Evaluasi Kualitas Dosimetri Rencana Radioterapi 3DCRT Berdasarkan Parameter Dose Volume Histogram (DVH) Pada Kasus Metastasis Tulang Lumbal Di RSUD Bali Mandara
DOI:
https://doi.org/10.31004/koloni.v5i4.1558Keywords:
Three-Dimensional Conformal Radiation Therapy (3DCRT), Dose Volume Histogram (DVH), dosimetry, lumbar bone metastasis, Planning Target Volume (PTV), Organ at Risk (OAR)Abstract
Lumbar bone metastases may cause pain, neurological impairment, and reduced quality of life, requiring optimal radiotherapy planning. Three-Dimensional Conformal Radiation Therapy (3DCRT) is one of the radiotherapy techniques that can be used for bone metastases while considering dose distribution to the target and surrounding normal tissues. The dosimetric quality of a treatment plan can be evaluated using the Dose Volume Histogram (DVH), particularly through Planning Target Volume (PTV) parameters. This study aimed to evaluate the dosimetric quality of 3DCRT radiotherapy treatment plans for lumbar bone metastases at RSUD Bali Mandara based on D95%, D2%, and Dmean parameters. A retrospective descriptive observational study with a case series approach was conducted on four radiotherapy treatment plans for patients with lumbar bone metastases. Data were obtained from the Treatment Planning System (TPS) and descriptively analyzed based on PTV DVH parameters, while the mean dose of the Organs at Risk (OARs) was used as supporting information. The results showed that D95% ranged from 97.2% to 100.8%, D2% from 105.4% to 106.2%, and Dmean from 101.5% to 104.1% of the prescribed dose. All treatment plans had D95% ≥95% and D2% ≤107% based on the evaluation criteria applied in this study. Mean OAR doses varied among patients and were associated with differences in anatomy, PTV size and location, and the spatial relationship between the target and OARs. Based on these findings, all four evaluated 3DCRT treatment plans met the PTV dosimetric criteria applied in this study, while the OAR data provided supporting information on dose distribution to normal tissues.Downloads
References
Alcorn, S. R., Artal Cortés, Á., Bradfield, L., Brennan, M., Dennis, K., Diaz, D. A., et al. (2024). External beam radiation therapy for palliation of symptomatic bone metastases: An ASTRO clinical practice guideline. Practical Radiation Oncology, 14(5), 377–397. https://doi.org/10.1016/j.prro.2024.04.018.
Arnold, C. C., Toussaint, A., Mantel, F., Flentje, M., & Bratengeier, K. (2023). Dosimetric evaluation of a spinal cord dose-limiting 3D-CRT technique for radiotherapy of spinal metastases. Journal of Applied Clinical Medical Physics, 24(10), e14042. https://doi.org/10.1002/acm2.14042.
Bentzen, S. M., Constine, L. S., Deasy, J. O., Eisbruch, A., Jackson, A., Marks, L. B., Ten Haken, R. K., & Yorke, E. D. (2010). Quantitative analyses of normal tissue effects in the clinic (QUANTEC): An introduction to the scientific issues. International Journal of Radiation Oncology • Biology • Physics, 76(3 Suppl.), S3–S9. https://doi.org/10.1016/j.ijrobp.2009.09.040.
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834.
Chow, R., Hoskin, P., Schild, S. E., Raman, S., Im, J., Zhang, D., et al. (2019). Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta-analysis. Radiotherapy and Oncology, 141, 56–61. https://doi.org/10.1016/j.radonc.2019.06.037.
Clézardin, P., Coleman, R., Puppo, M., Ottewell, P., Bonnelye, E., Paycha, F., Confavreux, C., Holen, I., & Colleoni, M. (2021). Bone metastasis. Nature Reviews Disease Primers, 7(1), 18. https://doi.org/10.1038/s41572-021-00281-4.
Coleman, R., Hadji, P., Body, J. J., Santini, D., Chow, E., Terpos, E., et al. (2020). Bone health in cancer: ESMO Clinical Practice Guidelines. Annals of Oncology, 31(12), 1650–1663. https://doi.org/10.1016/j.annonc.2020.07.019.
Drzymala, R. E., Mohan, R., Brewster, L. J., Chu, J. C. H., Goitein, M., & Muench, P. (1991). Dose-volume histograms. International Journal of Radiation Oncology • Biology • Physics, 21(1), 71–78. https://doi.org/10.1016/0360-3016(91)90168-4.
Hodapp, N. (2012). The ICRU Report 83: Prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlentherapie und Onkologie, 188(1), 97–99. https://doi.org/10.1007/s00066-011-0015-x.
International Commission on Radiation Units and Measurements. (1993). ICRU Report 50: Prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units and Measurements.
International Commission on Radiation Units and Measurements. (2010). ICRU Report 83: Prescribing, recording and reporting intensity-modulated photon-beam therapy (IMRT). Journal of the ICRU, 10(1). https://doi.org/10.1093/jicru/ndq002.
Kirkpatrick, J. P., van der Kogel, A. J., & Schultheiss, T. E. (2010). Radiation dose-volume effects in the spinal cord. International Journal of Radiation Oncology • Biology • Physics, 76(3 Suppl.), S42–S49. https://doi.org/10.1016/j.ijrobp.2009.04.095.
Lutz, S., Balboni, T., Jones, J., Lo, S., Petit, J., Rich, S. E., et al. (2017). Palliative radiation therapy for bone metastases: Update of an ASTRO evidence-based guideline. Practical Radiation Oncology, 7(1), 4–12. https://doi.org/10.1016/j.prro.2016.08.001.
Ryu, S., Deshmukh, S., Timmerman, R. D., Movsas, B., Gerszten, P., Yin, F. F., et al. (2023). Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: Phase 3 results of NRG Oncology/RTOG 0631 randomized clinical trial. JAMA Oncology, 9(6), 800–807. https://doi.org/10.1001/jamaoncol.2023.0356.
Soyfer, V., Corn, B. W., Shtraus, N., Schifter, D., & Tempelhof, H. (2013). The advantage of 3D conformal treatment of lumbar spine metastases in comparison to traditional PA or AP-PA techniques: Restoring an intermediate niche of therapeutic sophistication. Radiation Oncology, 8, 34. https://doi.org/10.1186/1748-717X-8-34.
Viswanathan, A. N., Yorke, E. D., Marks, L. B., Eifel, P. J., & Shipley, W. U. (2010). Radiation dose-volume effects of the urinary bladder. International Journal of Radiation Oncology • Biology • Physics, 76(3 Suppl.), S116–S122. https://doi.org/10.1016/j.ijrobp.2009.02.090.
Yeo, S. G. (2015). Palliative radiotherapy for thoracic spine metastases: Dosimetric advantage of three-dimensional conformal plans. Oncology Letters, 10(1), 497–501. https://doi.org/10.3892/ol.2015.3205.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Dhea Sukma Rahmadanni, Rickhy Krisopras Kakiay, I Kadek Sukadana, Burlian Mughnie, I Wayan Juliasa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
