[1]阮俊杰,李斌,李雅宁,等.体质量特征对结直肠癌放疗摆位误差的影响[J].中国医学物理学杂志,2026,43(4):430-435.[doi:DOI:10.3969/j.issn.1005-202X.2026.04.002]
　RUAN Junjie,LI Bin,et al.Effects of body mass factors on setup errors in colorectal cancer radiotherapy[J].Chinese Journal of Medical Physics,2026,43(4):430-435.[doi:DOI:10.3969/j.issn.1005-202X.2026.04.002]
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体质量特征对结直肠癌放疗摆位误差的影响()

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

卷:
43卷
期数:
2026年第4期
页码:
430-435
栏目:
医学放射物理
出版日期:
2026-04-28

文章信息/Info

Title:
Effects of body mass factors on setup errors in colorectal cancer radiotherapy
文章编号:
1005-202X（2026）04-0430-06
作者:
阮俊杰1; 2; 李斌2; 李雅宁2; 黄晓彤2; 迟锋2; 丁振华1
1.南方医科大学公共卫生学院放射医学系， 广东 广州 510515； 2.华南恶性肿瘤防治全国重点实验室/广东省恶性肿瘤临床医学研究中心/中山大学肿瘤防治中心放疗科， 广东 广州 510060
Author(s):
RUAN Junjie1;  2;  LI Bin2;  LI Yaning2;  HUANG Xiaotong2;  CHI Feng2;  DING Zhenhua1
1. Department of Radiation Medicine, School of Public Health, Southern Medical University, Guangzhou 510515, China 2. Department of Radiotherapy, State Key Laboratory of Oncology in South China/Guangdong Provincial Clinical Research Center for Cancer/Sun Yat-sen University Cancer Center, Guangzhou 510060, China
关键词:
结直肠癌; 摆位误差; 体质量特征; PTV外扩边界
Keywords:
Keywords: colorectal cancer setup error body mass factor planning target volume margin
分类号:
R318；R815.6
DOI:
DOI:10.3969/j.issn.1005-202X.2026.04.002
文献标志码:
A
摘要:
目的：探讨结直肠癌放疗前体质量特征（BMF）对摆位误差的影响，建立风险分层模型以优化计划靶区（PTV）外扩边界。方法：回顾性分析2021年3月~2022年12月于中山大学肿瘤防治中心Halcyon加速器放疗的22例结直肠癌患者，均采用热塑体膜联合腹板固定。测量计划CT图像脐部及髋部横断层面的前后、左右最大直径和骶骨旋转角度。放疗前通过锥形束CT与计划CT配准，获取三维方向（左右LR、头脚SI、前后AP）的摆位误差，并计算对应的PTV外扩边界。比较不同性别患者的摆位误差和BMF，采用Spearman相关分析BMF与摆位误差关联性。通过LASSO回归筛选BMF，结合多因素Logistics回归分析和十折交叉验证构建模型，将摆位误差分为高危风险组和低危风险组。结果：在LR、SI、AP方向的摆位误差分别为0.27（0.19, 0.36） cm、0.54（0.42, 0.71） cm和0.18（0.12, 0.21） cm，对应PTV外扩边界分别为0.83、0.87和0.46 cm。不同性别患者的摆位误差和BMF没有统计学意义（P>0.05）。脐部前后最大直径与SI方向误差呈正相关（R2=0.222, P=0.027）。骶骨旋转角度与AP方向误差呈负相关（R2=0.359, P=0.003）。基于脐部前后最大直径（阈值22.82 cm）可有效区分SI方向误差的高危风险组和低危风险组（P<0.05）。结论：当采用热塑体膜与腹板固定时，需注意SI方向的PTV外扩边界相对其他方向较大。基于脐部前后最大直径可作为SI方向摆位误差的风险分层指标，为PTV外扩边界的优化提供参考。
Abstract:
Abstract: Objective To investigate the effects of pre-treatment body mass factors (BMF) on setup errors in colorectal cancer radiotherapy, and establish a risk stratification model for optimizing planning target volume (PTV) margins. Methods A retrospective analysis was conducted on 22 colorectal cancer patients who received radiotherapy using the Halcyon accelerator at Sun Yat-sen University Cancer Center between March 2021 and December 2022. All patients were immobilized using a thermoplastic mask and abdominal board. The maximum anteroposterior and transverse diameters at the umbilical and hip levels, as well as the sacral rotation angle, were measured on planning computed tomography (CT) images. Daily pre-treatment cone-beam CT images were registered to the planning CT to obtain setup errors in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, and the corresponding PTV margins were calculated. Setup errors and BMF were compared between patients of different genders. Spearmans correlation analysis was performed to evaluate the association between BMF and setup errors. ? risk stratification model was developed by integrating LASSO regression for BMF selection, multivariate Logistics regression, and ten-fold cross-validation, enabling the classification of patients into high-risk and low-risk groups according to setup errors. Results The setup errors in the LR, SI, and AP directions were 0.27 (0.19, 0.36) cm, 0.54 (0.42, 0.71) cm, and 0.18 (0.12, 0.21) cm, respectively, and the corresponding PTV margins were 0.83, 0.87, and 0.46 cm, respectively. No statistically significant differences were observed in setup errors or BMF between patients of different genders (P>0.05). A significant positive correlation was identified between the maximum anteroposterior diameter at the umbilical level and setup errors in the SI direction (R2=0.222,?=0.027), whereas the sacral rotation angle showed a negative correlation with setup errors in the AP direction (R2=0.359,?=0.003).?he maximum anteroposterior diameter at the umbilical level (threshold: 22.82 cm) could be used to effectively distinguish between high-risk and low-risk groups for setup errors in the SI direction (P<0.05). Conclusion When using thermoplastic mask and abdominal board for immobilization, the PTV margin in the SI direction is relatively larger than those in other directions. The maximum anteroposterior diameter at the umbilical level serves as an index for risk stratification of setup errors in the SI direction, providing a reference for optimizing PTV margins.

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备注/Memo

备注/Memo:
【收稿日期】2025-10-26 【基金项目】广东省基础与应用基础研究基金（2025A1515010463）；广东省生物医学工程学会医学物理技术专项科研基金（2022YXWL0101） 【作者简介】阮俊杰，研究方向：放射治疗，E-mail: ruanjj@sysucc.org.cn 【通信作者】丁振华，教授，研究方向：核与放射突发事件医学应急，E-mail: dingzh@smu.edu.cn
更新日期/Last Update: 2026-04-28