IGRT对肺部恶性肿瘤精确放疗时摆位误差及摆位外扩边界值的影响
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摘要
目的探讨图像引导放疗(IGRT)在肺部恶性肿瘤中的应用价值。方法回顾性分析44例肺部恶性肿瘤患者的临床资料,所有患者采用热塑体模固定,每天行IGRT,根据锥形束CT图像与计划CT图像相匹配,获得患者左右(x)、头脚(y)、前后(z)3个方向的线性误差和旋转误差,并对误差进行校正,分析校正前后摆位误差的变化。结果校正后x、y、z轴上的平均摆位误差分别为(-0.02±0.20)、(0.04±0.21)、(-0.01±0.11)cm,均低于校正前,差异均有统计学意义(P﹤0.05);校正前与校正后旋转x、y、z轴上的平均摆位误差比较,差异均无统计学意义(P﹥0.05);校正后x、y、z轴上的摆位外扩边界值(MPTV)分别较校正前减少2.80、7.16、4.78 mm。结论 IGRT可明显减小肺部恶性肿瘤患者放疗时的摆位误差,缩小MPTV,提高放疗的精确性。
Objective To explore the value of image-guided radiotherapy(IGRT) in the treatment for lung malignant tumor. Method 44 patients with lung malignant tumor were retrospectively analyzed, all patients were administered with thermoplastic fixation, and treated with daily IGRT, the conical beam CT image were matched with the planned CT image, and then the linear error and rotation error of the 3 axes of left and right(x), head and foot(y), anterior and posterior(z) were obtained and corrected to analyze the change of the positioning error before and after correction. Result The mean positioning error of x, y and z axes were(-0.02 ± 0.20),(0.04 ± 0.21) and(-0.01 ± 0.11) cm after correction, which were lower compared with that before correction, the differences were statistically significant(P<0.05); there was no significant difference between the mean rotation error on x, y and z axes before and after correction(P>0.05); after correction, the expanding margin value(MPTV) of the x, y and z axes decreased 2.80, 7.16 and 4.78 mm compared with those before correction. Conclusion The application of IGRT can significantly reduce the radiotherapy positioning error in patients with lung malignant tumor, minimizing the MPTV, and improving the accuracy of radiotherapy.
Objective To explore the value of image-guided radiotherapy(IGRT) in the treatment for lung malignant tumor. Method 44 patients with lung malignant tumor were retrospectively analyzed, all patients were administered with thermoplastic fixation, and treated with daily IGRT, the conical beam CT image were matched with the planned CT image, and then the linear error and rotation error of the 3 axes of left and right(x), head and foot(y), anterior and posterior(z) were obtained and corrected to analyze the change of the positioning error before and after correction. Result The mean positioning error of x, y and z axes were(-0.02 ± 0.20),(0.04 ± 0.21) and(-0.01 ± 0.11) cm after correction, which were lower compared with that before correction, the differences were statistically significant(P<0.05); there was no significant difference between the mean rotation error on x, y and z axes before and after correction(P>0.05); after correction, the expanding margin value(MPTV) of the x, y and z axes decreased 2.80, 7.16 and 4.78 mm compared with those before correction. Conclusion The application of IGRT can significantly reduce the radiotherapy positioning error in patients with lung malignant tumor, minimizing the MPTV, and improving the accuracy of radiotherapy.
引文
[1]彭小保,陈文强,赵军军,等.图像引导技术在周围型肺癌患者放疗中的应用[J].现代肿瘤医学,2017,25(19):3134-3137.
[2]肖友立,谢冠慧,欧益民,等.CT模拟机及模拟定位机在头颈部肿瘤IMRT位置验证中的应用[J].现代肿瘤医学,2017,25(6):948-951.
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[5]张一戈,邱小平,陈维军,等.基于图像引导技术对头颈部肿瘤临床摆位误差的剂量学影响[J].中国医学物理学杂志,2015,32(1):25-30.
[6]盛馨,王凡,童铸廷,等.3种配准方式下头颈部肿瘤IGRT摆位误差的比较[J].安徽医科大学学报,2017,52(5):746-748.
