中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
10期
766-770
,共5页
丁昀%李建彬%王玮%王素贞%王金之%马志芳
丁昀%李建彬%王瑋%王素貞%王金之%馬誌芳
정윤%리건빈%왕위%왕소정%왕금지%마지방
乳腺肿瘤%成像,四维%金属夹%血清肿%内大体肿瘤体积%计划靶体积
乳腺腫瘤%成像,四維%金屬夾%血清腫%內大體腫瘤體積%計劃靶體積
유선종류%성상,사유%금속협%혈청종%내대체종류체적%계화파체적
Breast neoplasms%Imaging,four-dimensional%Surgical clips%Seroma%Internal gross target volume%Planning target volume
目的 基于四维CT(4D-CT)扫描,探讨保乳术后乳腺癌患者基于金属夹和血清肿确定术腔内大体肿瘤体积(IGTV)及计划靶体积(PTV)间体积和位置差异.方法 在4D-CT 10个时相图像上,基于术腔各边界金属夹勾画大体肿瘤靶体积(GTV)并定义为GTVc,基于术腔血清肿勾画GTV并定义为GTVs,两者结合勾画GTV并定义为GTVc+s,10个时相图像融合分别得到IGTVc、IGTVs和IGTVc+s,边界外扩15 mm,分别得到PTVc、PTVs和PTVc +s.结果 IGTVc+s的体积为(35.73±19.77) cm3,与IGTVc[(28.35±17.54)cm3]和IGTVs[(24.19±21.53)cm3]比较,差异均有统计学意义(均P＜0.05);IGTVc与IGTVs比较,差异无统计学意义(P =0.210).PTVc+s的体积为(191.59±69.74)cm3,大于PTVc[(161.53±61.07)cm3]和PTVs[(148.98±62.22)cm3],差异均有统计学意义(均P＜0.05);PTVc与PTVs比较,差异无统计学意义(P =0.171).IGTVc对IGTVc+s、IGTVs对IGTVc+s、PTVc对PTVc+s和PTVs对PTVc +s的相互包含度(DI)均优于IGTVc+s对IGTVc、IGTVc+s对IGTVs、PTVc+s对PTVc及PTVc +s对PTVs的DI(均P＜0.05).IGTVc/IGTVc+s、IGTVs/IGTVc+s间的适形指数(CI)分别为0.63±0.14和0.54±0.17,均高于IGTVc/IGTVs间CI(0.40±0.14,均P＜0.05).PTVc/PTVs、PTVc/PTVc+s和PTVs/PTVc+s的CI分别为0.73±0.12、0.78±0.13和0.75±0.17,差异无统计学意义(P＞0.05).基于不同参照物确定的IGTV间和PTV间的DI和CI均与对应靶区中心间距呈负相关(均P＜0.05).结论 不同参照物确定的术腔靶区间存在体积和空间位置差异,将基于4D-CT获取的10个时相靶区融合,并外扩得到PTV显著缩小了体积和位置差异,提高了靶区间的重合度.金属夹结合血清肿确定靶区,并进行外扩得到PTV是实施部分乳腺外照射较为理想的靶区.
目的 基于四維CT(4D-CT)掃描,探討保乳術後乳腺癌患者基于金屬夾和血清腫確定術腔內大體腫瘤體積(IGTV)及計劃靶體積(PTV)間體積和位置差異.方法 在4D-CT 10箇時相圖像上,基于術腔各邊界金屬夾勾畫大體腫瘤靶體積(GTV)併定義為GTVc,基于術腔血清腫勾畫GTV併定義為GTVs,兩者結閤勾畫GTV併定義為GTVc+s,10箇時相圖像融閤分彆得到IGTVc、IGTVs和IGTVc+s,邊界外擴15 mm,分彆得到PTVc、PTVs和PTVc +s.結果 IGTVc+s的體積為(35.73±19.77) cm3,與IGTVc[(28.35±17.54)cm3]和IGTVs[(24.19±21.53)cm3]比較,差異均有統計學意義(均P＜0.05);IGTVc與IGTVs比較,差異無統計學意義(P =0.210).PTVc+s的體積為(191.59±69.74)cm3,大于PTVc[(161.53±61.07)cm3]和PTVs[(148.98±62.22)cm3],差異均有統計學意義(均P＜0.05);PTVc與PTVs比較,差異無統計學意義(P =0.171).IGTVc對IGTVc+s、IGTVs對IGTVc+s、PTVc對PTVc+s和PTVs對PTVc +s的相互包含度(DI)均優于IGTVc+s對IGTVc、IGTVc+s對IGTVs、PTVc+s對PTVc及PTVc +s對PTVs的DI(均P＜0.05).IGTVc/IGTVc+s、IGTVs/IGTVc+s間的適形指數(CI)分彆為0.63±0.14和0.54±0.17,均高于IGTVc/IGTVs間CI(0.40±0.14,均P＜0.05).PTVc/PTVs、PTVc/PTVc+s和PTVs/PTVc+s的CI分彆為0.73±0.12、0.78±0.13和0.75±0.17,差異無統計學意義(P＞0.05).基于不同參照物確定的IGTV間和PTV間的DI和CI均與對應靶區中心間距呈負相關(均P＜0.05).結論 不同參照物確定的術腔靶區間存在體積和空間位置差異,將基于4D-CT穫取的10箇時相靶區融閤,併外擴得到PTV顯著縮小瞭體積和位置差異,提高瞭靶區間的重閤度.金屬夾結閤血清腫確定靶區,併進行外擴得到PTV是實施部分乳腺外照射較為理想的靶區.
