1. 前列腺癌三维适形放疗的不确定性因素分析 2. 上颌窦鳞癌术前放疗后病理反应的预后意义
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摘要
目的
研究盆腔肿瘤三维适形放疗的摆位误差大小，为盆腔肿瘤适形放疗计划设计时CTV外放PTV提供参考数据。
材料与方法
接受放疗的直肠癌病例3例和前列腺癌病例2例，均为男性，行俯卧位盆腔三维适形放疗，治疗时身下垫有孔泡沫板，热塑成型固定膜固定。每例病例连续5天照射，每次摆位时在体表固定点粘贴定位金点，加速器机头插入定位“+”字刻度板，照射正侧位治疗验证片各一张，共计摆位25次，照射治疗验证片50张。以第一次摆位片为标准，计算前后、头尾、左右方向摆位误差。
结果
分析5例病例25次摆位误差，人与人之间以及次与此之间均存在一定差别。前后方向摆位误差最大，平均值为0.98±0.68cm((?)±SD)，有9次摆位误差≥1cm，占测算次数的45％，其中2次误差≥2cm；头尾方向摆位误差为0.5～0.7±0.45cm，正位测定头尾方向误差小于侧位，分别为0.51±0.46cm和0.70±0.45cm((?)±SD)，正位和侧位分别有4次和7次摆位误差≥1cm；左右方向误差最小，为0.37±0.28cm((?)+SD)，仅1次误差≥1cm。
结论
在三维适形技术放疗盆腔肿瘤时，左右方向摆位误差最小，头尾方向居中，前后方向最大；CTV外放PTV应考虑：左右方向0.5cm，头尾方向1.0cm，前后方向1.5cm。
Purpose
To investigate the spatial distribution of set-up errors for patients treated with three-dimensional (3D) conformal radiation therapy for pelvic carcinoma and to provide referential safe margins out of CTV during treatment plan design. Materials and Methods
Five patients with rectal or prostate cancers entered the study. All were treated with three-dimensional conformal radiotherapy in a prone position. Belly board was used. Thermoplastic cast was used for immobilization. Measurements were made on a daily basis setup under five consecutive treatments. During patients positioning, gold particles were placed on the skin markers, one in the lateral, and the other in the back. Portal films from two projections (one anterior-posterior and one opposite lateral) were taken after the reticule localizer was inserted to the head of accelerator. Fifty portal films from 25 setups were analyzed. The spatial distribution of set-up errors from left-right, superior-inferior and anterior-posterior directions were evaluated comparing to the first set-up films (representing the standard treatment position).
Results
The magnitude of set-up errors from 25 positionings in 5 patients differed from patient to patient and day to day. Maximal set-up errors were inspected in the anterior-posterior direction, with a mean of 0.98±0.68 cm (X±SD), 9 of 20 measurements (45%) were > or =1 cm, and two in the 9 measurements were > or =2 cm; The set-up errors for superior-inferior were 0.5-0.7±0.45 cm (X±SD), and the average magnitude from anterior-posterior films was smaller than that from opposite lateral films, 0.51±0.46 cm and 0.70±0.45 cm, respectively. There were 4 and 7 times of > or =1 cm superior-inferior displacements measured from anterior-posterior films and lateral films respectively; the
研究盆腔肿瘤三维适形放疗的摆位误差大小，为盆腔肿瘤适形放疗计划设计时CTV外放PTV提供参考数据。
材料与方法
接受放疗的直肠癌病例3例和前列腺癌病例2例，均为男性，行俯卧位盆腔三维适形放疗，治疗时身下垫有孔泡沫板，热塑成型固定膜固定。每例病例连续5天照射，每次摆位时在体表固定点粘贴定位金点，加速器机头插入定位“+”字刻度板，照射正侧位治疗验证片各一张，共计摆位25次，照射治疗验证片50张。以第一次摆位片为标准，计算前后、头尾、左右方向摆位误差。
结果
分析5例病例25次摆位误差，人与人之间以及次与此之间均存在一定差别。前后方向摆位误差最大，平均值为0.98±0.68cm((?)±SD)，有9次摆位误差≥1cm，占测算次数的45％，其中2次误差≥2cm；头尾方向摆位误差为0.5～0.7±0.45cm，正位测定头尾方向误差小于侧位，分别为0.51±0.46cm和0.70±0.45cm((?)±SD)，正位和侧位分别有4次和7次摆位误差≥1cm；左右方向误差最小，为0.37±0.28cm((?)+SD)，仅1次误差≥1cm。
结论
在三维适形技术放疗盆腔肿瘤时，左右方向摆位误差最小，头尾方向居中，前后方向最大；CTV外放PTV应考虑：左右方向0.5cm，头尾方向1.0cm，前后方向1.5cm。
Purpose
To investigate the spatial distribution of set-up errors for patients treated with three-dimensional (3D) conformal radiation therapy for pelvic carcinoma and to provide referential safe margins out of CTV during treatment plan design. Materials and Methods
Five patients with rectal or prostate cancers entered the study. All were treated with three-dimensional conformal radiotherapy in a prone position. Belly board was used. Thermoplastic cast was used for immobilization. Measurements were made on a daily basis setup under five consecutive treatments. During patients positioning, gold particles were placed on the skin markers, one in the lateral, and the other in the back. Portal films from two projections (one anterior-posterior and one opposite lateral) were taken after the reticule localizer was inserted to the head of accelerator. Fifty portal films from 25 setups were analyzed. The spatial distribution of set-up errors from left-right, superior-inferior and anterior-posterior directions were evaluated comparing to the first set-up films (representing the standard treatment position).
