非小细胞肺癌立体定向放疗摆位误差分析  

The analysis of setup errors in stereotactic radiotherapy for non-small cell lung cancer

作　　者：李玉成 陈哲灵 贾勇士[1] 邵凯南[2] 詹文明[1] 李强[1] 邱凌云[1] 王成[3] 陈维军 Yu Cheng

机构地区：[1]浙江省人民医院,310014 [2]浙江省肿瘤医院,310012 [3]南华大学,410012

出　　处：《浙江临床医学》2021年第3期309-311,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金资助项目(81802623)。

摘　　要：目的通过分析非小细胞肺癌立体定向体部放射治疗(SBRT)的摆位误差,计算不同肺叶靶区外放边界,为精准放疗提供依据。方法选取2014年1月至2019年12月行SBRT的患者300例,回顾性分析其CBCT影像资料,根据体位固定方式分为热塑体模組和负压真空垫组,比较两组的摆位误差值,计算每个肺叶的靶区外放边界值。结果两组患者左右、头脚、前后三维方向的摆位误差分别为[(0.26±0.21),(0.21±0.18)]cm、[(0.25±0.23),(0.29±0.22)]cm、(0.26±0.12),(0.20±0.18)]cm。在前后和头脚方向,两组摆位误差值比较,差异均有统计学意义(P<0.05)。右肺上叶、右肺中叶、右肺下叶、左肺上叶、左肺下叶在X、Y、Z方向的外放边界分别为0.4 cm、0.4 cm、0.5 cm,0.6 cm、0.6 cm、0.6 cm,0.6 cm、0.7 cm、0.6 cm,0.4 cm、0.5 cm、0.4 cm,0.8 cm、0.8 cm、0.8 cm。结论放疗患者于每次治疗前行CBCT扫描可以有效降低摆位误差,提高放疗的精确性;计算每个肺叶靶区外放边界值,可以为放疗医生靶区外放提供参考,在消灭肿瘤的同时并明显降低正常组织的损伤。Objective To calculate the margin of different lung lobe target areas and provide a basis for precise treatment by analyzing intrafractional and interfractional setup errors of 300 patients treated with SBRT.Methods 300 SBRT patients who were treated in our hospital from January 2014 to December 2019 were selecte.The CBCT image data were analyzed retrospectively and divided into thermoplastic mask group and negative pressure vacuum cushion group according to the position fixation method,the setup error values of the vacuum cushion group and die thermoplastic mask group were compared,and the oudying boundary value of each lobe target area were calculated.Results Two groups in the patient's left and nght(X axis)direction,head and foot(Y axis),and front and back(Z axis)directions were[(0.22±0.19),(0.24±0.21)]cm,[(0.30±0.25),(0.24±0.23)]cm,[(0.21±0.18),(0.25±0.12)]cm,respectively.The set-up error values of the two fixed methods,the difference in the set-up error values in the inferior-superior,anterior-posterior directions of the patient were analyzed,the difference was statistically significant(P<0.05).The values of the margin of right upper lobe,right middle lung,right lower lobe,left upper lung,and left lower lung in the left and right,head and foot,anterior and posterior direction were 04 cm,0.4 cm,0.5 cm,0.6 cm,0.6 cm,0.6 cm,0.6 cm,0.7 cm,0.6 cm,0.4 cm,0.5 cm,0.4 cm,0.8 cm,0.8 cm,0.8 cm,respectively.Conclusion The CBCT scan of the patient before radiotherapy can effectively reduce the setup error and improve the accuracy of treatment,to calculate the margin of different lung lobes based on the setup error value.Therefore,the radiation doctor performs according to the obtained margin value to out of target,which greatly reduces the damage of normal tissues while eliminating tumors.

关 键 词：立体定向放射治疗 锥形束CT 非小细胞肺癌 摆位误差 

分 类 号：R73[医药卫生—肿瘤]