经会阴四维实时TPUS技术评估前列腺癌放疗中剂量靶区分次内的运动  

Evaluating intra-fractional prostate motion in radiotherapy of prostate cancer with four-dimensional real-time transperineal ultrasound

作　　者：李毅[1] 车少敏[1] 吴文婧[2] 王龙 张晓智[1] Li Yi;CHE Shaomin;WU Wenjing;WANG Long;ZHANG Xiaozhi(Department of Radiation Oncology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;Department of Radiology,Xi'an Center for Disease Control and Prevention,Xi'an 710054,China)

机构地区：[1]西安交通大学第一附属医院肿瘤放疗科,陕西西安710061 [2]西安市疾病预防控制中心,陕西西安710054

出　　处：《西安交通大学学报（医学版）》2020年第5期663-667,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：西安交通大学第一附属医院院基金资助项目(No.XJTU1AF-CRF-2018MS-25)。

摘　　要：目的应用经会阴四维实时超声图像引导(transperineal ultrasound,TPUS)技术评估前列腺癌放疗中分次内的运动,为前列腺大分割放疗提供参考。方法随机抽取10例前列腺癌患者,采用容积旋转调强放射治疗(volume modulated radiotherapy,VMAT)技术,治疗前均采用CBCT校正分次间摆位误差,治疗中利用TPUS技术监测所有患者60个分次内前列腺运动的数据,获取前列腺在三维方向上的移动位移范围。结果所有患者治疗分次内前列腺位移最大值在三维方向上分别为1.85 mm(左)、0.50 mm(右)、1.83 mm(前)、3.04 mm(后)、2.68 mm(头)、1.75 mm(脚)。位移值大于2 mm的分次占所有分次的比例分别为3%(左右)、11%(前后)、5%(头脚)。前列腺前后方向的运动幅度稍大于左右方向和前后方向,但差异无统计学意义。结论TPUS技术是一种无创、可靠的实时监测技术,可在前列腺癌放疗中实时探测前列腺运动范围,防止肿瘤靶区漏照或正常组织受到过多照射。Objective To evaluate intra-fractional prostate motion by applying four-dimensional real-time transperineal ultrasound(TPUS)so as to provide reference evidence for the moderate hypofrectionation radiotherapy for prostate cancer.Methods Ten patients with prostate cancer were randomly selected to be treated with volume modulated radiotherapy(VMAT).TPUS was utilized to collect 60 intra-fraction data.Prior to each treatment for all the patients,CBCT was adopted to correct inter-fraction setup errors.During treatment,four-dimensional real-time ultrasound images were acquired to monitor the 3D prostate motion.Results Among all the data,the maximum distance of prostate motion was 1.85 mm in the left direction,0.50 mm in the right direction,1.83 mm in the anterior direction,3.04 mm in the posterior direction,2.68 mm in the cranial direction,and 1.75 mm in the caudal direction.The percentage of fractions in which the distance of prostate motion was more than 2 mm among all treatment fractions was 3%in the left and right(LR)direction,11%in the anterior and posterior(AP)direction,and 5%in the cranial and caudal(CC)direction.The distance was greater in AP direction than in AP direction and CC direction.Conclusion TUPS is a non-invasive and reliable technique which can detect the real-time motion of the prostate during radiotherapy aiming to prevent tumor target areas from being missed or normal tissues from being overexposed.

关 键 词：前列腺肿瘤 超声引导放疗 分次内运动 实时评估 

分 类 号：R811.1[医药卫生—放射医学]