鼻咽癌放疗旋转与平移误差的相关性
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摘要
目的:研究放射治疗摆位时旋转、平移误差的相关性,探索减少分次放疗摆位误差的方法,以提高肿瘤放疗摆位的稳定性与精确性。方法:收集2015年7月至2017年12月期间接受调强放疗的70位鼻咽癌患者,按首次摆位旋转误差值进行分类:将旋转误差<2°设为对照组;旋转误差≥2°设为研究组。所有病例连续1周行锥形束CT扫描。首次放疗前对校正前、后分别进行一次锥形束CT扫描。结果:对照组首次摆位测得X、Y、Z方向校正前、后误差为:(1.05±0.73)、(1.20±0.74)、(1.44±1.20)mm;(0.43±0.29)、(0.41±0.25)、(0.39±0.30)mm。研究组首次摆位测得X、Y、Z方向校正前、后误差为:(1.17±0.91)、(1.61±1.27)、(1.43±0.82)mm;(0.62±0.35)、(0.83±0.39)、(0.77±0.44)mm。校正前摆位误差无显著性差异(P>0.05);校正后研究组摆位误差显著大于对照组(P<0.05)。对照组首次摆位、分次间摆位通过率为:88.57%、82.86%、71.43%和97.10%、97.10%、94.86%。研究组首次摆位、分次间摆位通过率为:71.43%、60.00%、68.57%和89.71%、82.29%、83.43%。放疗前首次摆位X、Y轴方向摆位误差通过率对照组高于研究组(P<0.05),Z轴无显著性差别(P>0.05);分次间摆位X、Y、Z轴方向摆位误差通过率对照组都高于研究组(P<0.05)。在X、Y、Z方向上研究组外放边界较对照组分别增大0.84、1.19、1.30 mm。旋转误差分布结果显示RX与Z轴有强相关,与Y轴中等相关;RY与X、Y、Z轴均为中等相关;RZ与X轴有强相关,与Y轴中等相关。结论:放射治疗过程中旋转误差对平移误差影响较大,旋转误差较大时平移误差也较大,尤其在放疗过程中分次间误差显著增大。减少旋转误差能有效地提高鼻咽癌放疗摆位精确度与稳定性。
Objective To study the correlation between rotational errors and translational errors in the intensity-modulated radiotherapy(IMRT) of nasopharyngeal carcinoma(NPC), and explore the method to reduce the setup error of fractionated radiotherapy for improving the stability and accuracy of patient positioning in radiotherapy. Methods Seventy patients receiving IMRT for NPC between July 2015 and December 2017 were enrolled in this study. According to the rotational errors at the first setup, the patients were assigned into control group(rotational errors<2°) and study group(rotational error≥2°). All patients received cone beam CT for a week. Before the first radiotherapy, cone beam CT was performed before and after correction. Results The first setup errors in X, Y, Z directions before and after correction were(1.05±0.73),(1.20±0.74),(1.44±1.20) mm and(0.43±0.29),(0.41±0.25),(0.39±0.30) mm in control group;(1.17±0.91),(1.61±1.27),(1.43±0.82) mm and(0.62±0.35),(0.83±0.39),(0.77±0.44) mm in study group. There was no significant difference in the setup error before correction(P>0.05). After correction, the setup errors of study group were significantly greater than those of control group(P<0.05). Significant differences were found in the passing rates of the first setup errors in X and Y directions which were higher in control group than in study group(88.57% vs 71.43%, 82.86% vs 60.00%, all P<0.05),not in the passing rates of the first setup errors in Z direction(71.43% vs 68.57%, P>0.05). The passing rates of the setup errors in fractionated radiotherapy in control group were 97.10%, 97.10%, 94.86%, respectively, significantly higher than89.71%, 82.29%, 83.43% in study group(P<0.05). MPTV in X, Y, and Z directions in control group were increased by 0.84,1.19, and 1.3 mm, compared with those values in control group. The analysis of rotational errors showed that Rxwas strongly correlated with the Z axis, moderately correlated with the Y axis, and that RYwas moderately correlated with the X,Y, and Z axes, and that Rzhad a strong correlation with the X axis and a moderate correlation with the Y-axis. Conclusion Rotational errors have remarkable effects on the translational errors during radiotherapy. When the rotational error is large,the translational error is also large. Reducing the rotational error can effectively improve the accuracy and stability of patient positioning in radiotherapy for NPC.
