[1]孙晓欢,谭丽娜,王中飞,等. 肺癌立体定向体部放疗以靶区为准进行锥形束CT在线配准的可行性研究[J].中国医学物理学杂志,2019,36(3):282-286.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.007]
　SUN Xiaohuan,TAN Lina,WANG Zhongfei,et al. Feasibility of CBCT online registration by target areas in stereotactic body radiotherapy for lung cancer[J].Chinese Journal of Medical Physics,2019,36(3):282-286.[doi:DOI:10.3969/j.issn.1005-202X.2019.03.007]
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 肺癌立体定向体部放疗以靶区为准进行锥形束CT在线配准的可行性研究()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第3期
页码:
282-286
栏目:
医学放射物理
出版日期:
2019-03-25

文章信息/Info

Title:
 Feasibility of CBCT online registration by target areas in stereotactic body radiotherapy for lung cancer
文章编号:
1005-202X（2019）03-0282-05
作者:
 孙晓欢; 谭丽娜; 王中飞; 肖锋
 空军军医大学第一附属医院放疗科， 陕西 西安 710032
Author(s):
 SUN Xiaohuan;  TAN Li’na;  WANG Zhongfei;  XIAO Feng
 Department of Radiation Oncology, the First Affiliated Hospital of Air Force Medical University, Xi’an 710032, China
关键词:
 ; 肺癌; 立体定向体部放疗; 锥形束CT; 靶区位移; 剂量分布; 在线配准
Keywords:
Keywords: lung cancer;  stereotactic body radiotherapy;  cone beam CT;  shifting of target area;  dose distribution;  online registration
分类号:
R815
DOI:
DOI:10.3969/j.issn.1005-202X.2019.03.007
文献标志码:
A
摘要:
 【摘要】目的：在使用锥形束CT（CBCT）立体定向体部放疗（SBRT）前进行位置验证时，由于呼吸运动，容易导致以骨性标志或外轮廓配准时靶区与计划图像严重偏离；反之，以靶区配准，则骨性标志或外轮廓容易出现严重偏离。本文探讨出现上述情况时，以靶区为准进行CBCT在线配准的可行性。方法：选取9例肺癌患者，对患者行4DCT扫描，采用美国瓦里安公司Eclipse 13.5计划系统，分别为9例患者设计VMAT计划，处方剂量为60 Gy/10次，使用美国瓦里安公司iX加速器进行治疗。为了验证靶区与外轮廓发生偏移对剂量分布的影响，本文在原始CT图像中，将靶区分别朝患者右侧脚方向和背部移动0.5和1 cm，再将原计划治疗中心依据肿瘤移动方向分别移动0.5、1 cm至移动后的靶区中心，重新计算剂量分布，生成模拟计划，并与原计划的靶区及正常器官受量进行比较。结果：原计划中靶区的最大剂量（Dmax）、最小剂量（Dmin）、平均剂量（Dmean）、60 Gy剂量包绕的靶区体积（V60）分别为108.5%±1.6%、98.3%±0.2%、101.1%±0.9%、95.1%±0.3%（Dmax, Dmin，Dmean均以相对靶区处方剂量的百分量表示），脊髓Dmax为（9.7±1.9） Gy，双肺V20为5.2%±1.9%，Dmean为（3.9±1.4） Gy。靶区向患者右侧移动1 cm、背部移动0.5和1 cm后、脚方向移动0.5和1 cm后，Dmax较原计划差异均具有统计学意义，脚方向移动0.5 cm后Dmin和V60较原计划也具有统计学差异，但是结果仍然满足RTOG0915号报告的要求。当靶区向患者背部移动0.5和1 cm时，脊髓受量与原计划差异具有统计学意义，靶区向患者脚方向移动0.5和1 cm时，全肺V20和Dmean与原计划差异具有统计学意义，但这些结果均满足RTOG0915号报告的要求。结论：本研究建议对于肺癌SBRT患者在线CBCT配准时，可以直接利用可见肿瘤进行配准，若误差小于1 cm，无需重新定位，可以直接移动治疗床进行治疗。
Abstract:
 Abstract: Objective Positioning verification before cone beam CT (CBCT)-guided stereotactic body radiotherapy (SBRT) is of great importance. However, due to the respiratory motion, target areas were seriously deviated from planning image when using the bony structure or the skin marker to align the CBCT with planning CT, and the bony structure or the body outline would not match when using the image registration based on target areas. Herein the feasibility of CBCT online registration by target areas is discussed. Methods Nine patients receiving SBRT for lung were enrolled in this study. All the patients were scanned with 4DCT. Varian Eclipse 13.5 treatment planning system was used to design volumetric modulated arc therapy (VMAT) plans for each patient, with a prescribed dose of 60 Gy/10 F, and Varian iX accelerator was adopted in the treatment. The planning target volume (PTV) on original CT image was shifted to the right, feet and back by 0.5 or 1.0 cm, and according to the shifting of PTV, the isocenter of each plan was shifted by 0.5 or 1.0 cm. Subsequently, the dose distribution was recalculated to generate a PTV-shift plan. The differences in the dosimetric parameters of target areas and organs-at-risk between the original plan and PTV-shift plan were evaluated, so as to investigate the effects of PTV-shift on dose distribution. Results The maximum dose (Dmax), minimum dose (Dmin), mean dose (Dmean) and V60 of PTV in the original plan were 108.5%±1.6%, 98.3%±0.2%,101.1%±0.9%, 95.1%±0.3%, respectively (Dmax, Dmin, Dmean were represented by the percentage relative to target prescription dose). The Dmax of the spinal was (9.7±1.9) Gy, and the V20 and Dmean of lungs were 5.2%±1.9% and (3.9±1.4) Gy, respectively. Statistical differences between two plans were found in the Dmax of PTV after PTV was shifted by 1 cm in X direction, 0.5 or 1.0 cm in Y and Z directions, and in Dmin and V60 of PTV after PTV was shifted by 0.5 cm in Y direction, but the results still satisfied the requirements of RTOG report 0915. Moreover, statistical differences were also found in the dose of spinal cord after PTV was shifted by 0.5 or 1.0 cm in Z direction, and in the V20 and Dmean of lungs after PTV was shifted by 0.5 or 1.0 cm in Y direction, but the results still satisfied the requirements of RTOG report 0915. Conclusion For patients receiving SBRT for lung cancer, the image registration based on target areas is recommended in CBCT online registration. Repositioning is not necessary if the setup error was small than 1 cm, and therapy can be initiated after adjusting the treatment couch.

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备注/Memo

备注/Memo:
 【收稿日期】2018-09-25
【作者简介】孙晓欢，硕士研究生，主要从事放射物理师工作，E-mail: sxhshuijing@163.com
【通信作者】肖锋，E-mail: xiaofeng@fmmu.edu.cn
更新日期/Last Update: 2019-03-25