[1]陈乐康,李楚豪,曾文杰,等.鼻咽癌放疗头颈部摆位误差及外轮廓变化对放疗剂量的影响[J].中国医学物理学杂志,2024,41(9):1057-1063.[doi:DOI:10.3969/j.issn.1005-202X.2024.09.001]
　CHEN Lekang,LI Chuhao,et al.Effects of head and neck positioning errors and external contour changes on radiation dose in radiotherapy for nasopharyngeal carcinoma[J].Chinese Journal of Medical Physics,2024,41(9):1057-1063.[doi:DOI:10.3969/j.issn.1005-202X.2024.09.001]
点击复制

鼻咽癌放疗头颈部摆位误差及外轮廓变化对放疗剂量的影响()
分享到：

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第9期
页码:
1057-1063
栏目:
医学放射物理
出版日期:
2024-10-25

文章信息/Info

Title:
Effects of head and neck positioning errors and external contour changes on radiation dose in radiotherapy for nasopharyngeal carcinoma
文章编号:
1005-202X（2024）09-1057-07
作者:
陈乐康1; 2; 李楚豪2; 曾文杰2; 蔡曼波1; 伍海彪1; 2
1.南华大学附属第一医院肿瘤科， 湖南 衡阳 421001； 2.南华大学核科学技术学院， 湖南 衡阳 421001
Author(s):
CHEN Lekang1;  2;  LI Chuhao2;  ZENG Wenjie2;  CAI Manbo1;  WU Haibiao1;  2
1. Department of Oncology, the First Affiliated Hospital of University of South China, Hengyang 421001, China 2. School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
关键词:
鼻咽癌; 调强放疗; 锥形束CT; 外轮廓; 摆位误差
Keywords:
Keywords: nasopharyngeal carcinoma intensity-modulated radiotherapy cone-beam computed tomography external contour positioning error
分类号:
R318；R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2024.09.001
文献标志码:
A
摘要:
目的：采用千伏级锥形束CT（CBCT）获取分次间鼻咽癌调强放疗中的外轮廓变化及摆位误差，分析其对靶区及危及器官剂量分布的影响。方法：选取21例鼻咽癌患者，将全部患者的137次CBCT图像与定位CT图像匹配后得到左右、头脚、腹背方向的摆位误差数据。选取颈部3个不同层面，测量其外轮廓横切面宽度，并利用Pearson系数和独立样本t检验分析其对摆位误差的影响。基于CBCT影像制定模拟计划，分析摆位误差和外轮廓变化对放疗剂量的影响，并应用Mann-Whitney秩和检验进行显著性分析。结果：左右、头脚、腹背方向的摆位误差分别为（1.04±0.73）、（1.13±0.87）、（1.38±0.95） mm。A、B、C层面上的头颈部最大外轮廓变化率分别为15.36%、14.94%、14.99%。模拟计划显示GTV D98、CTV1 D95、CTV2 D95靶区的模拟计划的剂量均小于执行的计划剂量，差异有统计学意义（P<0.05）；脑干和脊髓的模拟计划Dmax均大于计划剂量，差异有统计学意义（P<0.05）。结论：通过模拟计划可知，当摆位误差和外轮廓变化等不确定性因素存在时，靶区的剂量变化较大，其中GTV D98最大减小11.49%，CTV1 D95、CTV2 D95最大变化率分别为12.88%、21.64%。除左右晶体和左腮腺之外，其余的危及器官和靶区剂量均有显著性差异，表明实际放疗中摆位误差和外轮廓变化的存在会对剂量分布造成显著影响。
Abstract:
Abstract: Objective To acquire the external contour changes and positioning errors during fractionated intensity-modulated radiotherapy for nasopharyngeal carcinoma using kilovoltage cone-beam computed tomography (CBCT), and to analyze their effects on the dose distributions in target areas and organs-at-risk. Methods Twenty-one patients with nasopharyngeal carcinoma were enrolled in the study, and the positioning errors in the left-right, superior-inferior and anterior-posterior directions were obtained by matching 137 CBCT images with the positioning CT images. The transverse width of the external contour was measured at 3 different layers of the neck, and its effects on positioning errors were analyzed using Pearsons coefficient and independent sample t-tests. Additionally, simulation plans based on CBCT images were created to analyze the effects of positioning errors and external contour changes on radiotherapy dose, with Mann-Whitney U tests applied for significance analysis. Results The positioning errors in the left-right, superior-inferior and anterior-posterior directions were (1.04±0.73), (1.13±0.87) and (1.38±0.95) mm, respectively. The rates of external contour changes at the A, B and C layers of the head and neck were 15.36%, 14.94% and 14.99%, respectively. Compared with executed plans, simulation plans had lower GTV D98, CTV1 D95 and CTV2 D95 (P<0.05), and higher Dmax for the brainstem and spinal cord (P<0.05). Conclusion The simulation plans indicate that the presence of uncertainties such as positioning errors and external contour changes will significantly affect dose distributions in target areas, with the largest decrease observed in GTV D98 (11.49%) and the maximum change rates in CTV1 D95 and CTV2 D95 being 12.88% and 21.64%, respectively. Except for the left and right lenses and left parotid gland, significant differences are observed in the doses for the other organs-at-risk and target areas, suggesting that positioning errors and external contour changes in actual radiotherapy will exert significant effects on dose distributions.