Objective To study the correlation between rotational errors and translational errors in the intensity-modulated radiotherapy(IMRT) of nasopharyngeal carcinoma(NPC), and explore the method to reduce the setup error of fractionated radiotherapy for improving the stability and accuracy of patient positioning in radiotherapy. Methods Seventy patients receiving IMRT for NPC between July 2015 and December 2017 were enrolled in this study. According to the rotational errors at the first setup, the patients were assigned into control group(rotational errors<2°) and study group(rotational error≥2°). All patients received cone beam CT for a week. Before the first radiotherapy, cone beam CT was performed before and after correction. Results The first setup errors in X, Y, Z directions before and after correction were(1.05±0.73),(1.20±0.74),(1.44±1.20) mm and(0.43±0.29),(0.41±0.25),(0.39±0.30) mm in control group;(1.17±0.91),(1.61±1.27),(1.43±0.82) mm and(0.62±0.35),(0.83±0.39),(0.77±0.44) mm in study group. There was no significant difference in the setup error before correction(P>0.05). After correction, the setup errors of study group were significantly greater than those of control group(P<0.05). Significant differences were found in the passing rates of the first setup errors in X and Y directions which were higher in control group than in study group(88.57% vs 71.43%, 82.86% vs 60.00%, all P<0.05),not in the passing rates of the first setup errors in Z direction(71.43% vs 68.57%, P>0.05). The passing rates of the setup errors in fractionated radiotherapy in control group were 97.10%, 97.10%, 94.86%, respectively, significantly higher than89.71%, 82.29%, 83.43% in study group(P<0.05). MPTV in X, Y, and Z directions in control group were increased by 0.84,1.19, and 1.3 mm, compared with those values in control group. The analysis of rotational errors showed that Rxwas strongly correlated with the Z axis, moderately correlated with the Y axis, and that RYwas moderately correlated with the X,Y, and Z axes, and that Rzhad a strong correlation with the X axis and a moderate correlation with the Y-axis. Conclusion Rotational errors have remarkable effects on the translational errors during radiotherapy. When the rotational error is large,the translational error is also large. Reducing the rotational error can effectively improve the accuracy and stability of patient positioning in radiotherapy for NPC.
引文
[1]戴建荣,胡逸民.图像引导放疗的实现方式[J].中华放射肿瘤学杂志,2006,15(2):132-135.DAI J R,HU Y M.Implementation of image guided radiotherapy[J].Chinese Journal of Radiation Oncology,2006,15(2):132-135.
[2]ASTREINIDOU E,BEL A,RAAIJMAKERS C P,et al.Adequate margins for random setup uncertainties in head-and-neck IMRT[J].Int J Radiat Oncol Biol Phys,2005,61(3):938-944.
[3]于金明,袁双虎.图像引导放射治疗研究及其发展[J].中华肿瘤杂志,2006,28(2):81-83.YU J M,YUAN S H.Research and advancement of image-guided radiotherapy[J].Chinese Journal of Oncology,2006,28(2):81-83.
[4]LETOURNEAU D,MARTINEZ A A,LOCKMAN D,et al.Assessment of residual error for online cone-beam CT-guided treatment of prostate cancer patients[J].Int J Radiat Oncol Biol Phys,2005,62(4):1239-1246.
[5]MORIN O,GILLIS A,CHEN J,等.兆伏级锥形束CT系统说明及IGRT临床应用介绍[J].中国癌症杂志,2006,16(6):513-524.MORIN O,GILLIS A,CHEN J,et al.Megavolt cone beam CT system description and clinical application of IGRT[J].China Oncology,2006,16(6):513-524.
[6]MA Z D,LANGEN K M,MEEKS S L,et al.Evaluation of imageguidance protocols in the treatment of head and neck cancers[J].Int J Radiat Oncol Biol Phys,2007,67(3):670-677.
[7]潘建基.鼻咽癌'92分期修订工作报告[J].中华放射肿瘤学杂志,2009,18(1):2-6.PAN J J.Nasopharyngeal carcinoma'92 stage revision report[J].Chinese Journal of Radiation Oncology,2009,18(1):2-6.
[8]ROSENTHAL S A,GALVIN J M,GOLDWEIN J W,et al.Improved methods for determination of variability in patient positioning for radiation therapy using simulation and serial portal film measurements[J].Int J Radiat Oncol Biol Phys,1992,23(3):621-625.
[9]VAN HERK M.Errors and margins in radiotherapy[J].Semin Radiat Oncol,2004,14(1):52-64.
[10]HURKMANS C W,REMEIJER P,LEBESQUE J V,et al.Set-up verification using portal imaging:review of current clinical practice[J].Radiother Oncol,2001,58(2):105-120.
