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膀胱容积测量仪干预下CBCT观察不同BMI宫颈癌患者CTV至PTV外扩边界差异
贯士阔, 许青, 孟怡然, 柯桂好, 朱俊, 吴小华
200032 上海,复旦大学附属肿瘤医院放疗科 复旦大学上海医学院肿瘤学系
Comparison of CTV-PTV setup margins during IMRT for cervical cancer patients with different body mass index by bladder volume measurement device-assisted CBCT
Department of Radiation Oncology,Cancer Hospital of Fudan University,Department of Oncology,Shanghai Medical College of Fudan University,Shanghai 200032,China
Abstract： Objective To investigate the clinical target volume (CTV)-planned target volume (PTV) setup margins during intensity-modulated radiotherapy (IMRT) for cervical cancer patients with different body mass index (BMI), aiming to provide reference for precise individual therapy. Methods Forty patients diagnosed with cervical cancer undergoing IMRT in Cancer Hospital of Fudan University between March and September 2017 were recruited and assigned into the BMI≤18.4, 18.5-23.9, 24.0-27.9 and ≥28 kg/m2 groups according to the BMI classification criteria proposed by National Health and Family Planning Commission (NHFPC) of the People′s Republic of China. Assisted with the bladder volume measurement device, 9 cycles of kilo-voltage cone beam computed tomography (CBCT) images were subject to online registration and imaging analysis. CTV-PTV setup margins were calculated based on the formula of MPTV= 2.5Σ+0.7σamong four groups. Single factor variance analysis was performed. LSD test was utilized for two-group comparison. Results Among four groups, the CTV-PTV setup margins in the x,y and z directions were (6.87 mm,6.06 mm,8.49 mm),(3.13 mm,3.02 mm,3.14 mm),(4.70 mm,4.86 mm,5.31 mm) and (7.63 mm,8.28 mm,8.54 mm),respectively (P=0.038,0.048 and 0.004). Conclusions The setup errors in the BMI≤18.4 and ≥28 kg/m2 groups are significantly larger compared with those in the remaining groups Consequently, CTV-PTV setup margins should be enlarged to certain extent for patients with BMI≤18.4 and ≥28 kg/m2.
Guan Shikuo,Xu Qing,Meng Yiran et al. Comparison of CTV-PTV setup margins during IMRT for cervical cancer patients with different body mass index by bladder volume measurement device-assisted CBCT[J]. Chinese Journal of Radiation Oncology, 2018, 27(4): 392-395.
[1] 胡永,曾昭冲,张建英,等.头颈部肿瘤螺旋断层放疗中的CTV-PTV边界大小分析[J].实用肿瘤杂志,2012,27(4):411-414.DOI:10.13267/j.cnki.syzlzz.2012.04.027. Hu Y,Zeng ZC,Zhang JY,et al. Margin between clinical target volume and planning target volume in helical tomotherapy for head and neck cancer[J].J Pract Oncol,2012,27(4):411-414.DOI:10.13267/j.cnki.syzlzz.2012.04.027. [2] Langsenlehner T,Dller C,Winkler P,et al. Impact of inter-and intrafraction deviations and residual set-up errors on PTV margins[J].Strahlenther Onkol,2013,189(4):321-328.DOI:10.1007/s00066-012-0303-0. [3] Keys A,Fidanza F,Karvonen MJ,et al. Indices of relative weight and obesity[J].J Chronic Dis,1972,25(6-7):329-343.DOI:10.1016/0021-9681(72)90027-6. [4] 胡逸民,殷蔚伯,余子豪,等.治疗体位及体位固定技术[A]//殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].4版.北京:中国协和医科大学出版社,2008:95. Hu YM,Yin WB,Yu ZH,et al. Treatment of postural and postural fixation[A]//Yin WB,Yu ZH,Xu GZ,et al. Radiation Oncology[M].4th ed. Beijing:Peking Union Medical College Press,2008:95. [5] 孟怡然,许青,章真,等.用KV-CBCT探讨两种下肢固定方法对直肠癌IMRT摆位误差影响[J].中华放射肿瘤学杂志,2016,25(9):955-958.DOI:10.3760/cma.j.issn.1004-4221.2016.09.010. Meng YR,Xu Q,Zhang Z,et al. Influence of lower limb movements on setup errors in radiotherapy for rectal cancer using kilovoltage cone-beam CT (KV-CBCT)[J].Chin J Radiat Oncol,2016,25(9):955-958.DOI:10.3760/cma.j.issn.1004-4221.2016.09.010. [6] van Herk M,Remeijer P,Lebesque JV,et al. Inclusion of geometric uncertainties in treatment plan evaluation[J].Int J Radiat Oncol Biol Phys,2002,52(5):1407-1422.DOI:10.1016/S0360-3016(01)02805-X. [7] van Herk M.Errors and margins in radiotherapy[J].Semin Radiat Onchol,2004,14(1):52-64.DOI:10.1053/j.semradonc.2003.10.003. [8] Bijhold J,Van Herk M,Vijlbrief R,et al. Fast evaluation of patient set-up during radiotherapy by aligning features in portal and simulator images[J].Phys Med Biol,1991,36(12):1665-1679.DOI:10.1088/0031-9155/36/12/010. [9] Buchali A,Koswig S,Dinges S,et al. Impact of the filling status of the bladder and rectum on their integral dose distribution and the movement of the uterus in the treatment planning of gynaecological cancer[J].Radiother Oncol,1999,52(1):29-34.DOI:10.1016/S0167-8140(99)00068-7. [10] Taylor A,Powell MEB.An assessment of interfractional uterine and cervical motion:implications for radiotherapy target volume definition in gynaecological cancer[J].Radiother Oncol,2008,88(2):250-257.DOI:10.1016/j.radonc.2008.04.016. [11] Brierley JD,Cummings BJ,Wong CS,et al. The variation of small bowel volume within the pelvis before and during adjuvant radiation for rectal cancer[J].Radiother Oncol,1994,31(2):110-116.DOI:10.1016/0167-8140(94)90390-5. [12] Kim TH,Chie EK,Kim DY,et al. Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients[J].Int J Radiat Oncol Biol Phys,2005,62(3):769-775.DOI:10.1016/j.ijrobp.2004.11.015. [13] 洪超善,华丽,高琨,等.膀胱不同充盈程度对宫体-宫颈变形移动度的影响[J].中国癌症杂志,2012(11):847-855.DOI:10.3969/j.issn.1007-3969.2012.11.009. Hong CS,Hua L,Gao K,et al. The impact of different bladder filling degrees to deformation changes of uterus body-cervix[J].China Oncol,2012(11):847-855.DOI:10.3969/j.issn.1007-3969.2012.11.009. [14] 吴丽华,王颖,靳富,等.便捷式膀胱扫描仪在子宫颈癌放疗执行中的应用及其重要性[J].中国医学物理学杂志,2016,33(7):654-657.DOI:10.3969/j.issn.1005-202X.2016.07.002. Wu LH,Wang Y,Jin F,et al. Application and importance of portable bladder scanner in cervical cancer radiotherapy[J].Chin J Med Phys,2016,33(7):654-657.DOI:10.3969/j.issn.1005- 202X.2016.07.002. [15] 罗焕丽,王颖,李芳,等.便捷式膀胱容量测定仪BVI9400及超声系统iU22评估膀胱容量的对比研究[J].中国医疗器械杂志,2015,39(4):295-298.DOI:10.3969/j.issn.1671-7104.2015.04.017. Luo HL,Wang Y,Li F,et al. Comparative study on evaluating the bladder volume between bladderscan BVI9400 and ultrasound system iU22[J].Chin J Med Instrum,2015,39(4):295-298.DOI:10.3969/j.issn.1671-7104.2015.04.017. [16] 黄群锋,刘金迪,刘慧,等.直肠癌放疗中膀胱容积测量仪保持膀胱充盈度可行性探讨[J].中华放射肿瘤学杂志,2016,25(10):1088-1091.DOI:10.3760/cma.j.issn.1004-4221.2016.10.014. Huang QF,Liu JD,Liu H,et al. Feasibility of keeping the consistency of bladder filling by a bladderscan device during radiotherapy for rectal cancer[J].Chin J Radiat Oncol,2016,25(10):1088-1091.DOI:10.3760/cma.j.issn.1004-4221.2016.10.014. [17] Wong JR,Gao ZR,Merrick S,et al. Potential for higher treatment failure in obese patients:correlation of elevated body mass index and increased daily prostate deviations from the radiation beam isocenters in an analysis of 1,465 computed tomographic images[J].Int J Radiat Oncol Biol Phys,2009,75(1):49-55.DOI:10.1016/j.ijrobp.2008.07.049. [18] Lin LL,Hertan L,Rengan R,et al. Effect of body mass index on magnitude of setup errors in patients treated with adjuvant radiotherapy for endometrial cancer with daily image guidance[J].Int J Radiat Oncol Biol Phys,2012,83(2):670-675.DOI:10.1016/j.ijrobp.2011.07.026. [19] Lai YL,Yang SN,Liang JA,et al. Impact of body-mass factors on setup displacement in patients with head and neck cancer treated with radiotherapy using daily on-line image guidance[J].Radiat Oncol,2014,9:19.DOI:10.1186/1748-717X-9-19. [20] Bel A,Vos PH,Rodrigus PTR.High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure,using portal imaging[J].Int J Radiat Oncol Biol Phys,1996,35(2):321-332.DOI:10.1016/0360-3016(95)02395-X. [21] Ahamad A,D′Souza W,Salehpour M,et al. Intensity-modulated radiation therapy after hysterectomy:comparison with conventional treatment and sensitivity of the normal-tissue-sparing effect to margin size[J].Int J Radiat Oncol Biol Phys,2005,62(4):1117-1124.DOI:10.1016/j.ijrobp.2004.12.029. [22] Han Y,Shin EH,Huh SJ,et al. Interfractional dose variation during intensity-modulated radiation therapy for cervical cancer assessed by weekly CT evaluation[J].Int J Radiat Oncol Biol Phys,2006,65(2):617-623.DOI:10.1016/j.ijrobp.2006.02.005. [23] Roeske JC,Lujan A,Rotmensch J,et al. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies[J].Int J Radiat Oncol Biol Phys,2000,48(5):1613-1621.DOI:10.1016/S0360-3016(00)00771-9. [24] 黄永惠,黎杰,樊琳,等.膀胱不同容量时宫颈癌调强放射治疗宫颈动度研究[J].肿瘤预防与治疗,2010,23(1):27-31.DOI:10.3969/j.issn.1674-0904.2010.01.007. Huang YH,Li J,Fan L,et al. A motion research for cervical cancer patients received IMRT with different bladder volume[J].J Cancer Control Treat,2010,23(1):27-31.DOI:10.3969/j.issn.1674-0904.2010.01.007. [25] 徐律,伍其竖,林爱娣.不同计划靶体积外扩界在三维适形放疗治疗复发性宫颈癌中的临床效果评价[J].中国医药导报,2015,12(14):82-85. Xu L,Wu QS,Lin AD.Assessment on clinical effect of different PTV outside enlarge community of three-dimensional conformal radiotherapy in the treatment of recurrent cervical cancer[J].China Med Her,2015,12(14):82-85.
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