相似文献/References:

[1]张富利,王雅棣,许卫东,等.应用两种三维探测器阵列进行螺旋断层调强放疗计划剂量验证[J].中国医学物理学杂志,2015,32(02):218.[doi:10.3969/j.issn.1005-202X.2015.02.015]
[2]王捷,裴曦,曹瑞芬,等.一种快速调强放射治疗直接子野优化方法[J].中国医学物理学杂志,2015,32(01):4.[doi:10.3969/j.issn.1005-202X.2015.01.002]
[3]曾 彪,张九堂,席许平.单中心上下半野调强放射治疗的物理剂量验证[J].中国医学物理学杂志,2015,32(01):17.[doi:10.3969/j.issn.1005-202X.2015.01.005]
[4]李珠明,崔玉琴,白晓平,等.多通道剂量测量仪在调强放疗剂量检测中的应用[J].中国医学物理学杂志,2014,31(01):4600.[doi:10.3969/j.issn.1005-202X.2014.01.002]
[5]李丹明,孙新臣,张 胜,等.食道癌患者心脏图谱指导下心脏勾画的一致性研究[J].中国医学物理学杂志,2014,31(03):4857.[doi:10.3969/j.issn.1005-202X.2014.03.003]
[6]雷怀宇,张书旭.乏氧显像及其在放射治疗中的应用研究[J].中国医学物理学杂志,2014,31(04):4975.[doi:10.3969/j.issn.1005-202X.2014.04.001]
[7]潘宇辉,陈榕钦,柏朋刚,等.鼻咽癌调强放射治疗前后腮腺体积及空间几何位置变化研究[J].中国医学物理学杂志,2014,31(05):5120.[doi:10.3969/j.issn.1005-202X.2014.05.005]
[8]张俊俊,邱小平,李奇欣,等.ArcCheck系统在鼻咽癌容积旋转调强剂量验证中的应用[J].中国医学物理学杂志,2014,31(05):5136.[doi:10.3969/j.issn.1005-202X.2014.05.009]
[9]苏清秀,张 矛,金海国,等.比较调强放射治疗与三维适形放疗治疗中下段食管癌时心脏和冠状动脉的受量[J].中国医学物理学杂志,2014,31(05):5139.[doi:10.3969/j.issn.1005-202X.2014.05.010]
[10]桑 勇,陈维军,狄小云,等.多叶光栅叶片宽度对鼻咽癌剂量学的影响[J].中国医学物理学杂志,2014,31(06):5240.[doi:10.3969/j.issn.1005-202X.2014.06.004]
[11]陈广涛,汪 淇,刘亚强,等.TrueBeam加速器射野准直器跟随功能在鼻咽癌固定野调强放疗和容积旋转调强放疗中的应用[J].中国医学物理学杂志,2014,31(03):4865.[doi:10.3969/j.issn.1005-202X.2014.03.005]
[12]蒋晓芹,段宝风,艾平,等.基于图谱库的自动轮廓勾画软件(ABAS)在鼻咽癌调强放疗中的应用[J].中国医学物理学杂志,2013,30(02):3997.[doi:10.3969/j.issn.1005-202X.2013.02.008]
[13]张达光,蒋胜鹏,李智华,等.鼻咽癌调强放疗中解剖结构改变及剂量分布变化的研究[J].中国医学物理学杂志,2013,30(04):4239.[doi:10.3969/j.issn.1005-202X.2013.04.006]
[14]王志伟,段继梅,谷丹,等.腮腺尺寸变化对初治鼻咽癌调强放疗病例脑干、脊髓剂量的影响[J].中国医学物理学杂志,2016,33(5):533.[doi:10.3969/j.issn.1005-202X.2016.05.021]
　[J].Chinese Journal of Medical Physics,2016,33(9):533.[doi:10.3969/j.issn.1005-202X.2016.05.021]
[15]刘国才,官文静,田娟秀,等. 集成自适应回归核的肿瘤生物靶区随机游走勾画方法[J].中国医学物理学杂志,2018,35(7):758.[doi:DOI:10.3969/j.issn.1005-202X.2018.07.004]
