食管癌常规分割放射治疗外放边界不同因素分析—基于真实数据的探索  

Analysis of different factors on the target margin of esophageal cancer conventional segmentation--The exploration based on real data

作　　者：赵宇 朱耿强 郑永泰 刘超 赵瑞敖 葛彦东 万宝 张彦新 张伟 郇福奎 梁斌 王宏凯 ZHAO Yu;ZHU Gengqiang;ZHENG Yongtai;LIU Chao;ZHAO Ruiao;GE Yandong;WAN Bao;ZHANG Yanxin;ZHANG Wei;HUAN Fukui;LIANG Bin;WANG Hongkai(National Cancer Center/National Clinical Research Center for Cancer/Department of Radiation Oncology,Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《现代肿瘤医学》2024年第23期4482-4488,共7页Journal of Modern Oncology

基　　金：国家自然科学基金(编号:12205374);北京市自然科学基金(编号:1232033);中国癌症基金会北京希望马拉松专项基金(编号:LC2021B23);中国医学科学院医学与健康科技创新工程“网络化放射治疗计划设计方法研究”(编号:2022-I2M-C&T-B-079);中国癌症基金会北京希望马拉松专项基金“放射性肺炎预测系统研究”(编号:LC2021B15)。

摘　　要：目的:利用Elekta医用直线加速器的机载千伏级锥形束CT(cone beam computed tomography,CBCT),对影响食管癌常规分割患者摆位误差的不同因素进行分析,为临床靶区外放边界提供参考和依据。方法:回顾性选取我院放射治疗中心2020年01月至2023年09月共159例食管癌患者为研究对象,通过159例患者共获得1291组CBCT配准图像,分别记录其左右(lateral,LAT)、进出(longitudinal,LNG)、升降(vertical,VRT)三个方向的误差,计算患者总体摆位误差,并探究患者体质量指数(body mass index,BMI)、是否进行过手术治疗,以及非手术治疗的患者不同肿瘤原发部位等因素对相应摆位误差的影响。根据靶区外放边界公式计算相应外放结果。结果:三个方向的平均摆位误差分别为:左右方向(0.03±0.23)cm,进出方向(0.06±0.31)cm,升降方向(0.02±0.23)cm。对于BMI<24 kg/m^(2)患者组和BMI≥24 kg/m^(2)患者组升降方向的摆位误差分别为:(0.01±0.24)cm和(0.07±0.22)cm,且统计结果具有显著性差异(P=0.000)。非手术患者组和手术患者组左右方向摆位误差分别为:(0.04±0.23)cm和(0.02±0.20)cm,且统计结果具有显著性差异。对于非手术组患者中,原发部位分别位于颈段和胸段食管癌的患者在左右方向、升降方向摆位误差具有显著性差异(P_(LAT)=0.041,P_(VRT)≈0.000),分别为:左右方向(0.08±0.27)cm和(0.03±0.23)cm;升降方向(0.18±0.23)cm和(0.05±0.24)cm。结合ICRU50号和ICRU62号报告进行分析和计算,整体靶区外放边界为LAT=0.50 mm,LNG=0.74 mm,VRT=0.57 mm。结论:为了使食管癌患者放疗更精准,应根据患者体BMI范围、是否手术(非手术患者则应根据不同原发部位)等因素分别采用对应的靶区外放边界。Objective:The different factors influencing the setup errors of patients with esophageal cancer conventional segmentation were analyzed by using airborne kilovoltage computed tomography(CBCT)of Elekta medical linear accelerator,so as to provide a basis for the boundary of clinical target volume.Methods:159 patients from January 2020 to September 2023 in our cancer hospital radiotherapy center were selected in this study for data analysis of the whole course of treatment.The errors of 3 directions including LAT,LNG and VRT were recorded.The overall setup errors of patients were calculated,and the influences of body mass index(BMI),whether the patients had received surgical treatment,and the classification of different primary tumor sites on the corresponding setup errors of non-surgical patients were explored.Using the Margin formula to analyze the data.Results:The positioning errors of the three directions were as follows:LAT(0.03±0.23)cm,LNG(0.06±0.31)cm,VRT(0.02±0.23)cm.There were significant differences in positioning errors of vertical direction(Z)for patients with different BMI ranges(P=0.000).So,the vertical direction(Z)of BMI<24 kg/m^(2) patients and BMI≥24 kg/m^(2) patients were(0.01±0.24)cm and(0.07±0.22)cm.whether the patients had received surgical treatment or not has significant difference in the lateral direction,so the positioning error of lateral direction of non-surgical and surgical patients are(0.04±0.23)cm and(0.02±0.20)cm,respectively.However,in the non-surgical group,patients with cervical or thoracic esophageal cancer had significant difference in the positioning errors of the lateral direction(X)and the vertical direction(Z)(P_(LAT)=0.041,P_(VRT)≈0.000).They were(0.08±0.27)cm and(0.03±0.23)cm in the lateral direction,as well as(0.18±0.23)cm and(0.05±0.24)cm in the vertical direction.According to the analysis of ICRU50 and ICRU62 reports,the target margins are LAT=0.50 mm,LNG=0.74 mm and VRT=0.57 mm.Conclusion:In order to make radiotherapy more accurate for patients with esoph

关 键 词：食管癌 CBCT 摆位误差 体质量指数 靶区外放 

分 类 号：R735.1[医药卫生—肿瘤]