[11]周军,谭亚军.IGRT技术治疗鼻咽癌摆位误差影响PTV勾画的分析[J].国际检验医学杂志,2014(6):771-772.ZHOU J,TAN Y J.Analysis of the effect of placement error on PTVdelineation in the treatment of nasopharyngeal carcinoma with IGRT[J].International Journal of Laboratory Medicine,2014(6):771-772.
[12]邰国梅.应用机载千伏级CBCT研究鼻咽癌IMRT的摆位误差及其对受照剂量的影响[D].苏州:苏州大学,2010.TAI G M.Using airborne kilovolt CBCT to study the positioning error of nasopharyngeal carcinoma IMRT and its effect on irradiation dose[D].Suzhou:Suzhou University,2010.
[13]KAM M K,CHAU R M,SUEN J,et al.Intensity modulated radiotherapy in nasopharyneal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation[J].Int J Radiat Oncol Boil Phys,2003,56(1):145-157.
[14]倪千喜.调强放射治疗中摆位误差对鼻咽癌患者所受剂量的影响[J].医疗装备,2017,30(12):7-9.NI Q X.Effect of positioning error in IMRT on dose of patients with nasopharyngeal carcinoma[J].Chinese Journal of Medical Device,2017,30(12):7-9.
[15]HONG T S,TOME W A,CHAPPELL R J,et al.The impact of daily setup variations on head-and-neck intensity-modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2005,61(3):779-788.
[16]廖希一.应用IGRT机载千伏级锥形束CT研究头颈部肿瘤调强放疗的摆位误差[D].福州:福建医科大学,2009.LIAO X Y.The positioning error of IMRT for head and neck tumors was studied by IGRT airborne kilovolt cone beam CT[D].Fuzhou:Fujian Medical University,2009.
[17]叶森林,梁廷,荣知璧.应用OBI系统分析鼻咽癌调强放疗的摆位误差[J].医疗卫生装备,2012,33(3):64-65.YE S L,LIANG T,RONG Z B.Setup error analysis with on board imager system for nasopharyngeal carcinoma treated by intensity modulated radiotherapy[J].Chinese Medical Equipment Journal,2012,33(3):64-65.
[18]许峰,王瑾,柏森,等.应用锥形束CT分析肿瘤放疗中分次间及分次内摆位误差[J].癌症,2008,27(10):1111-1116.XU F,WANG J,BAI S,et al.Interfractional and intrafractional setup errors in radiotherapy for tumors analyzed by cone-beam computed tomography[J].Chinese Journal of Cancer,2008,27(10):1111-1116.
[19]许愿.鼻咽癌IMRT基于图像匹配对摆位误差影响的研究[D].苏州:苏州大学,2013.XU Y.Study on effects of image registration on setup errors for nasopharyngeal carcinoma undergoing intensity-modulated radiation therapy(IMRT)[D].Suzhou:Soochow University,2013.
[20]马广栋,李承军,付敬国,等.不同解剖区域配准方法对鼻咽癌体位误差的影响[J].医疗卫生装备,2011,32(7):63-64.MA G D,LI C J,FU J G,et al.Multiple regions-of-interest analysis of setup errors of nasopharyngeal carcinoma radiotherapy[J].Chinese Medical Equipment Journal,2011,32(7):63-64.
[21]张利文,石锦平,谢秋英,等.等中心偏移误差对容积调强放疗计划的剂量影响[J].肿瘤预防与治疗,2012,25(3):160-163.ZHANG L W,SHI J P,XIE Q Y,et al.The dose impact of the isocenter offset errors on the plan for volumetric modulated arc therapy[J].Journal of Cancer Control and Treatment,2012,25(3):160-163.
[22]郑茁,陈传本,陈荔莎,等.头颈部肿瘤摆位误差对调强放疗计划的影响[J].中国癌症防治杂志,2011,3(3):214-217.ZHENG Z,CHEN C B,CHEN L S,et al.The impact of setup errors on treating head and neck cancer with intensity modulated radiation therapy[J].Chinese Journal of Cancer Prevention and Treatment,2011,3(3):214-217.
[23]申红峰,王小深,欧光明,等.基于图像引导下头颈部肿瘤放射治疗患者摆位误差的相关性分析[J].中国医学装备,2016,13(10):22-24.SHEN H F,WANG X S,OU G M,et al.Research on correlation of setup errors for head and neck cancer patients with radiotherapy based on image guidance[J].China Medical Equipment,2016,13(10):22-24.
