摘要
目的:比较研究三维锥形束CT(3D-CBCT)与四维锥形束CT(4D-CBCT)在肺癌容积旋转调强治疗(VMAT)计划精确放射治疗中的应用。方法:选取在医院接受VAMT放射治疗的101例肺癌患者,根据治疗中扫描模式的不同,将使用3D-CBCT成像的患者纳入3D-CBCT组(45例),将使用4D-CBCT成像的患者纳入4D-CBCT组(56例),比较两组患者治疗中CT图像校正后分次间摆位误差、肿瘤靶区外放边界、肿瘤内靶区(ITV)体积、靶区计划靶体积(PTV)剂量和危及器官(OAR)心脏受照剂量。结果:两组患者治疗中CT图像校正后左右(X轴)方向、前后(Z轴)方向摆位误差均显著下降,差异有统计学意义(Z=-3.005,Z=-2.047;P<0.05),上下(Y轴)方向摆位误差无统计学差异;两组PTV外放范围均在Y轴方向最大;两组肺上叶肿瘤ITV体积差异无统计学意义,4D-CBCT组肺中下叶ITV体积明显低于3D-CBCT组,差异有统计学意义(Z=-2.245,P<0.05);4D-CBCT组靶区最大剂量(D_(max))、最小剂量(D_(min))、平均剂量(Dmeam)及靶区95%受照剂量(D_(95))Gy均大于3D-CBCT组,且D_(min)、D_(mean)及D_(95)差异有统计学意义(Z=-2.207,Z=-4.872,Z=-4.405;P<0.05);4D-CBCT组OAR心脏V_(20)、V_(30)、D_(mean)测量值均低于3D-CBCT组,其差异有统计学意义(Z=-2.077,Z=-2.208,Z=2.071;P<0.05)。结论:4D-CBCT与3D-CBCT相比,可减少摆位误差并提高摆位的精确性,缩小PTV的外放距离,提高靶区剂量,减少周围OAR的受量。
Objective:To compare the application of three-dimensional cone-beam computed tomography(3D-CBCT)and four-dimensional cone-beam computed tomography(4D-CBCT)in volumetric modulated arc therapy(VMAT)plan for lung cancer.Methods:A total of 101 patients with lung cancer who received VAMT were selected,and the patients who underwent 3D-CBCT imaging were divided into 3D-CBCT group(45 cases)and who underwent 4D-CBCT imaging were divided into 4D-CBCT(56 cases)according to the different scan mode in treatment.The positioning error,the external radiation boundary of tumor target area,target area volume within the tumor,the dosage of plan target volume(PTV)of target area and the cardiac exposure dosage of organs at risk(OAR)were compared between the two groups.Results:After the CT images of two groups in treatment were corrected,the positioning errors on the left and right direction(X-axis),the front and rear directions(Z-axis)decreased significantly,and the differences of them between two groups were significant(Z=-3.005,Z=-2.047,P<0.05),respectively,while the difference of the positioning error on up and down direction(Y-axis)between two groups were not statistically significant.The external irradiation ranges of PTV in both groups were the largest in the head and feet.There was no statistically significant difference in internal target volume(ITV)volume of upper lobe tumor of lung between the two groups.The ITV volume in the middle and lower lobes of lung of 4D-CBCT group was significantly lower than that of 3D-CBCT group(Z=-2.245,P<0.05).The maximum dose(Dmax),the minimum dose(Dmin),the mean dose(Dmean)and the 95%exposure dose(D95)Gy of the target area in 4D-CBCT group were larger than those in 3D-CBCT group,and the differences of Dmin,Dmean and D95 between two groups were statistically significant(Z=-2.207,Z=-4.872,Z=-4.405,P<0.05),respectively.The measured values of cardiac V20,V30 and Dmean of OAR in 4D-CBCT group were lower than those in 3D-CBCT group,and the differences of them between two group were significant(Z=-2.077,Z=-2.208,Z=2.071,P<0.05),respectively.Conclusion:4D-CBCT can reduce positioning errors,and improve the precision of positioning,and shorten the PTV distance of external irradiation,and increase the dosage of target area,and reduce the received dose of surrounding OAR.
作者
刘欣
仇好
杨荣邦
周大伟
张菲菲
韩洋
李威
段诗苗
LIU Xin;QIU Hao;YANG Rong-bang(Department of Radiotherapy,The First Affiliated Hospital of Bengbu Medical College.Graduate School of Bengbu Medical College,Bengbu 233004,China;不详)
出处
《中国医学装备》
2023年第10期36-41,共6页
China Medical Equipment
基金
安徽省中央引导地方科技发展基金(2020b07030008)“安徽省呼吸系统疾病(肿瘤)临床医学研究中心”。
