Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Treatment Planning for Minimizing Carotid Artery Dose in the Radiotherapy of Early Glottic Cancer

조기 성문암의 방사선치료에서 경동맥을 보호하기 위한 치료 계획

  • Ki, Yang-Kan (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Won-Taek (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Nam, Ji- Ho (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Dong-Hyun (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Lee, Ju-Hye (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Park, Dal (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Don-Won (Department of Radiation Oncology, Pusan National University School of Medicine)
  • 기용간 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김원택 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 남지호 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김동현 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 이주혜 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 박달 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김동원 (부산대학교 의학전문대학원 방사선종양학교실)
  • Received : 2011.04.20
  • Accepted : 2011.05.23
  • Published : 2011.06.30
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Abstract

Purpose: To examine the feasibility of the treatment planning for minimizing carotid artery dose in the radiotherapy of early glottic cancer. Materials and Methods: From 2007 to 2010, computed tomography simulation images of 31 patients treated by radiotherapy for early glottic cancer were analyzed. The virtual planning was used to compare the parallel-opposing fields (POF) with the modified oblique fields (MOF) placed at angles to exclude the ipsilateral carotid arteries. Planning target volume (PTV), irradiated volume, carotid artery, and spinal cord were analyzed at a mean dose, $V_{35}$, $V_{40}$, $V_{50}$ and with a percent dose-volume. Results: The beam angles were arranged 25 degrees anteriorly in 23 patients and 30 degrees anteriorly in 8 dose-volume of carotid artery shows the significant difference (p<0.001). The mean doses of carotid artery were 38.5 Gy for POF and 26.3 Gy for MOF and the difference was statistically significant (p=0.012). Similarly, $V_{35}$, $V_{40}$, and $V_{50}$ also showed significant differences between POF and MOF. Conclusion: The modified oblique field was respected to prevent a carotid artery stenosis and reduce the incidence of a stroke based on these results.

목 적: 조기 성문암 환자에서 방사선치료의 만기 합병증인 뇌졸증을 예방하기 위해 경동맥을 보호하는 치료계획을 세우고 타당성을 알아보고자 연구를 계획하였다. 대상 및 방법: 2007년 1월부터 2010년 12월까지 원발성 조기 성문암으로 방사선치료를 받은 환자 중 전산화단층촬영모의 치료를 받은 환자 31명의 모의치료 영상을 대상으로 하였다. 기존의 평행대항조사영역(parallel-opposing field, POF)과 조사영역의 빔방향상에서 동측의 경동맥을 제외하기 위해 빔각도를 조절한 조사영역(modified oblique field, MOF)으로 가상모의치료계획을 세우고 계획용표적체적, 경동맥과 척수의 선량분포, 평균선량과 $V_{35}$, $V_{40}$, $V_{50}$ 등을 기존 치료와 비교 분석하였다. 결 과: 전체 31명 중 23명(74.2%)에서 25도, 8명(25.8%)에서 30도 전방으로 조절되었다. 두 군 사이에 선량에 따른 Planning target volume의 체적백분율은 차이를 보이지 않았다(p=0.801). 경동맥의 선량에 따른 누적 체적백분율은 의미 있는 차이를 보였고(p<0.001), 26 Gy 이후에 MOF군에서 감소하기 시작했다. 경동맥의 평균선량은 POF군에서 38.5 Gy, MOF군에서 26.3 Gy였고(p=0.012), $V_{35}$, $V_{40}$, $V_{50}$ 모두에서 의미 있는 차이를 보였다. 결 론: 이번 연구 결과로 조기 성문암 환자에서 빔각도를 전방으로 조절하여 경동맥의 조사선량을 감소시켰다. 이를 통해 경동맥 협착증을 예방하고 궁극적으로 뇌졸증을 줄일 수 있을 것으로 예상한다.

Keywords

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