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摘要：
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目的:利用4D锥形束CT研究肺癌放疗的靶区外扩范围。方法:随机选取2013年10月8日至2014年6月26日南京医科大学第一附属医院20例肺癌患者,热塑体膜固定,平静呼吸下CT螺旋扫描定位,治疗前利用4D锥形束CT进行靶区位置验证,根据公式MPTV=2.5Σ总＋0.7σ总,分别计算只考虑摆位扩边、考虑摆位扩边和内扩边及考虑修正摆位扩边系统误差后3种情况下不同部位PTV在3个方向的外扩范围。结果:第1种情况只考虑摆位扩边,X方向4.185 mm,Y方向6.590 mm,Z方向4.117 mm。第2种情况考虑摆位扩边和内扩边,肺上叶组:X方向4.454 mm,Y方向7.108 mm,Z方向4.476 mm;肺中下叶组:X方向5.052 mm,Y方向13.511 mm,Z方向5.053 mm。第3种情况摆位扩边系统误差被修正,考虑内扩边,肺上叶组:X方向2.790 mm,Y方向4.797 mm,Z方向2.982 mm;肺中下叶组:X方向3.869 mm,Y方向12.809 mm,Z方向3.969 mm。结论:肺癌的PTV外扩范围必须考虑肿瘤运动,修正摆位扩边系统误差对肺上叶组肿瘤更有意义。 |
Objective: To define margins of PTV in radiotherapy on lung cancer using 4D-cone beam(CB)CT. Methods: 20 cases of lung cancer patients coming from the First Affiliated Hospital of Nanjing Medical University were randomly selected from October 8, 2013 to June 26, 2014, thermoplastic membrane fixed, spiral CT scanned under quiet breathing.4D-CBCT were performed to verify target position before treatment. We respectively calculated the margins of PTV in three directions when only considering setup margins, considering setup margins and internal margins, and only considering internal margins after system error correction of setup margins according to the formula MPTV=2.5Σtotal+0.7σtotal. Results: In the first condition margins of PTV only based on setup margins: X direction was 4.185 mm, Y direction 6.590 mm, Z direction 4.117 mm; in the second condition, margins of PTV based on setup margins and internal margins: X direction 4.454 mm, Y direction 7.108 mm, Z direction 4.476 mm in the upper lobe, however, X direction 5.052 mm, Y direction 13.511 mm, Z direction 5.053 mm in the middle-lower lobe; in the thirdly condition, system error of setup margins was corrected, in the upper lobe: X direction 2.790 mm, Y direction 4.797 mm, Z direction 2.982 mm; besides, in the middle-lower lobe: X direction 3.869 mm, Y direction 12.809 mm, Z direction 3.969 mm. Conclusion: Tumor movement should be considered when defining margins of PTV, and it's more meaningful to correct the system error of setup margins on the lung tumor in the upper lobe. |
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参考文献：
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