锥形束CT评价根治性宫颈癌调强放疗患者肿瘤临床靶区运动度的研究

发布时间：2018-08-10 07:10

【摘要】：目的探讨采用锥形束CT(CBCT)评价未手术宫颈癌患者适形调强放射治疗(IMRT)中肿瘤临床靶区(CTV)内界值的移动度,以期为未手术宫颈癌根治性放疗患者肿瘤CTV-ITV扩界值(IM)的设定提供参考。方法收集2013年12月至2014年10月未手术宫颈癌接受根治性IMRT的患者20例,比较CBCT与定位CT图像上肿瘤临床靶区的位移及形变情况。结果 20例宫颈癌患者140次CBCT图像上肿瘤临床靶区(CTV1-CBCT)相对于定位CT上CTV1形变体积为(33.56±22.52)cm~3(范围:1.04~110.22 cm~3),CTV1-CBCT相对于CTV1形变体积百分比为(10.19±6.32)%(范围:0.37%~32.01%)。患者140次CBCT扫描中,CTV1在宫体及宫旁前、宫体及宫旁后、宫颈前、宫颈后、宫体上、宫体偏侧、宫体对侧7个方位最大形变长度分别为(1.19±0.82)cm、(0.80±0.55)cm、(0.16±0.25)cm、(0.23±0.29)cm、(0.27±0.42)cm、(0.18±0.24)cm及(0.78±1.09)cm。2 cm的肿瘤IM只能使85%的CBCT扫描次数实现CTV1-CBCT完全覆盖;95%以上的CBCT扫描中宫体形变大于宫颈形变;患者间肿瘤临床靶区运动度有个体差异。结论应用CBCT获得三维方向不同大小IM和宫颈及宫体不同大小IM的靶区勾画策略并配合个体化的图像引导放疗策略可能是目前宫颈癌精确放疗较好的临床实现形式。
[Abstract]:Objective to evaluate the mobility of conformal intensity modulated radiotherapy (IMRT) (CTV) in patients with unoperated cervical cancer by conical beam CT (CBCT) (TBI), and to provide a reference for the setting of CTV-ITV extension value (IM) in patients with non-surgical radical radiotherapy for cervical cancer. Methods from December 2013 to October 2014, 20 patients with unoperated cervical cancer receiving radical IMRT were collected, and the displacement and deformation of tumor clinical target on CBCT and localization CT images were compared. Results the tumor clinical target area (CTV1-CBCT) was (33.56 卤22.52) cm~3 (range: 1.04 卤110.22 cm~3) on CBCT images of 20 patients with cervical cancer, and the percentage of CTV1 1-CBCT relative to CTV1 was (10.19 卤6.32)% (range: 0.37 卤32.01%). CTV1 was found in the uterine body and para-uterine body, after the uterine body and para-uterine body, before the cervix, after the cervix, on the upper uterine body, on the side of the uterine body, during the 140th CBCT scan. The maximum deformation length of the opposite side of uterine body was (1.19 卤0.82) cm, () 0.80 卤0.55) cm, (0.16 卤0.25) cm, (0.23 卤0.29) cm, (0.27 卤0.42) cm, (0.18 卤0.24 cm and (0.78 卤1.09) cm.2 cm, respectively. There were individual differences in the motility of the clinical target area among the patients. Conclusion using CBCT to obtain three dimensional IM with different direction and different size IM in cervix and uterine body, and combining with individual image guided radiotherapy strategy may be a better clinical form of accurate radiotherapy for cervical cancer at present.
【作者单位】：中南大学湘雅医院肿瘤放射治疗科;
【基金】：湖南省科技厅资助项目(2014FJ3102)
【分类号】：R730.55;R737.33

【参考文献】