| Purpose: The primary tumors have been treated by percutaneous radiation graft with intensity modulated radiation therapy(IMRT),stereotactic body radiation therapy(SBRT)with IMRT and IMRT,respectively.Based on the tolerance dose of normal organs treatment results,the purpose is to assess the technical safety,adverse events,and efficacy of computed tomography(CT)-guided 3-Dimensional brachytherapy,IMRT and SBRT in patients with locally advanced peripheral none small cell lung cancer(NSCLC).Methods and Materials: Twenty-six patients with histologically confirmed NSCLC were treated in affiliated hospital of Xinan medical university,and were enrolled in a prospective,officially approved phase 1 trial.The therapeutic equipment,which are Pinnace system made by Philips company,Oncentra 3-Dimensional brachytherapy system and Oncentra external radiation treatment system,have been used to percutaneous radiation graft to patients.The used dose for CT-guided 3-Dimensional brachytherapy: a single 30-Gy/F dose was delivered to the 90% isodose line of the gross lung tumor volume;a normal dose of at least GTVnd=70 Gy,2Gy/F for hilus pulmonis or mediastinal lymph nodes by IMRT;and at same-time the virtual IMRT and SBRT have been also used to analysed the results.The used dose for IMRT: a normal dose of at least GTVpl=120 Gy,2Gzy/F for primary lung lesions;a normal dose of at least GTVnd=70 Gy,2Gy/F for hilus pulmonis or mediastinal lymph nodes too.The used dose for SBRT: a normal dose for once a time is GTVpl=10 Gy/F with 6 time totally;a normal dose of at least GTVnd=70 Gy,2Gy/F for hilus pulmonis or mediastinal lymph nodes too.Based on the analysis and compute the tolerance dose of normal organs treatment results,we assessed treatment efficacy,adverse events,and radiation toxicity of these three radiotherapy methods.Results: The following data sets and analysis were obtained from the treatment results from CT-guided 3-Dimensional brachytherapy,IMRT and SBRT.1.The V20 of bilateral pulmonary after treated are 6.2%(4.1-11.1),29.3%(6.0-31.7)and 28.1%(9.3-32.8),respectively;and the difference among these three data sets have statistical significance.The V5 of bilateral pulmonary after treated are 21.3%(11.6-34.8);51.2 %(24.2-57.1);48.5%(28.8-59.7),respectively;and the difference among these three data sets have statistical significance.The MLD of bilateral pulmonary after treated are 6.6Gy(3.3-11.6),16.7Gy(5.12-19.7)and 18.6Gy(12.6-27.8),respectively;and the difference among these three data sets have statistical significance.2.The maximum dose for medulla spinalis treated by these three methods are 9.3Gy(3.1-13.1);22.5 Gy(1.7-39.7)and 25.9Gy(9.3-44.3),respectively;and the difference among these three data sets have statistical significance.3.The V30 of heart after treated are 4.3%(0-7.6),16.9 %(0-19.7)and 18.4%(0.2-25.2),respectively;and the V40 of heart after treated are 2.7%(0-5.5),12.8%(0-17.4)and 15.9%(0-21.9),respectively.Both the data of V30 and V40 of heart has statistical significance.4.Combination with the plans of primary lesion and lymphonodus,the V20 of bilateral pulmonary after treated are 26.9%(19.2-29.6),42.9(%20.4-59.7)and 40.6%(21.3-58.9),respectively;and there were the prominent difference among these three data sets.The V5 of bilateral pulmonary after treated are 48.1%(35.6-58.9),76.1%(40.1.-107.6)and 69.3%(39.8-100.0),respectively.The MLD of bilateral pulmonary after treated by CT-guided 3-Dimensional brachytherapy,IMRT with conventional intensity-modulated fusion and SBRT are 15.6Gy(11.0-18.9),25.5Gy(19.2-39.7)and 27.9Gy(18.6-41.4),respectively;and there were the prominent difference among these three data sets.5.After combination with the plans of primary lesion and lymphonodus,the maximum dose for medulla spinalis treated by these three methods are 31.9Gy(18.0-40.1),36.7Gy(22.3-49.4)and 41.2Gy(28.9-58.9),respectively.The V30 of heart after treated are 10.8%(1.3-23.1),38.7%(3.7-46.1)and 42.4%(5.1-53.2),respectively.The V40 of heart after treated by CT-guided 3-Dimensional brachytherapy,IMRT with conventional intensity-modulated fusion and SBRT are 8.8%(0.3-14.6),19.7%(1.2-28.4)and 24.9%(2.4-41.1),respectively;and there were the prominent difference among these three data sets.Conclusion:1.The V5,V20 and MLD of bilateral pulmonary treated by CT-guided 3-Dimensional Brachytherapy are much lower than that treated by IMRT and SBRT,and the protection for normal lung tissue is superior to the latter two methods.2.Both of the V30 and V40 of heart treated by CT-guided 3-Dimensional brachytherapy are much lower than that treated by IMRT and SBRT,and the protection for heart is better than that of the latter methods.3.The Dmax of medulla spinalis treated by CT-guided 3-Dimensional brachytherapy are much lower than that treated by IMRT and SBRT,and the protection for medulla spinalis is much better than that of the two later methods. |
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