中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2010年
12期
927-931
,共5页
张秋实%李建彬%徐敏%范廷勇%卢洁%张英杰%邢军%田世禹
張鞦實%李建彬%徐敏%範廷勇%盧潔%張英傑%邢軍%田世禹
장추실%리건빈%서민%범정용%로길%장영걸%형군%전세우
乳腺肿瘤%放射疗法%部分乳腺外照射%靶区体积重合度%自主呼吸控制
乳腺腫瘤%放射療法%部分乳腺外照射%靶區體積重閤度%自主呼吸控製
유선종류%방사요법%부분유선외조사%파구체적중합도%자주호흡공제
Breast neoplasm%Radiotherapy%External-beam partial breast irradiation%Target volume overlap rate%Active breathing control
目的 探讨保乳术后部分乳腺外照射(EB-PBI)自主呼吸控制(ABC)不同呼吸状态体积重合度及其差异,从靶区体积重合的角度,表述ABC辅助呼吸运动对EB-PBI分次内靶区位移的影响.方法 对术腔放置银夹拟行EB-PBI的患者行乳腺托架固定ABC辅助CT模拟定位,同时采集适度深吸气呼吸控制(mDIBH)状态、自由呼吸(FB)状态、深吸气呼吸控制(DEBH)状态各2套CT图像.应用Pinnacle3治疗计划系统,进行2套mDIBH图像间、2套FB图像间、2套DEBH图像间及mDIBH与DEBH图像间自动融合,计算融合图像.选定进行融合的2套图像的大体肿瘤体积(GTV)、临床靶区体积(CTV)、计划靶区体积(PTV)的重合度,比较同一配准中3种靶区各自重合度间及不同配准中同一种靶区重合度间的差异.结果 mDIBH/mDIBH配准中,GTV/GTV、CTV/CTV和PTV/PTV重合度分别为(83.54±11.41)%、(93.00±6.49)%和(95.26±4.90)%,GTV/GTV与CTV/CTV、GTV/GTV与PTV/PTV重合度间差异均有统计学意义(P＜0.05),而CTV/CTV与PTV/PTV重合度间差异无统计学意义(P＞0.05).FB/FB配准中,GTV/GTV、CTV/CTV、PTV/PTV重合度分别为(72.55±29.10)%、(89.36±9.53)%和(92.47±7.25)%,GTV/GTV与CTV/CTV、CTV/CTV与PTV/PTV重合度间差异均无统计学意义(均P＞0.05),而GTV/GTV与PTV/PTV重合度间差异有统计学意义(P＜0.05).DEBH/DEBH配准中,GTV/GTV、CTV/CTV、PTV/PTV重合度分别为(79.48±22.31)%、(92.83±6.77)%和(95.05±4.81)%,3组靶区两两间重合度差异均有统计学意义(均P＜0.05).mDIBH/mDIBH与DEBH/DEBH间、mDIBH/mDIBH与FB/FB间、FB/FB与DEBH/DEBH间的GTV、CTV和PTV重合度差异均无统计学意义(均P＞0.05),而mDIBH/mDIBH与mDIBH/DEBH间、FB/FB与mDIBH/DEBH间的GTV、CTV和PTV重合度差异均有统计学意义(均P＜0.05).结论 ABC辅助实施EB-PBI,两次mDIBH间、两次FB间和两次DEBH间各靶区体积重合度差异不明显,且三者的PTV/PTV重合度均达到较高水平.因此,从靶区重合度的角度,若施照前进行在线摆位误差校正,EB-PBI实施进行呼吸控制的必要性值得商榷.