[24]郑祖安,付秀根,钟伟伟,等.面颈部肿瘤影像引导精确放射治疗摆位误差的研究[J].中华肿瘤防治杂志,2012,19(20):1554-1556.ZHENG Z A,FU X G,ZHONG W W,et al.Study on the setting error of precise radiotherapy guided by facial and cervical tumor imaging[J].Chinese Journal of Cancer Prevention and Treatment,2012,19(20):1554-1556.
[25]潘建基,潘才住,陈传本,等.摆位系统误差对鼻咽癌调强放疗剂量的影响[J].中华放射肿瘤学杂志,2007,16(5):394-396.PAN J J,PAN C Z,CHEN C B,et al.Effects of positioning system error on dose of IMRT for nasopharyngeal carcinoma[J].Chinese Journal of Radiation Oncology,2007,16(5):394-396.
[26]XING L,LIN Z X,DONALDSON S S,et al.Dosimetric effects of patient displacement and collimator and gantry angle misalignment[J].Radiother Oncol,2000,56(1):97-108.
[27]GUTFELD O,KRETZLER A E,KASHANI R,et al.Influence of rotations on dose distribution in spinal stereotactic body radiotherapy(SBRT)[J].Int J Radiat Oncol Biol Phys,2009,73(5):1596-1601.
[2]ASTREINIDOU E,BEL A,RAAIJMAKERS C P,et al.Adequate margins for random setup uncertainties in head-and-neck IMRT[J].Int J Radiat Oncol Biol Phys,2005,61(3):938-944.
[3]于金明,袁双虎.图像引导放射治疗研究及其发展[J].中华肿瘤杂志,2006,28(2):81-83.YU J M,YUAN S H.Research and advancement of image-guided radiotherapy[J].Chinese Journal of Oncology,2006,28(2):81-83.
[4]LETOURNEAU D,MARTINEZ A A,LOCKMAN D,et al.Assessment of residual error for online cone-beam CT-guided treatment of prostate cancer patients[J].Int J Radiat Oncol Biol Phys,2005,62(4):1239-1246.
[5]MORIN O,GILLIS A,CHEN J,等.兆伏级锥形束CT系统说明及IGRT临床应用介绍[J].中国癌症杂志,2006,16(6):513-524.MORIN O,GILLIS A,CHEN J,et al.Megavolt cone beam CT system description and clinical application of IGRT[J].China Oncology,2006,16(6):513-524.
[6]MA Z D,LANGEN K M,MEEKS S L,et al.Evaluation of imageguidance protocols in the treatment of head and neck cancers[J].Int J Radiat Oncol Biol Phys,2007,67(3):670-677.
[7]潘建基.鼻咽癌'92分期修订工作报告[J].中华放射肿瘤学杂志,2009,18(1):2-6.PAN J J.Nasopharyngeal carcinoma'92 stage revision report[J].Chinese Journal of Radiation Oncology,2009,18(1):2-6.
[8]ROSENTHAL S A,GALVIN J M,GOLDWEIN J W,et al.Improved methods for determination of variability in patient positioning for radiation therapy using simulation and serial portal film measurements[J].Int J Radiat Oncol Biol Phys,1992,23(3):621-625.
[9]VAN HERK M.Errors and margins in radiotherapy[J].Semin Radiat Oncol,2004,14(1):52-64.
[10]HURKMANS C W,REMEIJER P,LEBESQUE J V,et al.Set-up verification using portal imaging:review of current clinical practice[J].Radiother Oncol,2001,58(2):105-120.
[11]周军,谭亚军.IGRT技术治疗鼻咽癌摆位误差影响PTV勾画的分析[J].国际检验医学杂志,2014(6):771-772.ZHOU J,TAN Y J.Analysis of the effect of placement error on PTVdelineation in the treatment of nasopharyngeal carcinoma with IGRT[J].International Journal of Laboratory Medicine,2014(6):771-772.
[12]邰国梅.应用机载千伏级CBCT研究鼻咽癌IMRT的摆位误差及其对受照剂量的影响[D].苏州:苏州大学,2010.TAI G M.Using airborne kilovolt CBCT to study the positioning error of nasopharyngeal carcinoma IMRT and its effect on irradiation dose[D].Suzhou:Suzhou University,2010.
[13]KAM M K,CHAU R M,SUEN J,et al.Intensity modulated radiotherapy in nasopharyneal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation[J].Int J Radiat Oncol Boil Phys,2003,56(1):145-157.
[14]倪千喜.调强放射治疗中摆位误差对鼻咽癌患者所受剂量的影响[J].医疗装备,2017,30(12):7-9.NI Q X.Effect of positioning error in IMRT on dose of patients with nasopharyngeal carcinoma[J].Chinese Journal of Medical Device,2017,30(12):7-9.