　LIU Guocai,GUAN Wenjing,TIAN Juanxiu,et al. A random walk method with adaptive regression-kernel for delineation of biological target volumes of tumors[J].Chinese Journal of Medical Physics,2018,35(9):758.[doi:DOI:10.3969/j.issn.1005-202X.2018.07.004]
[16]雷怀宇,张书旭,张国前,等. 保护颈动脉鞘的局部晚期鼻咽癌IMRT计划对靶区及危及器官剂量的影响[J].中国医学物理学杂志,2018,35(11):1252.[doi:DOI:10.3969/j.issn.1005-202X.2018.11.003]
　LEI Huaiyu,ZHANG Shuxu,ZHANG Guoqian,et al. Effects of carotid sheath-sparing intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma on doses of target areas and organs-at-risk[J].Chinese Journal of Medical Physics,2018,35(9):1252.[doi:DOI:10.3969/j.issn.1005-202X.2018.11.003]
[17]叶淑敏,滕建建,石锦平,等. MLC叶片系统误差对鼻咽癌VMAT和IMRT计划剂量影响的比较[J].中国医学物理学杂志,2019,36(10):1139.[doi:DOI:10.3969/j.issn.1005-202X.2019.10.005]
　YE Shumin,TENG Jianjian,SHI Jinping,et al. Comparison of dosimetric impacts of MLC systematic errors on VMAT and IMRT plans for nasopharyngeal carcinoma[J].Chinese Journal of Medical Physics,2019,36(9):1139.[doi:DOI:10.3969/j.issn.1005-202X.2019.10.005]
[18]黄霞,苏坤普,罗焕丽,等.铅门跟随与固定技术结合有无均整器模式的鼻咽癌IMRT剂量学比较[J].中国医学物理学杂志,2020,37(7):858.[doi:DOI:10.3969/j.issn.1005-202X.2020.07.011]
　HUANG Xia,SU Kunpu,LUO Huanli,et al.Different intensity-modulated radiotherapy plans for nasopharyngeal carcinoma: a dosimetric comparison among JTT-FFF, JTT-FF, SJT-FFF and SJT-FF[J].Chinese Journal of Medical Physics,2020,37(9):858.[doi:DOI:10.3969/j.issn.1005-202X.2020.07.011]
[19]顾慧宽,陈利,胡江,等.鼻咽癌调强放疗计划质量量化评价方法研究[J].中国医学物理学杂志,2021,38(10):1196.[doi:DOI:10.3969/j.issn.1005-202X.2021.10.003]
　GU Huikuan,CHEN Li,HU Jiang,et al.Quantitative evaluation of the quality of intensity-modulated radiotherapy plan for nasopharyngeal carcinoma[J].Chinese Journal of Medical Physics,2021,38(9):1196.[doi:DOI:10.3969/j.issn.1005-202X.2021.10.003]

备注/Memo

备注/Memo:
【收稿日期】2024-04-10 【基金项目】国家自然科学基金（12005093）；湖南省自然科学基金（2021JJ30610） 【作者简介】陈乐康，研究方向：医学物理、肿瘤放射物理学，E-mail: 20200820311@stu.usc.edu.cn 【通信作者】伍海彪，博士，高级工程师，研究方向：肿瘤放射治疗与放射性损伤，E-mail: wuhaibiao@163.com
更新日期/Last Update: 2024-09-25