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IGRT技术在肺癌SBRT治疗靶区位置误差测定中的应用

  • 摘要: 目的:探讨图像引导放射治疗(image guided radiation therapy,IGRT)技术在测定并校正肺部恶性肿瘤体部立体定向放射治疗(stereotactic body radiation therapy,SBRT)过程中靶区位置误差的意义。方法:选择复旦大学附属肿瘤医院收治的14例肺部恶性肿瘤并接受SBRT的患者。每次治疗前后均进行千伏级锥形束CT (kVCBCT)扫描,与计划CT图像进行在线配准,校正误差后进行治疗。治疗后再次进行CBCT扫描并配准。分别记录治疗前后靶区位置误差。根据临床靶区(CTV)计划靶区(PTV)外放公式MPTV(外放)=2.5Σ+0.7σ计算PTV外扩大小。结果:治疗前靶区位置左右、头脚、腹背方向误差最大值分别为10.0 mm、16.9 mm、8.7 mm,误差平均值分别为(2.4±2.8) mm、(3.4±4.6) mm、(2.9±3.4) mm。在线校正并治疗后,靶区位置左右、头脚、腹背方向的误差最大值分别为7.6 mm、4.6 mm、7.0 mm,误差平均值分别为(2.1±2.0) mm、(1.5±1.6) mm、(1.7±2.0) mm。无图像引导PTV外扩大小为左右7.96 mm、头脚11.72 mm、腹背9.63 mm,有图像引导并在线校正PTV外扩大小为左右6.65 mm、头脚4.87 mm、腹背5.65 mm。结论:IGRT技术可即时校正SBRT治疗前由摆位引起的靶区位置误差,并测定治疗过程中的靶区位置移动,能提高治疗精度,并有助于PTV外扩的制定。

     

    Abstract: Objective:To discuss the significance of imageguided radiation therapy(IGRT) technique in measuring and correcting of target position errors in stereotactic body radiotherapy (SBRT) treatment for lung cancer. Methods:Totally 14 cases underwent SBRT treatment were enrolled in this study. Patients were scanned by kilovoltage cone beam CT (KVCBCT) before and after treatment, and online registered to the planning CT images; the target position error was corrected before treamtnet, and the CBCT was scanned and registered again after treatment. The target position errors were recorded before and after treatment. The CTVPTV margin was calculated by the formula 2.5Σ+0.7σ. Results:The maximum pretreatment error in rightleft, headfeet and backbelly directions were 10 mm, 16.9 mm and 8.7 mm,respectively. The mean value of target position errors in rightleft, headfeet and backbelly directions were (2.4±2.8) mm,(3.4±4.6) mm and (2.9±3.4)mm,respectively. The maximum posttreatment target position errors in rightleft, headfeet and backbelly directions after online correction were 7.6 mm,4.6 mm, and 7.0 mm, respectively, and the mean values were (2.1±2.0)mm,(1.5±1.6) mm and (1.7±2.0) mm,respectively. Without the usage of imageguide, the PTV margins in rightleft, headfeet and backbelly directions were 7.96 mm, 11.72 mm and 9.63 mm, respectively; with the usage of imageguide, the PTV margins in rightleft, headfeet and backbelly directions were 6.65 mm,4.87 mm and 5.65 mm, respectively. Conclusions:The IGRT technology can online correct the pretreatment target position errors and determine the target position removing during treatment. It can improve the treatment accuracy, and contribute to set the PTV margins.

     

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