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- W2023531820 abstract "La chimioradiothérapie complétée par une curiethérapie est le traitement standard des cancers du col utérin localement évolués. La radiothérapie est responsable de toxicité digestive et hématologique, majorée par la chimiothérapie. L’utilisation de la radiothérapie conformationnelle avec modulation d’intensité (RCMI) par des faisceaux statiques permet une diminution de cette toxicité. La technique de RCMI RapidArc® pourrait améliorer l’épargne des organes à risque et l’homogénéité du volume-cible prévisionnel, tout en diminuant le temps de traitement. L’objectif de l’étude est la comparaison des plans de traitement de 20 patientes, simulés en RCMI par faisceaux fixes et RapidArc®. Les volumes cibles étaient le volume-cible anatomoclinique (volume tumoral macroscopique, utérus, tiers supérieur du vagin, aires ganglionnaires obturatrices, iliaques et présacrées), et le volume-cible prévisionnel (volume-cible anatomoclinique +1 cm). Les organes à risque délinéés étaient le rectum, la vessie, l’intestin et la moelle osseuse. La dose prescrite était de 45 Gy en 25 fractions. La RCMI classique a été délivrée par cinq faisceaux fixes et la RCMI RapidArc® par deux arcs. Les comparaisons ont été effectuées par le test non paramétrique de Wilcoxon. La couverture moyenne du volume-cible prévisionnel était supérieure avec la RCMI RapidArc® (p = 0,01). Elle permettait une meilleure épargne intestinale (p = 0,01) et la RCMI par faisceaux fixes, une meilleure épargne vésicale (p = 0,01) et rectale (p = 0,05). Le volume total recevant 20 Gy était moins grand avec la RCMI RapidArc® (p < 0,001). Le RCMI RapidArc® permettait de diminuer le temps de traitement (trois contre 12 minutes avec les faisceaux fixes) et le nombre d’unités moniteur (UM) (376,5 contre 962,2 en moyenne, p = 0,0001). La technique de RCMI RapidArc® semble apporter des résultats dosimétriques supérieurs à ceux de la RCMI par faisceaux fixes, avec moins d’UM et temps de traitement plus court. Concurrent radiochemotherapy is the standard treatment for locally advanced cervical cancer. This treatment is responsible for bowel and hematologic toxicities. The use of intensity-modulated radiotherapy (IMRT), in static beams, allows a decrease of this toxicity. The technique of RapidArc® IMRT could lower the dose delivered to the organs at risk and improve the homogeneity of the planning target volume coverage, while decreasing the processing time. For 20 patients, treatment plans performed with IMRT and RapidArc® were compared. The target volumes were: the clinical target volume (gross tumour volume, uterus, upper third of the vagina, the hypogastric, iliac and presacral nodal regions), and the planning target volume (clinical target volume + 1 cm). The delineated organs at risk were: rectum, bladder, bowel and bone marrow. The dose was 45 Gy in 25 fractions. IMRT were delivered with five beams and RapidArc® with two arcs. The comparisons were made by the non-parametric test of Wilcoxon. Medium coverage of the planning target volume was better with RapidArc® (P = 0.01). It was also better regarding the sparing of bowel (P = 0.01) and IMRT was better regarding the sparing of bladder (P = 0.01) and rectum (P = 0.05). The total volume receiving 20 Gy was less important with RapidArc® (P < 0.001). RapidArc® allowed to decrease the treatment time (3 versus 12 minutes with IMRT) and the number of monitor units (MU) (376.5 versus 962.2, on average, P = 0.0001). The technique of RapidArc® seems to obtain better dosimetric results compared to RCMI, with fewer MU, and a significant decrease in treatment time." @default.
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- W2023531820 date "2012-05-01" @default.
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- W2023531820 title "Comparaison dosimétrique des radiothérapies conformationnelles avec modulation d’intensité par faisceaux statiques et RapidArc® des cancers du col" @default.
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- W2023531820 doi "https://doi.org/10.1016/j.canrad.2012.02.002" @default.
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