摘要
目的通过对比四维X线断层扫描(four dimension computed tomography,4DCT)联合呼吸门控、腹部加压以及自由呼吸模式下立体定向放射治疗(stereotactic body radiotherapy,SBRT)计划参数的对比,分析呼吸管理对肿瘤靶区体积、剂量精度的影响。方法选取2021年10月—2022年12月在山东第一医科大学附属中心医院肿瘤科就诊的12例早期非小细胞肺癌(non-small cell lung cancer,NSCLC)采用立体定向放射治疗的患者,分别设计3套图像计划,每套图像12例为一组。搜集4DCT扫描图像,按呼吸时相将CT数据重建,分层处理得到0%~90%图像(0%为吸气末,50%为呼气末),勾画各时相肿瘤靶区,利用最大密度投影融合成全时相图像,用来模拟自由呼吸模式下的普通CT图像(FB'组);将30%~70%时相图像用最大密度投影融合,因其与利用呼吸附件腹部加压后其呼吸时相相同,定义为腹部适度加压组图像(RA'组);将吸气末0%时相图像模拟主动呼吸控制状态图像(ABC'组)。在这3组图像上分别得到肿瘤靶区、肿瘤内靶区及计划靶区,比较3组治疗模式中肿瘤靶区及危机器官剂量学差异。结果(1)ABC'组、RA'组及FB'组肿瘤内靶区体积值差异有统计学意义(P<0.05)。计划靶区适形性指数、均匀性指数、5%计划靶区(planned target volume,PTV)体积的剂量及体积的剂量、及95%PTV体积的剂量差异均无统计学意义(P>0.05)。(2)ABC'组、RA'组及FB'组患者计划靶区双肺剂量5 Gy照射时的百分体积、双肺剂量20 Gy照射时的百分体积、平均肺剂量,差异有统计学意义(P<0.05)。心脏最大剂量、<15 cm^(3)体积的剂量示RA'组、ABC'组均略低于FB'组,但差异无统计学意义(P>0.05)。结论在非小细胞肺癌立体定向放射治疗中应用呼吸门控、适度腹部加压等呼吸管理方式联合4DCT,较自由呼吸模式下的FB'组有效地减小肿瘤内靶区体积、双肺剂量5 Gy的百分体积、双肺剂量20 Gy的百分体积、平均肺剂量等指标,减少呼吸动度对靶区的影响,提高定位、治疗的精度。腹部加压呼吸管理技术是对呼吸门控呼吸管理技术不适应者的一种有效补救措施。
Objective By comparing the parameters of stereotactic body radiotherapy(SBRT)planning under four dimension computed tomography(4DCT)combined with respiratory gating,abdominal compression,and free breathing modes,the impact of respiratory management on the volume and dose accuracy of the tumor(NSCLC)target area is analyzed.Methods A total of 12 patients with non-small cell lung cancer who received stereotactic radiotherapy at Central Hospital Affiliated to Shandong First Medical University from October 2021 to December 2022 were selected,three sets of image plans were designed,and each set of 12 cases as a group.The 4DCT scans were collected,the CT data were reconstructed according to the respiratory time-phase,and the 0%to 90%images(0%at the end of inspiration and 50%at the end of expiration)were obtained by layered processing.The tumor target area was outlined in each time-phase,and the full-time images were fused into full-time images by using the maximum density projection to simulate the normal CT images in the free-breathing mode(FB'group);30%to 70%time-phase images were fused by using the maximum density projection,which were defined as abdominal moderate pressure group images(RA'group),because the time-phase was the same as that of abdominal compression by using the breathing attachment.The 0%time-phase image at the end of inspiration was modeled as the active breathing control state image(ABC'group).Tumor target areas,intra-tumor target areas,and planned target areas were obtained on these three groups of images,and the dosimetric differences in tumor target areas and organs in crisis were compared among the three treatment modalities.Results(1)There was a significant difference in the volume of the target area within the tumor between groups ABC',RA'and FB'(P<0.05).The conformal index,uniformity index,dose of 5%PTV volume,and dose of 95%PTV volume of the planned target area were not statistically significant(P>0.05).(2)The percentage volume of dual lung dose 5 Gy and 20 Gy,and average lung dose were statistically significant(P<0.05).Maximum cardiac dose,less than 15 cm^(3)The volume dose showed that the RA'group and ABC'group were slightly lower than the FB'group,but there was no statistical significance(P>0.05).Conclusion The application of respiratory gating,moderate abdominal pressure,and other respiratory management methods combined with four-dimensional CT scanning in stereotactic radiotherapy for non-small cell lung cancer effectively reduces the target area volume,percentage volume of dual lung dose 5 Gy and 20 Gy,average lung dose,and other indicators compared to the FB'group under free breathing mode,reducing the impact of respiratory activity on the target area,and improving the accuracy of localization and treatment.Abdominal pressure breathing management technology is an effective remedial measure for those who are not suitable for respiratory gated breathing management technology.
作者
祖国红
孙美丽
窦岩
岳晨曦
汪延明
赵惠
ZU Guohong;SUN Meili;DOU Yan;YUE Chenxi;WANG Yanming;ZHAO Hui(Department of Oncology and Radiotherapy,Central Hospital Affiliated to Shandong First Medical University,Jinan Shandong 250013,China;Department of Oncology and Radiotherapy,the 960th Hospital of the PLA Joint Logistics Support Force,Jinan Shandong 250031,China)
出处
《中国卫生标准管理》
2024年第19期88-92,共5页
China Health Standard Management
基金
山东省医药卫生科技发展计划项目(202109030457)。
关键词
四维X线断层扫描
联合呼吸管理
非小细胞肺癌
立体定向放射治疗
治疗计划
精度影响
four dimension computed tomography
combined with respiratory management
non-small cell lung cancer
stereotactic body radiotherapy
treatment planning
precision impact
