宫颈癌容积调强弧形治疗与调强放疗技术对患者分次内误差的影响  

Effect on Patients with Intrafractional Errors Resulting from Volumetric Modulated Arc Therapy and Step-and-shoot IMRT Techniques in Cervical Cancer Radiotherapy

作　　者：王恩阳[1] 徐飞[1] 贾明轩[1] 曾越灿[1] 

机构地区：[1]中国医科大学附属盛京医院放射治疗中心,沈阳110022

出　　处：《临床误诊误治》2016年第4期89-93,共5页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金资助项目(81201803)

摘　　要：目的分析宫颈癌容积调强弧形治疗技术(volumetric modulated arc therapy,VMAT)与调强放疗技术(intensity modulated radiation therapy,IMRT)对患者分次内误差的影响。方法选取2013年10月—2014年7月我中心经病理诊断确诊的20例宫颈癌患者,根据放疗方法的不同分为IMRT组和VMAT组各10例。应用Elekta Synergy加速器对所有患者在首次摆位后、摆位误差调整后及治疗结束后进行千伏级锥形束CT(k V-CBCT)扫描。通过获取的k V-CBCT图像和计划CT图像的配准,分别测量出患者首次摆位后、摆位误差调整后及治疗结束后在X轴左右(LR)、Y轴头脚(SI)和Z轴前后(AP)的误差。通过误差测量,分别估算出两组治疗中分次内误差并比较。结果 VMAT组在LR、SI、AP 3个方向上的分次内误差均小于IMRT组(P=0.009;P=0.008;P=0.009)。VMAT组发生腹痛9例,急性放射性肠炎1例;IMRT组发生腹痛7例,急性放射性肠炎3例。结论在宫颈癌放疗中,VMAT可得到更低的分次内误差,并可提高宫颈癌放疗的精度,值得临床推广应用。Objective To analyze the effect on patients with the intrafractional errors resulting from volumetric modulated arc therapy（ VMAT） and intensity modulated radiation therapy（ IMRT） techniques in cervical cancer radiotherapy.Methods Clinical data of 20 cases of cervical cancer diagnosed by pathological diagnosis in our center during October 2013 to July 2014 were analyzed according to the different methods of radiotherapy,and were divided into VMAT group and IMRT group（ n = 10 each group）. All the patients with cervical cancer accepted k V-CBCT（ kilovoltage cone-beam computed tomography） scans after initial setup,correction and treatment with Elekta synergy accelerator. By acquiring k V-CBCT images and planned CT images,the errors of patients after initial setup were measured after correction and treatment on the X axis（ leftright,LR）,the Y axis（ superior-inferior,SI） and Z axis（ anterior-posterior,AP）,respectively. By the measurement of errors,the intrafractional errors of patients with cervical cancer in the radiotherapy were estimated and compared between the two groups. Results By using VMAT technique,the intrafractional errors of patients in the LR,SI and AP were less than that of IMRT group in three dimensional directions（ P = 0. 009; P = 0. 008; P = 0. 009）. Abdominal pain occurred in 9 patients and acute radiation-induced enteritis occurred in 1 patient in the VMAT technique; abdominal pain occurred in 7 patients and acute radiation-induced enteritis occurred in 3 patient in the IMRT technique. Conclusion In cervical cancer radiotherapy,compared with IMRT technique,VMAT technique can achieve lower rate of intrafractional errors and can improve the accuracy of cervical cancer radiotherapy,which is worthy of clinical application.

关 键 词：宫颈肿瘤 容积调强弧形治疗 调强放疗 千伏级锥形束CT 

分 类 号：R737.33[医药卫生—肿瘤]