宫颈癌容积旋转调强放疗中患者腹围变化对摆位误差的影响
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摘要
目的:通过分析千伏级锥形束CT(cone beam CT,CBCT)引导宫颈癌容积旋转调强放疗(volumetric-modulated arc therapy,VMAT)的数据,研究患者腹围变化对摆位误差的影响。方法:选取30例宫颈癌VMAT治疗患者,治疗前记录腹围,行千伏级CBCT校正扫描,并进行在线匹配,记录治疗前摆位误差。采用SPSS 17.0统计学软件进行数据分析,通过配对样本t检验分析差异、Pearson法分析腹围变化与摆位误差的关系。结果:随着治疗次数的增加,患者腹围均有一定幅度的下降,其中16例患者第5周开始下降>3 cm,结束时平均腹围下降4.3 cm;患者上下、前后、左右3个方向上平均摆位误差均>3 mm,且有一个或多个方向误差>5 mm;Pearson相关性分析显示腹围下降增加摆位误差(上下、前后、左右方向的P值分别为0.048、0.043、0.040),差异有统计学意义。其余14例患者腹围下降≤2 cm,摆位误差在上下、前后、左右方向均能达到精准性放疗要求。结论:宫颈癌患者放疗后期腹围下降明显时会影响摆位误差,特别是第5、6周,建议后期密切监测患者腹围变化,适当增加CBCT校正扫描次数,保证治疗精准化和最优化。
Objective To analyze the influence of abdominal circumference on the setup error of cervical cancer by analyzing the data of volumetric modulated arc therapy(VMAT) guided by kilovoltage CBCT. Methods The abdominal circumference was recorded in 30 patients with cervical cancer VMAT, and the abdominal circumference was recorded before the treatment.The kilovolt grade CBCT correction scan was performed, and the preoperative pendulum position error was recorded. SPSS17.0 software was used for data processing and statistical analysis. The difference was analyzed by the paired sample t test,and the relationship between the abdominal circumference and the pendulum error was analyzed by Pearson method. Results With the increase of the number of treatment, the abdominal circumference of the patients decreased to a certain extent.There were 16 cases had the decline higher than 3 cm at the fourth week with an average abdominal circumference decreased by 4.3 cm at the end of the treatment; the average pendulum errors of the 16 patients were higher than 3 mm at up-down,anterior-posterior as well as left-right directions, and the error was higher than 5 mm at one or multi directions; the correlation analysis showed that the abdominal circumference increased with the pendulum position error, and the there were significant differences existed with P values being 0.048, 0.043 and 0.040 respectively at up-down, anterior-posterior as well as left-right directions. The remained 14 patients had the abdominal circumference declined by not more than 2 cm, and the requirements for precision radiotherapy were met at up-down, anterior-posterior as well as left-right directions. Conclusion The abdominal circu-mference of the cervical cancer patients affects obviously the setup error at the late stage of radiotherapy, especially at the fifth and sixth week. It's suggested that the abdominal circumstance be monitored strictly and the frequency of CBCT correction scan be heightened at the late stage so as to ensure the precision and optimization of the treatment.
Objective To analyze the influence of abdominal circumference on the setup error of cervical cancer by analyzing the data of volumetric modulated arc therapy(VMAT) guided by kilovoltage CBCT. Methods The abdominal circumference was recorded in 30 patients with cervical cancer VMAT, and the abdominal circumference was recorded before the treatment.The kilovolt grade CBCT correction scan was performed, and the preoperative pendulum position error was recorded. SPSS17.0 software was used for data processing and statistical analysis. The difference was analyzed by the paired sample t test,and the relationship between the abdominal circumference and the pendulum error was analyzed by Pearson method. Results With the increase of the number of treatment, the abdominal circumference of the patients decreased to a certain extent.There were 16 cases had the decline higher than 3 cm at the fourth week with an average abdominal circumference decreased by 4.3 cm at the end of the treatment; the average pendulum errors of the 16 patients were higher than 3 mm at up-down,anterior-posterior as well as left-right directions, and the error was higher than 5 mm at one or multi directions; the correlation analysis showed that the abdominal circumference increased with the pendulum position error, and the there were significant differences existed with P values being 0.048, 0.043 and 0.040 respectively at up-down, anterior-posterior as well as left-right directions. The remained 14 patients had the abdominal circumference declined by not more than 2 cm, and the requirements for precision radiotherapy were met at up-down, anterior-posterior as well as left-right directions. Conclusion The abdominal circu-mference of the cervical cancer patients affects obviously the setup error at the late stage of radiotherapy, especially at the fifth and sixth week. It's suggested that the abdominal circumstance be monitored strictly and the frequency of CBCT correction scan be heightened at the late stage so as to ensure the precision and optimization of the treatment.
引文
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[3]于娇,陈鑫,赵淑红,等.宫颈癌术后调强放疗摆位误差分析[J].医疗卫生装备,2017,38(1):81-84.
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[7]JOHNSTON M,CLIFFORD S,BROMLEY R,et al. Volumetric-modulated arc therapy in head and neck radiotherapy:a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma[J]. Clin Oncol(R Coll Radiol),2011,23(8):503-511.