[7]黄啸天,张俊,周云峰,等.方差分析法在肺癌立体定向放射治疗摆位误差及计划靶区外放边界中的应用[J].中国医学物理学杂志,2017,34(6):579-584.
[8]李润霄,樊晓妹,王京,等.锥形束CT图像引导下子宫颈癌术后调强放疗摆位误差及计划靶区外扩范围的研究[J].中华妇产科杂志,2015,50(10):784-785.
[9]童琴,杨昌宣,肖爱农,等.锥形束CT图像引导下宫颈癌患者放疗摆位误差的临床应用分析[J].中南医学科学杂志,2015,43(2):201-203.
[10]王焱,蔡钢,陆维,等.肺部肿瘤立体定向放疗技术中基于锥形束CT影像的摆位误差分析[J].中国癌症杂志,2017,27(6):501-504.
[11]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.
[12]朱娟,董洪敏,王文玲,等.应用锥形束CT研究椎骨转移瘤的放疗摆位误差及PTV外扩边距[J].中华放射医学与防护杂志,2015,35(10):764-766.
[13]邢晓汾,郭瑞嵩,傅翔宇,等.肺部肿瘤立体定向放射治疗摆位误差及靶区外扩距离[J].中国医学物理学杂志,2015,32(4):529-533.
[14]吴冰,何俊翔,付敬国,等.图像引导放射治疗在盆腔肿瘤放疗中的应用研究[J].中国医疗器械杂志,2015,39(4):299-301.
[15]王昌民,胡伟刚,彭佳元,等.IGRT技术在肺癌SB RT治疗靶区位置误差测定中的应用[J].中国临床医学,2016,23(6):841-845.
[2]肖友立,谢冠慧,欧益民,等.CT模拟机及模拟定位机在头颈部肿瘤IMRT位置验证中的应用[J].现代肿瘤医学,2017,25(6):948-951.
[3]Stroom JC,de Boer HC,Huizenga H,et al.Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability[J].Int J Radiat Oncol Biol Phys,1999,43(4):905-919.
[4]梁恒坡,韩倩,李良,等.体质指数对肺癌患者图像引导放疗中摆位误差的影响[J].中国临床研究,2017,30(3):320-322.
[5]张一戈,邱小平,陈维军,等.基于图像引导技术对头颈部肿瘤临床摆位误差的剂量学影响[J].中国医学物理学杂志,2015,32(1):25-30.
[6]盛馨,王凡,童铸廷,等.3种配准方式下头颈部肿瘤IGRT摆位误差的比较[J].安徽医科大学学报,2017,52(5):746-748.
[7]黄啸天,张俊,周云峰,等.方差分析法在肺癌立体定向放射治疗摆位误差及计划靶区外放边界中的应用[J].中国医学物理学杂志,2017,34(6):579-584.
[8]李润霄,樊晓妹,王京,等.锥形束CT图像引导下子宫颈癌术后调强放疗摆位误差及计划靶区外扩范围的研究[J].中华妇产科杂志,2015,50(10):784-785.
[9]童琴,杨昌宣,肖爱农,等.锥形束CT图像引导下宫颈癌患者放疗摆位误差的临床应用分析[J].中南医学科学杂志,2015,43(2):201-203.
[10]王焱,蔡钢,陆维,等.肺部肿瘤立体定向放疗技术中基于锥形束CT影像的摆位误差分析[J].中国癌症杂志,2017,27(6):501-504.
[11]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.
[12]朱娟,董洪敏,王文玲,等.应用锥形束CT研究椎骨转移瘤的放疗摆位误差及PTV外扩边距[J].中华放射医学与防护杂志,2015,35(10):764-766.
[13]邢晓汾,郭瑞嵩,傅翔宇,等.肺部肿瘤立体定向放射治疗摆位误差及靶区外扩距离[J].中国医学物理学杂志,2015,32(4):529-533.
[14]吴冰,何俊翔,付敬国,等.图像引导放射治疗在盆腔肿瘤放疗中的应用研究[J].中国医疗器械杂志,2015,39(4):299-301.
[15]王昌民,胡伟刚,彭佳元,等.IGRT技术在肺癌SB RT治疗靶区位置误差测定中的应用[J].中国临床医学,2016,23(6):841-845.