CAJ | 학술논문

目的探讨肺肿瘤运动规律及其影响因素,指导精确放疗临床靶区外放.方法搜集射波刀治疗的原发或转移肺肿瘤患者70例共83个病灶,其中7例患者7个病灶侵犯胸壁.CT引导下将纯金标记(金标)置入肿瘤体内或邻近位置.X线模拟定位机下测量金标(肿瘤)的运动幅度.1周后行层厚为1.25 mm的16层螺旋肺部CT扫描,根据解剖学标志划分肺尖部、中部、底部,记录不同部位的左右(x轴)、前后(y轴)、头脚(z轴)方向移动数据.结果 63例患者的76个病灶肺尖部、中部、底部x轴移动距离分别为(1.6±0.8)、(2.6 4±1.1)、(2.8±1.7)mm(F=1.76,P=0.179),y 轴的分别为(2.0±1.3)、(4.3±2.8)、(4.0.4±2.0)mm(F=2.06,P=0.135),z轴的分别为(2.7±0.8)、(7.3±3.6)、(12.0±5.3)mm(F=16.33,P=0.000).7个侵犯胸壁病灶移动距离很小,分别为(0.9±0.7)、(0.7±0.7)、(2.0±0.6)mm.相关分析显示x、y、z轴方向移动距离与患者性别、年龄、身高、体重和1s呼吸率无关(r=-0.001～0.136,P均>0.05).结论呼吸导致的肺肿瘤移动距离主要受肿瘤位置和是否侵犯胸壁影响,了解其运动规律及影响因素有利于肺肿瘤放疗内边界的确定.
목적 탐토폐종류운동규률급기영향인소,지도정학방료림상파구외방.방법 수집사파도치료적원발혹전이폐종류환자70례공83개병조,기중7례환자7개병조침범흉벽.CT인도하장순금표기(금표)치입종류체내혹린근위치.X선모의정위궤하측량금표(종류)적운동폭도.1주후행층후위1.25 mm적16층라선폐부CT소묘,근거해부학표지화분폐첨부、중부、저부,기록불동부위적좌우(x축)、전후(y축)、두각(z축)방향이동수거.결과 63례환자적76개병조폐첨부、중부、저부x축이동거리분별위(1.6±0.8)、(2.6 4±1.1)、(2.8±1.7)mm(F=1.76,P=0.179),y 축적분별위(2.0±1.3)、(4.3±2.8)、(4.0.4±2.0)mm(F=2.06,P=0.135),z축적분별위(2.7±0.8)、(7.3±3.6)、(12.0±5.3)mm(F=16.33,P=0.000).7개침범흉벽병조이동거리흔소,분별위(0.9±0.7)、(0.7±0.7)、(2.0±0.6)mm.상관분석현시x、y、z축방향이동거리여환자성별、년령、신고、체중화1s호흡솔무관(r=-0.001～0.136,P균>0.05).결론 호흡도치적폐종류이동거리주요수종류위치화시부침범흉벽영향,료해기운동규률급영향인소유리우폐종류방료내변계적학정.
Objective To investigate the mobility of the lung tumors in order to guide the margin that CTV is to be expanded to PTV during stereotaetic radiotherapy for lung tumors.Methods Eighty-three lung tumom ineluded,in which 7 invaded the chest wall.1-2 gold marker(s)was/were implanted into or nearby the tumor.The motion of lung tumors in x(right-left),y(superior-inferior)and:(anterior-posterior)directions were measured via X-ray simulator system.One week later,1.25 mm thick of 16-slice spiral CT lung scan were taken.Apex,middle,and bottom of the lung were classified according to anatomic boderlines.Results No significant difference was detected among movements of apex,middle and bottom of the lung lesions in x axis direction((1.6±0.8),(2.6±1.1),(2.8±1.7)mm,respectively(F=1.76,P=0.179))and,y axis direction((2.0±1.3),(4.3±2.8),(4.0±2.0)mm,respectively(F=2.06,P=0.135))in 76 lesions of 63 patients.Significant differences were detected in:axis((2.7±0.8),(7.3±3.6),(12.0±5.3)mm(F=16.33,P=0.000)).The mobilities of the 7 lesions of 7 patients invading the chest wall were very small in all directions(0.9±0.7,0.7±0.7.and 2.0±0.6 mm,respectively).Motion amplitude did not correlate with the sex,age,height,weight and FEV1/FVC(r=-0.001-0.136.all P>0.05).Conclusions Motion amplitude of lung tumor due to breathing is associated with tumor loeation and status of chest wall invoivement.Identification of the mobile rules and the influencing factors is important for the internal margin set-up in lung tumor radiotherapy.