (HCC) patients who received both therapies. Methods and Materials Treatments from ten patients with HCC given EBRT either before or after SIRT were analyzed. The dosimetry framework used here considered differences in the radiobiological effects and fractionation schemes of SIRT versus EBRT, making use of the concepts of biological effective dose (BED) and equivalent dose (EQD). Absorbed dose from SIRT was calculated, converted to BED, and summed with BED from EBRT dose plans. Two of these patients were further explored in a virtual planning exercise to investigate the feasibility of combining stereotactic body radiotherapy (SBRT) and SIRT. Results The combination of EBRT and SIRT in ten patients with HCC showed no major toxicity. No Child-Pugh scores went above 8 and ALBI scores from only one patient worsened to grade 3 (>-1.39) from treatment through 3-months follow-up. A framework with radiobiological modelling was developed to manage the combined treatments in terms of their sum BED. The exploratory SIRT plus SABR inverse dose plans for two patients, incorporating radiobiologically-informed 90Y SIRT dosimetry, achieved dose distributions comparable to SBRT-alone. Conclusions Treatment with both EBRT and SIRT can be given safely to patients with HCC. The BED and EQD concepts should be used in combined dosimetry to account for the differing radiobiological effects of EBRT and SIRT. Inverse dose planning of EBRT following SIRT could provide improved dose distributions and flexibility to the clinical workflow. Further research into combination therapy is needed through prospective trials. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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