目的 探討保乳術後部分乳腺外照射(EB-PBI)自主呼吸控製(ABC)不同呼吸狀態體積重閤度及其差異,從靶區體積重閤的角度,錶述ABC輔助呼吸運動對EB-PBI分次內靶區位移的影響.方法 對術腔放置銀夾擬行EB-PBI的患者行乳腺託架固定ABC輔助CT模擬定位,同時採集適度深吸氣呼吸控製(mDIBH)狀態、自由呼吸(FB)狀態、深吸氣呼吸控製(DEBH)狀態各2套CT圖像.應用Pinnacle3治療計劃繫統,進行2套mDIBH圖像間、2套FB圖像間、2套DEBH圖像間及mDIBH與DEBH圖像間自動融閤,計算融閤圖像.選定進行融閤的2套圖像的大體腫瘤體積(GTV)、臨床靶區體積(CTV)、計劃靶區體積(PTV)的重閤度,比較同一配準中3種靶區各自重閤度間及不同配準中同一種靶區重閤度間的差異.結果 mDIBH/mDIBH配準中,GTV/GTV、CTV/CTV和PTV/PTV重閤度分彆為(83.54±11.41)%、(93.00±6.49)%和(95.26±4.90)%,GTV/GTV與CTV/CTV、GTV/GTV與PTV/PTV重閤度間差異均有統計學意義(P＜0.05),而CTV/CTV與PTV/PTV重閤度間差異無統計學意義(P＞0.05).FB/FB配準中,GTV/GTV、CTV/CTV、PTV/PTV重閤度分彆為(72.55±29.10)%、(89.36±9.53)%和(92.47±7.25)%,GTV/GTV與CTV/CTV、CTV/CTV與PTV/PTV重閤度間差異均無統計學意義(均P＞0.05),而GTV/GTV與PTV/PTV重閤度間差異有統計學意義(P＜0.05).DEBH/DEBH配準中,GTV/GTV、CTV/CTV、PTV/PTV重閤度分彆為(79.48±22.31)%、(92.83±6.77)%和(95.05±4.81)%,3組靶區兩兩間重閤度差異均有統計學意義(均P＜0.05).mDIBH/mDIBH與DEBH/DEBH間、mDIBH/mDIBH與FB/FB間、FB/FB與DEBH/DEBH間的GTV、CTV和PTV重閤度差異均無統計學意義(均P＞0.05),而mDIBH/mDIBH與mDIBH/DEBH間、FB/FB與mDIBH/DEBH間的GTV、CTV和PTV重閤度差異均有統計學意義(均P＜0.05).結論 ABC輔助實施EB-PBI,兩次mDIBH間、兩次FB間和兩次DEBH間各靶區體積重閤度差異不明顯,且三者的PTV/PTV重閤度均達到較高水平.因此,從靶區重閤度的角度,若施照前進行在線襬位誤差校正,EB-PBI實施進行呼吸控製的必要性值得商榷.
목적 탐토보유술후부분유선외조사(EB-PBI)자주호흡공제(ABC)불동호흡상태체적중합도급기차이,종파구체적중합적각도,표술ABC보조호흡운동대EB-PBI분차내파구위이적영향.방법 대술강방치은협의행EB-PBI적환자행유선탁가고정ABC보조CT모의정위,동시채집괄도심흡기호흡공제(mDIBH)상태、자유호흡(FB)상태、심흡기호흡공제(DEBH)상태각2투CT도상.응용Pinnacle3치료계화계통,진행2투mDIBH도상간、2투FB도상간、2투DEBH도상간급mDIBH여DEBH도상간자동융합,계산융합도상.선정진행융합적2투도상적대체종류체적(GTV)、림상파구체적(CTV)、계화파구체적(PTV)적중합도,비교동일배준중3충파구각자중합도간급불동배준중동일충파구중합도간적차이.결과 mDIBH/mDIBH배준중,GTV/GTV、CTV/CTV화PTV/PTV중합도분별위(83.54±11.41)%、(93.00±6.49)%화(95.26±4.90)%,GTV/GTV여CTV/CTV、GTV/GTV여PTV/PTV중합도간차이균유통계학의의(P＜0.05),이CTV/CTV여PTV/PTV중합도간차이무통계학의의(P＞0.05).FB/FB배준중,GTV/GTV、CTV/CTV、PTV/PTV중합도분별위(72.55±29.10)%、(89.36±9.53)%화(92.47±7.25)%,GTV/GTV여CTV/CTV、CTV/CTV여PTV/PTV중합도간차이균무통계학의의(균P＞0.05),이GTV/GTV여PTV/PTV중합도간차이유통계학의의(P＜0.05).DEBH/DEBH배준중,GTV/GTV、CTV/CTV、PTV/PTV중합도분별위(79.48±22.31)%、(92.83±6.77)%화(95.05±4.81)%,3조파구량량간중합도차이균유통계학의의(균P＜0.05).mDIBH/mDIBH여DEBH/DEBH간、mDIBH/mDIBH여FB/FB간、FB/FB여DEBH/DEBH간적GTV、CTV화PTV중합도차이균무통계학의의(균P＞0.05),이mDIBH/mDIBH여mDIBH/DEBH간、FB/FB여mDIBH/DEBH간적GTV、CTV화PTV중합도차이균유통계학의의(균P＜0.05).결론 ABC보조실시EB-PBI,량차mDIBH간、량차FB간화량차DEBH간각파구체적중합도차이불명현,차삼자적PTV/PTV중합도균체도교고수평.인차,종파구중합도적각도,약시조전진행재선파위오차교정,EB-PBI실시진행호흡공제적필요성치득상각.
