图像引导放疗在58例肺癌患者中的应用观察  

Image-guided radiotherapy for fifty-eight patients with lung cancer

作　　者：梁军[1] 张涛[1] 王文卿[1] 唐源[1] 陈东福[1] 张寅[1] 张连胜[1] 李明辉[1] 符贵山[1] 戴建荣[1] 王绿化[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2009年第4期278-280,共3页Chinese Journal of Radiation Oncology

摘　　要：目的观察图像引导放疗（IGRT）在肺癌中的应用价值。方法搜集近1年内采用IGRT的58例肺癌病例，其中左肺癌22例，右肺癌30例，肺癌纵隔淋巴结转移5例，椎体转移1例。比较摆位前后IGRT数据，比较大体肿瘤体积（GTV）在IGRT图像与模拟定位CT图像的变化。结果摆位误差在x、y,z轴上分别为（0．02±0．26）、（-0．14±0．49）、（-0．13±0．27）cm和旋转轴上的分别为-0．15°±1．59°、-0．01°±1．50°、0．12°±1．08°。15例IGRT图像显示GTV有移位，其中左上肺最多见有5例。向腹方向移位9例，4例为左上肺病变。23例疗中GTV缩小，其中右上肺10例，左上肺5例。16个病变有在右方向上缩小，其中右上肺7个。22个病变均呈非对称性缩小，GTV平均缩小4．9cm^3。GTV缩小时放疗剂量为4～46Gy，其中9例为20—30Gy。结论IGRT的应用明显减少了肺癌患者放疗摆位误差。IGRT观察N25．9％GTV有移动，44．2％疗中GTV缩小，何时进行靶区修改有待进一步研究。Objective To study the value of image-guided radiotherapy （IGRT） in lung cancer. Methods From Mar. 2007 to Dec. 2007,58 patients with lung cancer were treated with IGRT. Set-up errors in each axial direction was calculated based on IGRT images of each patient. The change of GTV was evaluated on both cone-beam CT and CT simulator images. Results Twenty-two patients with left lung cancer,30 with right lung cancer,5 with mediastinal lymphanode metastasis and one with vertebra metastasis were included. The set-up error in x,y and z axes was （0.02 ± 0.26） cm, （0.14 ± 0.49） em and （ - 0.13 ± 0.27） cm, respectively,while the rotary set-up error in each axis was -0.15±1.59°, -0.01°±1.50° and 0.12°±1.08°, respectively. The set-up errors were significantly decreased by using of IGRT. GTV movement was observed in 15 patients （25.9%）, including 5 with left upper lung cancer. GTV moving to the anterior direction was observed in 9 patients,including 4 with left upper lung cancer. GTV reduced in 23 （44.2%） patients during treatment. Asymmetric GTV reduction of 22 lesions was observed,with a mean reductive volume of 4.9 cm3. When GTV began to shrink, the irradiation dose was 4 - 46 Gy, with 20 - 30 Gy in 9 patients. Conclusions The use of IGRT can significantly reduce set-up errors. GTV movement and reduction are observed in some cases. The time to modify the target volume needs to be further studied.

关 键 词：肺肿瘤/放射疗法 图像引导 摆位误差 大体肿瘤体积 

分 类 号：R686[医药卫生—骨科学]