Method for irradiating oncology patients, primarily using cobalt distance apparatuses

FIELD: medicine, in particular, radiotherapy.

SUBSTANCE: during irradiation of oncology patients on cobalt distance apparatuses dose field is formed by injecting topographic-anatomic information of patient into dose planning system and generating with its consideration of main dose field on basis of results of calculations of main dose field, dose deficiency area is located within limits of target and iso-centers of additional dose fields are positioned therein, while width of radiation beams, generating additional dose fields, is less than width of beam of main dose fields 1,5-2,5 times, while value of dose of main field is 0,7-0,85 of resulting dose within limits of target.

EFFECT: possible generation of dose field with minimal possible dose change on target while simultaneously decreasing radiation loads on normal tissues and skin.

2 dwg, 1 ex

 

The invention relates to medicine, namely to methods of treatment of cancer patients with radiotherapy.

There is a method of treatment of cancer patients, mainly of cobalt remote devices by forming proportionate to the target dose field [1].

The known method of treatment is based on one static and the movable radiation.

The disadvantages of the dose field formation with a single isocenter are: static exposure - high dose to normal tissue at the entrance and within the boundaries of the beams, for rolling irradiation - formation zone is not enough low dose gradient in the field isocenter within the width of the beam, do not meet the required differential dose at a target, and, as a consequence, the inability to reduce the radial loads on the adjacent to the target normal tissue. This restricts the summation to the tumor maximum therapeutic dose.

The technical result, which directed this solution lies in the formation of the dose field with the lowest possible drop dose at a target while reducing the radial loads on normal tissue and skin that will help to improve therapeutic dose in the target and to improve treatment results.

Calculations of dose fields are produced on the computer is the system of dose planning remote exposure.

The essence of the dose field formation lies in the fact that topographic-anatomical patient information entered into the system dose planning, taking into account the shape and size of the target, the location of the critical organs and tissues form the basic dose field, then by the results of the calculation of the basic dose fields define the scope of the deficit of the dose within the target and have it isocentre additional dose fields. The width of the beam, forming the main dose field is assigned close to the size of the target in the direction perpendicular to the beam axis or the bisector of the sector. The width of the beam, forming an extra dose field, in all cases 1.5-2.5 times smaller than the width of the main beam dose field. The dose of the primary field is 0.7-0.85 from the resulting dose in the target. When forming the main field in the form of a sector, the largest sector is assigned greater than or equal to πexcept when the size of the target perpendicular to the bisector of the sector is approximately 1.5 times smaller than the size in the direction of the bisector of the sector. In the latter case, the value of the sector's main field is assigned less than π. The value of the sector additional dose field is always less than π and may vary from π/6 to ˜π/2 depending on the specific situation.

The method is illustrated by drawings, where figure 1 presents the network-dose field, formed by the method [1], figure 2 - the resulting dose field of the proposed method.

Figures 1 and 2 for example, tumors of the urinary bladder associated dose field in the application of one or more isocenters exposure.

Target - the bladder, the size of 9.4 cm 8.4 cm, the critical organ is the rectum and the skin.

According to the method of [1] the value of the sector amounted to 290° if the width of the beam 12 cm (Figure 1).

In the proposed method the value of the sector 230° and the width of the beam 9 see further introduced two sectors 50° width beams 4 see the Isocenter of additional elements is located in the area of dose deficit and is separated from the isocenter of the adjustable element 2 cm (Figure 2).

From the comparison of dose distributions according to the method of [1] and the proposed method follows that in the first case, 90% isodose covers less than 40% of the target area and the average dose is 87% of the maximum value, and the second more than 90% of the target area and the average dose in the target - 85%.

The average dose to the critical organ was the first case 70% of the dose in the target, in the second case - 46%, i.e. decreased by approximately 1.5 times. Thus, the formation of a conformal dose field has allowed to increase the impact on tumor target cells and at the same time significantly reduce the radiation dose to the critical organ that allows summed up what I tumors greater therapeutic dose, than way [1].

An example of clinical application. Patient B., diagnosed with bladder cancer stage 3, enrolled in MGIB No. 62 in the radiology Department and received radiation therapy for the proposed method to the total focal dose of 66 Gy. Topographic-anatomical information about the irradiated volume, size, shape and position of the tumor was obtained from CT screening. These data were entered into the system dose planning. The main dose field was implemented in the form of a sector of the swing value of 230 degrees, symmetrically located relative to the main (major) axis of the target, with the isocenter in the center of the target and the width of the beam in proportion to the target in the direction perpendicular to the bisector of the sector. Calculated main field dose was assessed deficiency dose, i.e. the part of the target, the dose of which was less than 80% isodose. The deficit of the dose was detected in the lower third of the bladder. In this area were added dose field, implemented in the form of two sectors swing value of 50 degrees with the isocenter in the center of this area, below the isocenter of the main field dose at 2 cm, with axes arranged perpendicular to the main axis of the target, and the beam width, the greater the size of the area of deficiency dose field in the direction of the main axis of the target. The dose contribution from jus the th dose field was appointed 0.7 from the resulting dose in the target, accordingly, each additional field - 0.15. Calculated total field was evaluated from the viewpoint of the uniformity of dose distribution in the target and the load on the critical organ is the rectum. Turned out to be expedient to raise the isocenter additional sectors 5 mm upwards. The newly calculated dose field was rated as satisfactory and the irradiation plan was adopted as a therapeutic. The patient was discharged in satisfactory condition, radiation reaction on the part of the intestinal mucosa, skin, and overall condition is not expressed. Four years later, after the course of radiation therapy, the patient's condition is satisfactory.

Thus, this solution will allow you to:

- dose form field with the lowest possible drop dose at a target;

to reduce radiation exposure to normal tissue and skin;

- to increase the total therapeutic dose;

to improve the results of treatment.

The source of information

1. RF patent №2101048, MKI A 61 N 5/10, 1998.

The method of dose field formation during irradiation of cancer patients on cobalt remote devices by introducing a system of dose planning topographic-anatomical information of the patient and forming with its view of the underlying dose field, characterized in that the calculation results basicly what about the dose field define the scope of the deficit of the dose within the target and have it isocentre additional dose fields, the width of the beam irradiation, forming an extra dose field, less than the width of the main beam dose field in 1,5-2,5 times, and the dose size of the main field is 0,7-0,85 resulting dose within the target.



 

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