自主屏气技术对肝癌放疗靶区几何学影响

doi:10.3760/cma.j.issn.1004-4221.2017.02.011

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Abstract Objective To use the fusion image of the end-inhalation holding (EIH) phase and end-exhalation holding (EEH) phase to define the target volume of individual patient with liver cancer, and to evaluate the target geometry, feasibility, and clinical significance of the technology. Methods Eighteen patients with liver cancer who were treated in our hospital from 2012 to 2013 were enrolled as subjects. With the same posture and scan range, all patients underwent contrast-enhanced three-dimensional computed tomography (3DCT) scans in the phases of free breathing (FB), EIH, and EEH. Gross tumor volume (GTV), clinical target volume (CTV), and organ of risk (OAR) were delineated on the above images. CTV_FB was defined as GTV on the FB phase image (GTV_FB) plus a margin of 10 mm, while planning target volume (PTV_FB) was defined as CTV_FB plus a margin of 10 mm in the right-left and anterior-posterior directions and a margin of 20 mm in the superior-inferior direction. GTV_EI and GTV_EE were defined as GTV on the EIH and EEH images, respectively. Based on the EEH images, the registered EEH and EIH images were fused to form GTV_EI+EI. CTV_EI+EE was defined as GTV_EI+EI plus a margin of 10 mm, while PTV_EI+EE was defined as CTV_EI+EE plus a margin of 5 mm in the right-left and anterior-posterior directions and a margin of 10 mm in the superior-inferior direction. The Pinnacle³ v8.0m treatment planning system was used to design two 3D conformal radiotherapy plans for each patient. The volume, degree of inclusion (DI), matching index (MI), and central displacement of CTV_FB and CTV_EI+EE, as well as PTV_FB and PTV_EI+EE, were compared between the two plans. Results In the 18 patients, the mean CTV_FB was significantly smaller than the mean CTV_EI+EE (149.00±87.54 cm³ vs. 188.17±125.72 cm³, P=0.014);there was no significant difference between the mean PTV_FB and PTV_EI+EE (276.68±146.41 cm³ vs. 253.66±117.35 cm³, P=0.080). DI of CTV_FB to CTV_EI+EE, PTV_FB to PTV_EI+EE, CTV_EI+EE to CTV_FB, and PTV_EI+EE to PTV_FB were (99.83±0.09)%,(84.55±8.45)%,(80.83±12.31)%, and (99.78±0.08)%, respectively. MI of CTV_EI+EE to CTV_FB and PTV_EI+EE to PTV_FB were 0.83±0.07 and 0.87±0.03, respectively. The central displacements of CTV_EI+EE from CTV_FB in x, y, and z axes were 0.55±1.07 cm, 0.76±3.02 cm, and -0.26±1.98 cm, respectively (P=0.432, 0.971, 0.587). Conclusions In the treatment of liver cancer, the target volume delineation and image fusion using 3DCT images in EIH and EEH phases may avoid target omission due to respiratory movement, making it possible to increase radiation dose to target volume and improve the efficacy of radiotherapy.

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	Hong Chaoshan
	Zhu Xiaodong
	Qu Song
	Qing Liping
	Fu Qingguo
	Deng Ye

Key words： End-inhalation holding End-exhalation holding Target region delineate Degree of inclusion Matching index Liver neoplasms/radiotherapy

Received: 28 December 2015

Corresponding Authors: Zhu Xiadong

Cite this article:

Hong Chaoshan,Zhu Xiaodong,Qu Song et al. Effect of independent breath-holding technology on target geometry in radiotherapy for liver cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 171-177.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.02.011 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I2/171

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