勾画标准培训对乳腺癌保乳术后放疗靶区勾画的作用  

The influence of delineating criteria training on the delineation of tumor bed and whole breast target after breast-conserving surgery

作　　者：徐敏[1] 李建彬[1] 于志强[1] 杨涛[1] 王晓东[1] 周新[1] 张广龙[1] 刘同海[1] 

机构地区：[1]山东省医学科学院山东省肿瘤重点实验室山东省肿瘤医院和研究所放疗科,济南250117

出　　处：《中华放射肿瘤学杂志》2012年第6期534-538,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然基金面上项目（30870742）;山东省科技发展计划项目（2009GGl0002019）

摘　　要：目的探讨勾画标准培训对保乳术后瘤床靶区和全乳靶区勾画的影响。方法选择12例保乳术后患者，5位勾画者先对每位患者依据金属夹勾画瘤床靶区（GTV，）、依据术腔血清肿勾画瘤床靶区（GTV2）、勾画全乳靶区（cTV），随后参照勾画标准重复勾画GTV1、GTV2、CTV，比较5位勾画者间差异和参照标准前后差异并行单因素方差分析或配对t检验。结果5位勾画者参照标准前的GTV1、GTV2、CTV均不同（F=11．16、7．54、3．78，P=0．000、0．000、0．009），参照勾画标准后的GTV1、GTV2不同（F=4．78、4．24，P=0．002、0．005），但cTV相似（F=1．52，P=0．209）。参照勾画标准前后的GTV1、GTV2、CTV变异系数不同（t=3．14、2．81、2．70，P=0．009、0．017、0．021），匹配指数也不同（F=16．08、8．61、8．48，P=0．000、0．000、0．000）。结论乳腺癌靶区勾画标准的制订可降低勾画者之间荠异．尤其是对伞乳靶区的勾画匿为明显。Objective To explore the influence of delineator and contouring criteria training on the delineation of the tumor bed and whole breast target after breast-conserving surgery. Methods Twelve breast cancer patients after breast conserving surgery were selected. Tumor bed marked by clips was defined as gross target volume 1 （ GTV1 ）, tumor bed formed by seroma was defined as GTV2 and the whale breast was defined as clinical target volume （CTV）. Five junior radiation oncologists first delineated GTV1 , GTV2 and CTV for each patient following their own criteria. After contouring criteria training, they then delineated GTV1 , GTV2 and CTV for the same group of patients again. The differences of the volumes of GTV1 , GTV2 and CTV before and after training among different delineators were compared. One-way ANOVA or matching t-test was performed. Results The inter-delineator variability on GTV1 , GTV~ and CTV delineation before training was statistically significant （ F = 11.16,7.54 and 3.78, P = 0. 000,0. 000 and 0. 009 ）. After training, the inter-delineator variability on GTV~ and GTV2 delineation had statistical significance （t = 4. 78 and 4. 24 ,P =0. 002 and 0. 005 ）, but the inter-delineator variability on CTV delineation had no statistical significance （ t = 1.52 ,P = 0. 209 ）. The coefficient of variance of the GTV1 , GTV2 and CTV before and after training was significantly different （ t = 3.14, 2. 81, 2.70, P = 0. 009, 0. 017 and 0. 021 ）. The matching index of GTV1, GTV2 and CTV before and after training was significantly different （F= 16. 08, 8. 61, 8. 48, P = 0. 000, 0. 000 and 0. 000）. Conclusions In delineating the target of breast cancer, application of the criteria of target delineation can reduce the difference among the delineators, especially for CTV.

关 键 词：乳腺肿瘤 放射疗法 瘤床靶区 全乳靶区 靶区勾画标准 

分 类 号：R737.9[医药卫生—肿瘤]