CAJ | 학술논문

目的用图像引导放疗(IGRT)技术对椎骨转移瘤行三维适形或调强放疗以提高放疗精度.方法用医科达SynergyTM的锥形束CT(CBCT)对15例椎骨转移患者进行扫描,通过IGRT技术对15例患者进行三维适形或调强放疗.采用x轴3 mm、y轴3mm、z轴4 mm外放临床靶体积至计划靶体积.缩野照射时脊髓安全边界外放3mm.结果 4例颈椎骨转移患者首次CBCT扫描采集的图像与计划参考图像比较在左右、头脚、前后方向上平均误差分别为1.8、0、3.6 mm;调整治疗床后3个方向上的平均误差分别为0.1、0.4、0.3 mm;11例胸、腰椎骨转移患者首次CBCT扫描采集的图像与计划参考图像比较在3个方向上的平均误差分别为1.9、0.1、-2.1mm;调整治疗床后3个方向的平均误差分别为0.9、0.5、-0.3mm.结论 IGRT技术是治疗椎骨转移瘤的重要组成部分,可使椎骨转移瘤的放疗精度控制在2 mm以内,为提高瘤床照射剂量、保护脊髓、提高患者生存质量提供可能.
목적 용도상인도방료(IGRT)기술대추골전이류행삼유괄형혹조강방료이제고방료정도.방법 용의과체SynergyTM적추형속CT(CBCT)대15례추골전이환자진행소묘,통과IGRT기술대15례환자진행삼유괄형혹조강방료.채용x축3 mm、y축3mm、z축4 mm외방림상파체적지계화파체적.축야조사시척수안전변계외방3mm.결과 4례경추골전이환자수차CBCT소묘채집적도상여계화삼고도상비교재좌우、두각、전후방향상평균오차분별위1.8、0、3.6 mm;조정치료상후3개방향상적평균오차분별위0.1、0.4、0.3 mm;11례흉、요추골전이환자수차CBCT소묘채집적도상여계화삼고도상비교재3개방향상적평균오차분별위1.9、0.1、-2.1mm;조정치료상후3개방향적평균오차분별위0.9、0.5、-0.3mm.결론 IGRT기술시치료추골전이류적중요조성부분,가사추골전이류적방료정도공제재2 mm이내,위제고류상조사제량、보호척수、제고환자생존질량제공가능.
Objective To evaluate the precision of image guided radiotherapy (IGRT) for vertebra metastasis.Methods Cone-beam computed tomography (CBCT, ELEKTA SynergyTM) scanning was performed to 15 patients with vertebra metastasis treated with three dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT).CBCT images were then compared with corresponding planning images to calculate the position errors.The isocenter was adjusted based on the errors calculated , CBCT scanning was re - performed , and the new - errors were then calculated .Results Compared to the firstly collected CBCT images, the average errors of 4 cases of cervical bone metastases in x (left-right), y (cervical-caudal), and z (anterior-posterior) directions were 1.8 mm, 0 mm and 3.6 mm respectively.After adjusting the isocenter, the new-errors were reduced to 0.1 mm, 0.4 mm and 0.3 mm.For 11 cases of thoracic and lumbar bone metastases, the average errors in x, y, and z directions were 1.9 mm, 0.1 mm, and -2.1 mm, respectively.While the new-errors were reduced to 0.9 mm, 0.5 mm and -0.3 mm.Conclusions IGRT can improve the precision of radiotherapy for vertebra metastasis to less than 2 mm, which provides a possibility of dose escalation in GTV while reduce the dose in the spinal cord.