头颈部肿瘤放射治疗不同解剖区域位置精度分析  

Positional accuracy of various anatomical regions in head and neck cancer radiotherapy

作　　者：赖建军[1] 俞玉凤[1] 王佳浩 李夏东[2] 吴稚冰[2] 邓清华[2] 吴式琇[1] 马胜林[2] 汪黎栋 LAI Jianjun;YU Yufeng;WANG Jiahao(Department of Radiation Oncology,Hangzhou Cancer Hospital,Hangzhou 310002,China)

机构地区：[1]杭州市肿瘤医院放疗科,310002 [2]杭州市第一人民医院放疗科

出　　处：《浙江医学》2018年第13期1469-1471,1474,1520,共4页Zhejiang Medical Journal

摘　　要：目的量化分析头颈部肿瘤放射治疗中不同解剖区域位置精度,为肿瘤靶区外放边界和危及器官的精准勾画提供参考。方法对34例行调强放射治疗(IMRT)的头颈部肿瘤患者共计182组锥形束CT(CBCT)图像资料进行分析,定义Clinical ROI为临床常用配准框,5个局部解剖区域(包括后枕骨区域、下颌骨腮腺区域、C1~C3区域、C4~C6区域、C7及以下区域)为配准框进行摆位误差分析及相关性分析,并计算不同解剖区域配准条件下靶区外放边界。结果在3个平移方向,Clinical ROI摆位误差在(0.17±0.17)cm以内,5个局部解剖区域摆位误差范围在(0.25±0.28)cm以内;其中C1~C3区域摆位误差与Clinical ROI区域的一致性最好,两者在X轴、Y轴、Z轴平移方向均呈极强相关(r=0.81、0.83、0.81,均P<0.05)。根据不同解剖区域统计的摆位误差值计算3个平移方向外放边界,后枕骨区域、下颌骨腮腺区域、C4~C6区域、C7及以下区域外放边界需要>0.5cm。结论头颈部肿瘤放射治疗中不同解剖区域位置精度不同,临床定义靶区外放边界和危及器官的精准勾画需要考虑局部摆位误差和解剖位置变化带来的影响。Objective To quantify the positional accuracy of various anatomical regions in head and neck cancer radiotherapy,providing the precise contouring for planned tumor volume(PTV)and organ at risk(OAR).Methods Total 182 cone beam-computed tomography(CBCT)image data from 34 patients with head and neck cancer undergoing intensity modulated radiation therapy(IMRT)were retrospectively analyzed.The clinical commonly used large region of interest(Clinical ROI)and five ROIs(occipital bone,mandibular and parotid gland,vertebrae C1-C3,C4-C6,and the vertebrae caudal of C7)were defined in the planning CT as registration frame for analysis of setup error with CBCT image.The five local setup error was compared with global setup error and then margins were calculated.Results The setup error of clinical ROI was(0.17±0.17)cm and that of the local ROIs was within(0.25±0.28)cm.The setup error fromvertebrae C1-C3 and clinical ROI were closely correlated(r=0.81-0.83,P<0.01).The margin ranges from clinical ROI were within 0.5cm and the margin ranges from local ROIs were(0.15-0.76)cm.Conclusion The positional accuracy from various anatomical regions is different in head and neck cancer radiotherapy.In modern precise radiotherapy for head and neck cancer,the influence from local setup error and deformation for margins and OARs should be assessed.

关 键 词：头颈部肿瘤 放射治疗 摆位误差 危及器官 

分 类 号：R730.55[医药卫生—肿瘤]