[15]HONG T S,TOME W A,CHAPPELL R J,et al.The impact of daily setup variations on head-and-neck intensity-modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2005,61(3):779-788.
[16]廖希一.应用IGRT机载千伏级锥形束CT研究头颈部肿瘤调强放疗的摆位误差[D].福州:福建医科大学,2009.LIAO X Y.The positioning error of IMRT for head and neck tumors was studied by IGRT airborne kilovolt cone beam CT[D].Fuzhou:Fujian Medical University,2009.
[17]叶森林,梁廷,荣知璧.应用OBI系统分析鼻咽癌调强放疗的摆位误差[J].医疗卫生装备,2012,33(3):64-65.YE S L,LIANG T,RONG Z B.Setup error analysis with on board imager system for nasopharyngeal carcinoma treated by intensity modulated radiotherapy[J].Chinese Medical Equipment Journal,2012,33(3):64-65.
[18]许峰,王瑾,柏森,等.应用锥形束CT分析肿瘤放疗中分次间及分次内摆位误差[J].癌症,2008,27(10):1111-1116.XU F,WANG J,BAI S,et al.Interfractional and intrafractional setup errors in radiotherapy for tumors analyzed by cone-beam computed tomography[J].Chinese Journal of Cancer,2008,27(10):1111-1116.
[19]许愿.鼻咽癌IMRT基于图像匹配对摆位误差影响的研究[D].苏州:苏州大学,2013.XU Y.Study on effects of image registration on setup errors for nasopharyngeal carcinoma undergoing intensity-modulated radiation therapy(IMRT)[D].Suzhou:Soochow University,2013.
[20]马广栋,李承军,付敬国,等.不同解剖区域配准方法对鼻咽癌体位误差的影响[J].医疗卫生装备,2011,32(7):63-64.MA G D,LI C J,FU J G,et al.Multiple regions-of-interest analysis of setup errors of nasopharyngeal carcinoma radiotherapy[J].Chinese Medical Equipment Journal,2011,32(7):63-64.
[21]张利文,石锦平,谢秋英,等.等中心偏移误差对容积调强放疗计划的剂量影响[J].肿瘤预防与治疗,2012,25(3):160-163.ZHANG L W,SHI J P,XIE Q Y,et al.The dose impact of the isocenter offset errors on the plan for volumetric modulated arc therapy[J].Journal of Cancer Control and Treatment,2012,25(3):160-163.
[22]郑茁,陈传本,陈荔莎,等.头颈部肿瘤摆位误差对调强放疗计划的影响[J].中国癌症防治杂志,2011,3(3):214-217.ZHENG Z,CHEN C B,CHEN L S,et al.The impact of setup errors on treating head and neck cancer with intensity modulated radiation therapy[J].Chinese Journal of Cancer Prevention and Treatment,2011,3(3):214-217.
[23]申红峰,王小深,欧光明,等.基于图像引导下头颈部肿瘤放射治疗患者摆位误差的相关性分析[J].中国医学装备,2016,13(10):22-24.SHEN H F,WANG X S,OU G M,et al.Research on correlation of setup errors for head and neck cancer patients with radiotherapy based on image guidance[J].China Medical Equipment,2016,13(10):22-24.
[24]郑祖安,付秀根,钟伟伟,等.面颈部肿瘤影像引导精确放射治疗摆位误差的研究[J].中华肿瘤防治杂志,2012,19(20):1554-1556.ZHENG Z A,FU X G,ZHONG W W,et al.Study on the setting error of precise radiotherapy guided by facial and cervical tumor imaging[J].Chinese Journal of Cancer Prevention and Treatment,2012,19(20):1554-1556.
[25]潘建基,潘才住,陈传本,等.摆位系统误差对鼻咽癌调强放疗剂量的影响[J].中华放射肿瘤学杂志,2007,16(5):394-396.PAN J J,PAN C Z,CHEN C B,et al.Effects of positioning system error on dose of IMRT for nasopharyngeal carcinoma[J].Chinese Journal of Radiation Oncology,2007,16(5):394-396.
[26]XING L,LIN Z X,DONALDSON S S,et al.Dosimetric effects of patient displacement and collimator and gantry angle misalignment[J].Radiother Oncol,2000,56(1):97-108.
[27]GUTFELD O,KRETZLER A E,KASHANI R,et al.Influence of rotations on dose distribution in spinal stereotactic body radiotherapy(SBRT)[J].Int J Radiat Oncol Biol Phys,2009,73(5):1596-1601.