Objective To explore the overlap ratio of the target volume in different respiratory statuses of active breath control(ABC)and their differences during external-beam partial breast irradiation (EB-PBI), and from the perspective of target volume overlap to determine the influence of the ABC-assisted breathing condition on intra-fractional target movement of EB-PBI. Methods The patients, who received breast-conserving surgery with silver clips marked at the margins of the cavity and were suitable for EB-PBI,were immobilized on the breast bracket to undertake CT simulation assisted by ABC device, six sets of CT simulation images including two sets of image in state of moderate deep inspiration breathing control (mDIBH), two sets of images in state of free breath(FB)and two sets of images in state of deep expiration breathing control(DEBH)were obtained. The six sets of images were transferred to Piunacle3 treatment planning system(TPS), then automatic fusion and registration between two sets of mDIBH images, two sets of FB images, two sets of DEBH images and mDIBH image and DEBH image were achieved separately.Thereafter, the overlap ratios of GTV with GTV, CTV with CTV, PTV with PTV were calculated by the Pinnacle3 TPS. The differences between the overlap ratios of the three kinds of targets in the same registered image and the difference between the overlap ratios of the same kind of target in the different registered images were statistically analyzed using statistical package of SPSS 11.5. Results Based on mDIBH/mDIBH registration, the overlap ratios of GTV/GTV, CTV/CTV and PTV/PTV were(83.54 ± 11.41)%,(93.00 ±6.49)% , and(95.26 ± 4.90)% , respectively, and the differences of the overlap ratios between GTV/GTV and CTV/CTV, GTV/GTV and PTV/PTV were all statistically significant(P ＜ 0.05), but statistically not significant between CTV/CTV and PTV/PTV(P ＞ 0. 05). Based on FB/FB registration, the overlap ratios of GTV/GTV, CTV/CTV and PTV/PTV were(72.55 ±29. 10)%,(89.36 ±9.53)% and(92. 47 ±7.25)% , respectively, and the differences of the overlap ratios between GTV/GTV and CTV/CTV, CTV/CTV and PTV/PTV were all not statistically significant(P ＞ 0. 05), but statistically significant between GTV/GTV and PTV/PTV(P ＜ 0.05). Based on DEBH/DEBH registration, the overlap ratios of GTV/GTV, CTV/CTV and PTV/PTV were(79.48 ± 22.31)%,(92.83 ± 6.77)% and(95.05 ± 4. 81)%,respectively, and the differences of the overlap ratios between GTV/GTV and CTV/CTV(P =0.000),CTV/CTV and PTV/PTV(P = 0. 037), GTV/GTV and PTV/PTV(P = 0. 000)were statistically all significant(P=0.000). The differences of the overlap ratios of GTV/GTV, CTV/CTV, and PTV/PTV(P=0.000)between mDIBH/mDIBH and DEBH/DEBH, mDIBH/mDIBH and FB/FB, FB/FB and DEBH/DEBH were all statistically significant(P = 0. 000), and not statistically significant between mDIBH/mDIBH and mDIBH/DEBH, FB/FB and mDIBH/DEBH. Conclusions During the delivering of EB-PBI assisted by ABC, the intra-fractional overlap ratios of the target volume between the same breathing state is increasing in the order of GTV/GTV → CTV/CTV → PTV/PTV. The difference of the overlap ratios of the target volumes between mDIBH and mDIBH, FB and FB, DEBH and DEBH is not significant, and the overlap ratios of PTV/PTV in the three breathing statuses of mDIBH, FB and DEBH reaches a higher level. Therefore, from the perspective of target volume overlap, if the setup error is corrected online before delivering, the necessity of breathing control during delivering of EB-PBI is worthy discussing.