Results
The magnitude of set-up errors from 25 positionings in 5 patients differed from patient to patient and day to day. Maximal set-up errors were inspected in the anterior-posterior direction, with a mean of 0.98±0.68 cm (X±SD), 9 of 20 measurements (45%) were > or =1 cm, and two in the 9 measurements were > or =2 cm; The set-up errors for superior-inferior were 0.5-0.7±0.45 cm (X±SD), and the average magnitude from anterior-posterior films was smaller than that from opposite lateral films, 0.51±0.46 cm and 0.70±0.45 cm, respectively. There were 4 and 7 times of > or =1 cm superior-inferior displacements measured from anterior-posterior films and lateral films respectively; the
引文
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1. Skala M, Berry M, Duchesne G, et al. Australian and New Zealand three- dimensional conformal radiation therapy consensus guidelines for prostate cancer. Australasian Radiology 2004;48:493-501.
2. Weber DC, Nouet P, Rouzaud M, et al. Patient positioning in prostate radiotherapy: is prone better than supine? Int J Radial Oncol Biol Phys 2000;47:365-371.
3. Happersett L, Mageras GS, Zelefsky MJ, et al. A study of the effects of internal organ motion on dose escalation in conformal prostate treatments. Radiother Oncol 2003;66:263-270.
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4. Antolak JA, Rosen II, Childress CH, et al. Prostate target volume variations during a course of radiotherapy. Int J Radiat Oncol Biol Phys 1998;42:661-672.
5. Happersett L, Mageras GS, Zelefsky MJ, et al. A study of the effects of internal organ motion on dose escalation in conformal prostate treatments. Radiother Oncol 2003;66:263-270.
6. Wang L, Jacob R, Lili Chen, et al. Stereotactic IMRT for prostate cancer: Setup accuracy of a new stereotactic body localization system. JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 2004;5:18-28.
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11．钟亚华，周云峰，谢丛华等．真空成型袋在盆腔野放射治疗中的价值．中华放射肿瘤学杂志 2002；11：240-246页．
12. Hanley J, Lumley MA, Mageras GS, et al. Measurement of patient positioning errors in three-dimensional conformal radiotherapy of the prostate. Int J Radiat Oncol Biol Phys 1997; 37: 435-444.
13. Rudat V, Schraube P, Oetzel D, et al. Combined error of patient positioning variability and prostate motion uncertainty in 3D conformal radiotherapy of localized prostate cancer, Int J Radiat Oncol Biol Phys 1996; 35: 1027-1034.
14. Bayley AJ, Catton CN, Haycocks T, et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radiother Oncol 2004; 70: 37-44.
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21. Fokdal L, Honore H, Hoyer M, et al. Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer. Int J Radiat Oncol Biol Phys 2004;59:436-444.
22. Roeske JC, Forman JD, Mesina CF, et al. Evaluation of changes in the size and location of the prostate, seminal vesicles, bladder, and rectum during a course of external beam radiation therapy. Int J Radiat Oncol Biol Phys 1995;33:1321-1329.
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12. Hanley J, Lumley MA, Mageras GS, et al. Measurement of patient positioning errors in three-dimensional conformal radiotherapy of the prostate. Int J Radiat Oncol Biol Phys 1997; 37: 435-444.
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14. Bayley AJ, Catton CN, Haycocks T, et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radiother Oncol 2004; 70: 37-44.
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