[8]RENARD-OLDRINI S,GUINEMENGT L,SALLERON J,et al. Dosimetric comparaison between VMAT and tomotherapy with para-aortic irradiation for cervix carcinoma[J]. Cancer Radiother,2015,19(8):733-738.
[9]SHARFO A W,VOET P W,BREEDVELD S,et al. Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning[J]. Radiother Oncol,2015,114(3):395-401.
[10]QIN A Q,LIANG Z G,YE J X,et al. Significant efficacy of additional concurrent chemotherapy with radiotherapy for postoperative cervical cancer with risk factors:a systematic review and meta-analysis[J]. Asian Pac J Cancer Prev,2016,17(8):3 945-3 951.
[11]聂芳芳,陈小琴,付杰,等.早期高危宫颈癌术后同期放化疗研究进展[J].中华放射肿瘤学杂志,2017,26(12):1 470-1 474.
[12]ZIA S Y,SMITH W,OZBEK U,et al. The impact of weight loss on setup accuracy for head and neck cancer patients in the era of image guided radiation therapy[J]. J Radiat Oncol,2016,5(4):359-362.
[13]叶志雄,许青,彭佳元,等.直肠癌IMRT中患者体重下降与位移误差的相关性研究[J].中华放射肿瘤学杂志,2017,26(6):650-652.
[14]SU J Q,CHEN W,YANG H Y,et al. Different setup errors assessed by weekly cone-beam computed tomography on different registration in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J]. Onco Targets Ther,2015,8:2 545-2 553.
[15]吴婷,曹洋森.基于XVI行容积旋转调强放疗治疗盆腔肿瘤摆位误差分析[J].医疗卫生装备,2017,38(4):98-101.
[16]CHONG I,HAWKINS M,HANSEN V,et al. Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography[J]. Int J Radiat Oncol Biol Phys,2011,81(4):e431-e438.
[2]YU C X,TANG G. Intensity-modulated arc therapy:principles,technologies and clinical implem entation[J]. Phys Med Boil,2011,56(5):R31-R54.
[3]于娇,陈鑫,赵淑红,等.宫颈癌术后调强放疗摆位误差分析[J].医疗卫生装备,2017,38(1):81-84.
[4]BERTELSEN A,HANSEN C R,JOHANSEN J,et al. Single arc volumetric modulated arc therapy of head and neck cancer[J]. Radiother Oncol,2010,95(2):142-148.
[5]王占宇,谭军文,龙雨松,等.非均整与均整模式下宫颈癌容积旋转调强放疗计划的剂量学比较[J].中国医学物理学杂志,2017,34(11):1 110-1 116.
[6]ZHANG W Z,ZHAI T T,LU J Y,et al. Volumetric modulated arc therapy vs C-IMRT for the treatment of upper thoracic esophageal cancer[J]. PLoS One,2015,10(3):e0121385.
[7]JOHNSTON M,CLIFFORD S,BROMLEY R,et al. Volumetric-modulated arc therapy in head and neck radiotherapy:a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma[J]. Clin Oncol(R Coll Radiol),2011,23(8):503-511.
[8]RENARD-OLDRINI S,GUINEMENGT L,SALLERON J,et al. Dosimetric comparaison between VMAT and tomotherapy with para-aortic irradiation for cervix carcinoma[J]. Cancer Radiother,2015,19(8):733-738.
[9]SHARFO A W,VOET P W,BREEDVELD S,et al. Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning[J]. Radiother Oncol,2015,114(3):395-401.
[10]QIN A Q,LIANG Z G,YE J X,et al. Significant efficacy of additional concurrent chemotherapy with radiotherapy for postoperative cervical cancer with risk factors:a systematic review and meta-analysis[J]. Asian Pac J Cancer Prev,2016,17(8):3 945-3 951.
[11]聂芳芳,陈小琴,付杰,等.早期高危宫颈癌术后同期放化疗研究进展[J].中华放射肿瘤学杂志,2017,26(12):1 470-1 474.
[12]ZIA S Y,SMITH W,OZBEK U,et al. The impact of weight loss on setup accuracy for head and neck cancer patients in the era of image guided radiation therapy[J]. J Radiat Oncol,2016,5(4):359-362.
[13]叶志雄,许青,彭佳元,等.直肠癌IMRT中患者体重下降与位移误差的相关性研究[J].中华放射肿瘤学杂志,2017,26(6):650-652.
[14]SU J Q,CHEN W,YANG H Y,et al. Different setup errors assessed by weekly cone-beam computed tomography on different registration in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J]. Onco Targets Ther,2015,8:2 545-2 553.
[15]吴婷,曹洋森.基于XVI行容积旋转调强放疗治疗盆腔肿瘤摆位误差分析[J].医疗卫生装备,2017,38(4):98-101.
[16]CHONG I,HAWKINS M,HANSEN V,et al. Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography[J]. Int J Radiat Oncol Biol Phys,2011,81(4):e431-e438.