胸段食管癌图像调强放疗的摆位误差和近期疗效评价  

Analysis on the setup errors and short-term efficiency evaluation of image-guided radiation therapy for thoracic esophageal carcinoma

作　　者：刘凯[1] 秦永辉[1] 王多明[1] 王若峥[1] 

机构地区：[1]新疆医科大学附属肿瘤医院放疗科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2013年第1期21-25,共5页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区科技支疆项目(200991137)

摘　　要：目的探讨图像引导调强放疗(image guided radiation therapy,IGRT)治疗胸段食管癌的疗效。方法采用KV级的锥形束CT(cone beam CT,CBCT)获取摆位误差纠正前/后患者左右(X)、头脚(Y)、腹背(Z)3个方向的线性摆位误差进行对比并研究其对靶区和危及器官剂量分布的影响;同时选择接受调强放疗(intensity modulated radiotherapy,IMRT)的胸段食管癌患者,分为IGRT组(80例,IGRT治疗)、IMRT组(82例,IMRT治疗),比较2组患者的急性放射反应及近期疗效。结果 (1)IGRT摆位误差纠正前/后X、Y、Z 3个方向摆位的系统误差和随机误差均显著降低(P<0.05),模拟计算得出原发肿瘤平均剂量变化为-4.32%～2.24%,心脏剂量变化为-4.57%～23.54%,肺脏剂量变化为-1.86%～12.45%,脊髓剂量变化为-10.05%～21.43%。(2)IGRT组与IMRT组比较,0级+Ⅰ级的急性皮肤反应、上消化道反应和呼吸道反应分别为:92.5%、86.25%、88.75%和91.46%、53.65%、43.90%,其中0级+Ⅰ级上消化道反应和呼吸道反应比较差异有统计学意义(P<0.05);2组患者的近期疗效总有效率分别为98.50%和96.34%,差异无统计学意义(P>0.05)。结论应用IGRT能够明显提高靶区及危及器官剂量分布的精确性,减少患者毒副反应并取得了良好的疗效。Objective To evaluate the efficiency sophageal carcinoma. Methods The pre-/post of image guided radiation therapy （IGRT） for thoracic e （head-foot） and Z （anterior-posterior） directions posl had tioning setup uncertainty data on X （left-right）, Y been collected using Cone Beam CT（CBCT） for corn pared the setup error of precorrection and pretreatment positions. Furthermore, the effect of setup uncer tainty on dose distribution of target area and peripheral organs at risk （OAR） was estimated. At the same time, 112 cases of esophageal cancer patients who accepted intensity-modulated radiation therapy （IMRT） in our hospital were included in our study and randomly divided into IGRT group（80 cases） and IMRT group（32 cases）, the acute radiation toxicity reaction and short term efficiency were evaluated and com pared between the two groups. Results （1） The systematic and random errors representing the setup un certainty were significantly decreased in X, Y, and Z directions after the online adjustment by IGRT （P 〈 0.05）. The ranges of average dose variation were --4.32 % - 2.24%, --4.57%- 23. 54%, 1.86 % 12.45G, and 10.05G-21.43G for GTVnx of heart, lung, and spinal cord, respectively. （2） The 0 grade and 1 grade of the acute skin reaction, the acute upper gastrointestinal reaction and the acute respira tory reaction between the IGRT group and the IMRT group were 92.5%vs 91.46%, 86. 25% vs 53.65~, 88. 75% vs 43.90%. The difference of 0 grade and 1 grade of the acute upper gastrointestinal reaction and the acute respiratory reaction were statistically significant （P〉0.05）. The short-term efficiency of the two groups were 100% vs 97.62%o and there was no statistical difference （P 〉0.05）. Conclusion The ap plication of IGRT significantly increases the accuracy of dose distribution of target area and peripheral or gans at risk, which can reduce the patient＇s side reaction and obtained good therapeutic efficiency.

关 键 词：食管癌 图像引导放射治疗 剂量分布 疗效 

分 类 号：R735.1[医药卫生—肿瘤]