목적 기우사유CT(4D-CT)소묘,탐토보유술후유선암환자기우금속협화혈청종학정술강내대체종류체적(IGTV)급계화파체적(PTV)간체적화위치차이.방법 재4D-CT 10개시상도상상,기우술강각변계금속협구화대체종류파체적(GTV)병정의위GTVc,기우술강혈청종구화GTV병정의위GTVs,량자결합구화GTV병정의위GTVc+s,10개시상도상융합분별득도IGTVc、IGTVs화IGTVc+s,변계외확15 mm,분별득도PTVc、PTVs화PTVc +s.결과 IGTVc+s적체적위(35.73±19.77) cm3,여IGTVc[(28.35±17.54)cm3]화IGTVs[(24.19±21.53)cm3]비교,차이균유통계학의의(균P＜0.05);IGTVc여IGTVs비교,차이무통계학의의(P =0.210).PTVc+s적체적위(191.59±69.74)cm3,대우PTVc[(161.53±61.07)cm3]화PTVs[(148.98±62.22)cm3],차이균유통계학의의(균P＜0.05);PTVc여PTVs비교,차이무통계학의의(P =0.171).IGTVc대IGTVc+s、IGTVs대IGTVc+s、PTVc대PTVc+s화PTVs대PTVc +s적상호포함도(DI)균우우IGTVc+s대IGTVc、IGTVc+s대IGTVs、PTVc+s대PTVc급PTVc +s대PTVs적DI(균P＜0.05).IGTVc/IGTVc+s、IGTVs/IGTVc+s간적괄형지수(CI)분별위0.63±0.14화0.54±0.17,균고우IGTVc/IGTVs간CI(0.40±0.14,균P＜0.05).PTVc/PTVs、PTVc/PTVc+s화PTVs/PTVc+s적CI분별위0.73±0.12、0.78±0.13화0.75±0.17,차이무통계학의의(P＞0.05).기우불동삼조물학정적IGTV간화PTV간적DI화CI균여대응파구중심간거정부상관(균P＜0.05).결론 불동삼조물학정적술강파구간존재체적화공간위치차이,장기우4D-CT획취적10개시상파구융합,병외확득도PTV현저축소료체적화위치차이,제고료파구간적중합도.금속협결합혈청종학정파구,병진행외확득도PTV시실시부분유선외조사교위이상적파구.
Objective To explore the differences in volume and localization of the internal gross target volume and planning target volume delineated by clips and/or seroma based on four-dimensional computed tomography (4D-CT) during free-breathing in breast cancer patients after breast conserving surgery.Methods Fifteen breast cancer patients after breast-conserving surgery (BCS) were recruited for external-beam partial breast irradiation (EB-PBI).On the ten sets CT images,the gross tumor volumes (GTV) formed by the clips,the seroma,and both the clips and seroma were delineated and defined as GTVc,GTVs and GTVc + s,respectively.Ten GTVc,GTVs and GTVc + s on the ten sets CT images produced the IGTVc,IGTVs,IGTVc + s.The PTVc,PTVs,PTVc + s were created by adding 15 mm to the IGTVc,IGTVs,IGTVc + s,respectively.The IGTV and PTV volume and distance between the centers of IGTVc,IGTVs,IGTVc + s and PTVc,PTVs,PTVc + s were all recorded.Conformity index (CI) and degree of inclusion (DI) were calculated for IGTV/IGTV and PTV/PTV,respectively.Results The volume of IGTVc + s[(35.73 ± 19.77) cm3] was significantly larger than the IGTVc [(28.35 ± 17.54)cm3] and IGTVs [(24.19 ± 21.53) cm3] (P ＜ 0.05),and the volume of PTVc + s [(191.59 ± 69.74)cm3] was significantly larger than that of the PTVc [(161.53 ± 61.07) cm3] and PTVs [(148.98 ±62.22) cm3] (P ＜ 0.05).There were significant differences between the DIs of IGTVc in IGTVc + s and IGTVc + s in IGTVc,the DIs of IGTVs in IGTVc + s and IGTVc + s in IGTVs,the DIs of PTVc in PTVc +s and PTVc + s in PTVc,and the DIs of PTVs vs.PTVc + s and PTVc + s in PTVs (P ＜ 0.05 for all).The CI of IGTVc/IGTVc + s (0.63 ± 0.14) and the CI of IGTVs/IGTVc + s (0.54 ± 0.17) were significant larger than that of the CI of IGTVc/IGTVs (0.40 ± 0.14) (P ＜ 0.05).There were non-significant differences among the CI of PTVc/PTVs,PTVc/PTVc + s and PTVs/PTVc + s (0.73 ± 0.12,0.78 ± 0.13 vs.0.75 ± 0.17).The DIs and CIs of IGTV/IGTV and PTV/PTV were negatively correlated with their centroid distance (P ＜ 0.05).Conclusions There are volume difference and spatial mismatch between the target volumes delineated on the basis of surgical clips and seroma.The DI and CI between the PTVs are larger than that between the IGTV.External-beam partial breast irradiation should be implemented based on the PTV that is defined based on both seroma and surgical clips.
