形变配准在螺旋断层治疗联合近距离治疗宫颈癌剂量叠加中的应用

doi:10.3760/cma.j.cn113030-20201206-00589

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摘要目的探讨形变配准在螺旋断层(HT)调强联合高剂量率近距离治疗的宫颈癌放疗中评估膀胱直肠受量的可行性。方法对18例宫颈癌患者回顾分析,比较直肠和膀胱D2cm³及高危临床靶区(HR-CTV) D90%的二维参数相加的均匀剂量法(EUD)和高剂量重叠法(OHD)的受量,以及应用MIM Maestro®软件的刚性图像配准(RIR)和形变图像配准(DIR)受量。用戴斯相似性系数(DSC)和平均一致性距离(MDA)评估配准精度。结果 EUD、OHD、RIR、DIR的膀胱和直肠D2cm³分别为(80.11±3.59)、(82.23±3.46)、(80.99±6.01)、(81.19±3.11)Gy (EQD2Gy)(P=0.516)和(72.90±3.58)、(73.83±4.28)、(72.45±6.05)、(71.98±2.89)Gy (EQD2Gy)(P=0.625),HR-CTV的D90%分别为(85.51±2.91)、(87.65±3.46)、(81.53±3.63)、(85.81±3.30)Gy (EQD2Gy)(P<0.001)。RIR和DIR的膀胱、直肠、HR-CTV的DSC均值分别为0.69、0.65、0.63和0.85、0.81、0.78(P<0.001),DIR的MDA均值分别为2.88、2.48、2.66mm。结论 4种方法膀胱、直肠D2cm³相近,DIR匹配优于RIR (DSC>0.8)。DIR在HT和后装剂量叠加中具一定参考价值。

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	王为
	周晴
	蒋马伟

关键词 ：形变图像配准, 剂量评估, 宫颈肿瘤/近距离疗法, 宫颈肿瘤/螺旋断层疗法

Abstract：Objective To assess the feasibility of deformable image registration (DIR) in evaluating cumulative dose distribution of bladder and rectum of cervical cancer patients during helical tomotherapy (HT)-based intensity-modulated radiotherapy (IMRT) and high-dose-rate(HDR) brachytherapy. Methods Clinical data of 18 patients were retrospectively analyzed. Cumulative bladder/rectum D2cm³ and high-risk clinical target volume (HR-CTV) D90% parameters were calculated and compared to two direct parameter-adding methods with two registration-adding methods. Equivalent uniform dose (EUD group) and overlapping high dose (OHD group) methods were employed as parameter-adding methods. The registration-adding methods including rigid image registration (RIR group) and deformable image registration (DIR group) were adopted based on a commercial image registration software (MIM Maestro®). The dice similarity coefficient (DSC) and mean distance to agreement (MDA) were measured to assess the accuracy of RIR and DIR. Results In the EUD,OHD,RIR and DIR groups, the cumulative doses of bladder/rectum D2cm³ and HR-CTV D90% were (80.11±3.59)Gy (EQD2Gy),(82.23±3.46)Gy (EQD2Gy),(80.99±6.01)Gy (EQD2Gy) and (81.19±3.11)Gy (EQD2Gy)(P=0.516);(72.90±3.58)Gy (EQD2Gy),(73.83±4.28)Gy (EQD2Gy),(72.45±6.05)Gy (EQD2Gy) and (71.98±2.89)Gy (EQD2Gy)(P=0.625), and (85.51±2.91)Gy (EQD2Gy),(87.65±3.46)Gy (EQD2Gy),(81.53±3.63)Gy (EQD2Gy) and (85.81±3.30)Gy (EQD2Gy)(P<0.001), respectively. The mean DSC of the bladder, rectum and HR-CTV were 0.69, 0.65 and 0.63 with RIR;and 0.85, 0.81 and 0.78 with DIR (P<0.001), respectively. In DIR, the average MDA of bladder, rectum, and HR-CTV were 2.88, 2.48 and 2.66mm, respectively. Conclusions The cumulative DVH parameters among 4 groups show no significant difference in the bladder/rectum D2cm³/D0.2cm³. Since the DIR group achieves satisfactory volume matching of greater than 0.8 with DSC analysis, it can yield acceptable results for clinical application between HT IMRT and HDR BT for cervical cancer.

Key words： Deformable image registration Dose evaluation Cervical neoplasm/brachytherapy Cervical neoplasm/helical tomotherapy

收稿日期: 2020-12-06

通讯作者: 蒋马伟,Email:jiangmawei@xinhuamed.com.cn

引用本文:

王为,周晴,蒋马伟. 形变配准在螺旋断层治疗联合近距离治疗宫颈癌剂量叠加中的应用[J]. 中华放射肿瘤学杂志, 2022, 31(1): 59-64.

Wang Wei,Zhou Qing,Jiang Mawei. Application of deformable image registration in radiotherapy dose accumulation of helical tomotherapy combined with brachytherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 59-64.

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