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颈段、胸上段食管癌容积弧形调强放疗与固定野调强放疗分次内误差的比较

黄大钡,郭纪慈,李 珍,余建荣,张志高

  

  1. 528403 广东中山 中山市人民医院放射治疗科
  • 收稿日期:2016-08-30 修回日期:2016-10-28 出版日期:2017-01-30 发布日期:2017-01-30

Study of the intra-fractional setup errors for cervical or upper thoracic esophageal carcinoma in VMAT and IMRT

HUANG Dabei, GUO Jici, LI Zhen, YU Jianrong, ZHANG Zhigao.
  

  1. Department of Radiation Oncology, People’s Hospital of Zhongshan City, Zhongshan 528403, China
  • Received:2016-08-30 Revised:2016-10-28 Online:2017-01-30 Published:2017-01-30

摘要: 目的 分析颈段、胸上段食管癌容积弧形调强放疗(VMAT)和固定野调强放疗(IMRT)的分次内误差,比较两种治疗技术在减少摆位误差方面的优劣。方法 收集2013年6月至2014年12月在我科接受VMAT与IMRT的颈段、胸上段食管癌患者各25例,所有患者分别在每次治疗摆位纠正前、摆位纠正后及治疗后行锥形束CT(CBCT)并与计划CT匹配,获取分次内误差,对两种治疗技术进行对比分析。结果 IMRT组在X(左右)、Y(头脚)、Z(腹背)3个轴方向的摆位纠正后误差分别为(0.63±0.47)mm、(0.84±0.35)mm、(0.67±0.41)mm,治疗后误差依次为(1.01±0.42)mm、(1.08±0.89)mm、(1.07±0.70)mm,治疗后误差高于纠正后误差,差异有统计学意义(P<0.05);VMAT组在X、Y、Z 3个轴方向的摆位纠正后误差分别为(0.62±0.50)mm、(0.78±0.40)mm、(0.72±0.54)mm,治疗后误差依次为(0.71±0.52)mm、(0.84±0.41)mm、(0.79±0.63)mm,治疗后误差略高于纠正后误差,差异无统计学意义(P>0.05)。1~6周每周获得的分次内误差,随着治疗周数的增多,两组各方向的平均误差均有所增加,且IMRT组数据高于VMAT组,差异有统计学意义(P<0.05)。VMAT组的治疗时间和加速器跳数为(2.85±0.73)min和589.00±63.00,均优于IMRT组的(8.14±1.06)min和792.00±83.00,差异有统计学意义(P<0.05)。结论 在颈段、胸上段食管癌的放疗中,VMAT能大大缩短治疗时间,减少治疗中不确定因素的影响和患者不舒适度,有效降低患者分次内误差,但放疗分次内误差仍随着治疗时间延长逐渐增大。

Abstract: Objective To compare the intra-fractional setup errors between volumetric modulated arc therapy(VMAT) and static intensity modulated radiotherapy(IMRT) for cervical or upper thoracic esophageal carcinoma. Methods Fifty cervical or upper thoracic esophageal carcinoma patients were selected in this study. VMAT plans with two single arcs and IMRT with nine fields designed for each patients. Patients received cone-beam computed tomography(CBCT) scans before initial setup, after re-positioning and after radiation delivery. The CBCT images were registered to the planning CT images, then the intra-fractional setup errors were obtained and the differences were analyzed. Results In IMRT group, the after re-positioning error was(0.63±0.47)mm,(0.84±0.35)mm,(0.67±0.41)mm at X, Y, Z axes,the after radiation delivery was(1.01±0.42)mm,(1.08±0.89)mm,(1.07±0.70)mm,respectively. The latter was higher than the former, and the difference was statistically significant(P<0.05). In VMAT group, the after re-positioning error was(0.62±0.50)mm,(0.78±0.40)mm,(0.72±0.54)mm at X, Y, Z axes,the after radiation delivery was(0.71±0.52)mm,(0.84±0.41)mm,(0.79±0.63)mm, respectively. The latter was little higher than the former, and the difference was no statistical significance(P>0.05). The average error in X,Y,Z axes of both groups were increased, and the statistical datas of IMRT group were higher than the VMAT(P<0.05). The treatment time and monitor units in VMAT group were (2.85±0.73)min and 589.00±63.00, which was better then (8.14±1.06)min and 792.00±83.00 in IMRT group(P<0.05). Conclusion VMAT could greatly shorten the treatment time, reduce the influence of uncertain factors and patients discomfort, effectively reduce the intra-fractional setup errors. In addition, the error was gradually increased with the increasing of treatment time.

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