4D-CBCT在肺癌容积旋转调强计划精准治疗中的临床应用  

Clinical Application of 4D-CBCT in Precise Treatment of Lung Cancer Volumetric Modulated Arc Therapy Program

作　　者：柴林燕[1] 高莹[1] 张晓智[1] 王科峰 CHAI Lin-yan;GAO Ying;ZHANG Xiao-zhi;WANG Ke-feng(Department of Radiotherapy,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi Province,China;Department of Endocrinology,Shaanxi Kangfu Hospital,Xi'an 710065,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院放疗科,陕西西安710061 [2]陕西省康复医院内分泌科,陕西西安710065

出　　处：《中国CT和MRI杂志》2022年第4期65-68,共4页Chinese Journal of CT and MRI

基　　金：国家自然科学基金资助项目(81301937)。

摘　　要：目的研究四维锥形束CT(4D-CBCT)在肺癌容积旋转调强(VMAT)计划精准放疗中的临床应用及对肿瘤控制效果的影响。方法选取2018年5月至2019年10月我院接受VMAT放射治疗的102例肺癌患者临床资料为样本进行回顾性研究,并根据CBCT扫描模式不同分为4D组65例和3D组37例,比较两组放疗摆位误差、内靶区(ITV)体积、靶区剂量、心脏受照剂量及肿瘤控制效果。结果两组校正后和治疗后X轴、Y轴以及Z轴方向平移误差绝对值均明显降低(P<0.05),且两组校正后和治疗后X轴、Y轴以及Z轴方向平移误差绝对值差异无统计学意义(P>0.05);3D组和4D组肺上叶肿瘤ITV体积差异无统计学意义(P>0.05),4D组肺中下叶肿瘤ITV体积明显低于3D组(P<0.05);4D组PTV的D;、D;及D;均高于3D组,心脏V10、V20、V30及D(mean)均低于3D组,差异有统计学意义(P<0.05);3D组和4D组ORR分别为78.38%和81.54%(P>0.05),两组近期疗效差异无统计学意义(P>0.05)。结论4D-CBCT用于肺癌VMAT治疗可明显减小内靶区勾画体积,提升靶区剂量并降低心脏等邻近器官受照剂量,对提升肿瘤控制效果和减少并发症具有积极作用。Objective To study the clinical application of 4 D-cone beam computed tomography(CTDCT)in the precise radiotherapy of volumetric modulated arc therapy(VMAT)program of lung cancer and its influence on tumor control effects.Methods From May 2018 to October 2019,the clinical data of 102 patients with lung cancer who underwent VMAT radiotherapy in our hospital were selected as samples and retrospectively studied.According to different CBCT scan patterns,the patients were divided into 4 D group(65 cases)and 3 D group(37 cases).Radiotherapy placement error,internal target area(ITV)volume,target area dose,cardiac exposure dose and tumor control effects were compared between the two groups.Results The absolute values of translational errors in the X-axis,Y-axis and Z-axis after correction and after treatment were significantly decreased in the two groups(P<0.05),and there were no significant differences in the absolute values of translational errors in the X-axis,Y-axis and Z-axis after correlation and after treatment between the two groups(P>0.05).There was no significant difference in the ITV volume of upper lobe tumor between 3 D group and 4 D group(P>0.05),and the ITV volume of middle and lower lobe tumor in 4 D group was significantly lower than that in 3 D group(P>0.05).The D;,D;and D;of PTV in 4 D group were higher than those in 3 D group while the cardiac V10,V20,V30 and D;were lower than those in 3 D group(P<0.05).The ORR values in 3 D group and 4 D group were 78.38%and 81.54%respectively(P>0.05),and there was no significant difference in the short-term efficacy between the two groups(P>0.05).Conclusion 4 D-CBCT for lung cancer VMAT can significantly reduce the internal target delineation volume,increase the target area dose and reduce the exposure dose of adjacent organs such as the heart,and it has a positive effect on improving tumor control effects and reducing complications.

关 键 词：肺癌 放射治疗 容积旋转调强 锥形束CT 

分 类 号：R730.55[医药卫生—肿瘤] R734.2[医药卫生—临床医学]