宫颈癌放疗中患者体型改变的特征量与摆位误差的关联
|
摘要
目的:评估宫颈癌患者在螺旋断层放疗(TOMO)中耻骨联合上缘层面的横纵轴宽度比值(简称横纵比)与摆位误差的关联。方法:选取行TOMO的宫颈癌患者30例,采用热塑体膜固定,利用图像引导系统获取分次摆位MVCT图像,并与定位kVCT图像进行配准,记录左右、腹背、头脚方向上的摆位误差。记录每分次患者的横纵比,并将其与摆位误差进行Pearson相关性分析。结果:对于横纵比稳定性>0.8的18例患者,其横纵比与头脚和腹背方向上的随机误差、年龄、体质量指数都呈显著负相关,关联系数R分别为-0.621、-0.488、-0.560、-0.552(P=0.006、0.040、0.016、0.017)。横纵比稳定性<0.8的12例患者中,其年龄、体质量指数与δ_(横纵比)的相关性系数R分别为-0.796、-0.566(P=0.002、-0.055)。结论:在宫颈癌患者TOMO中,横纵比可以作为一个临床观测指标,评估摆位误差的大小。
Objective To evaluate the correlation between the characteristic variation(the aspect ratio)of superior margin of pubic symphysis and setup errors during Tomotherapy for cervical cancer.Methods Thirty cervical cancer patients treated with Tomotherapy were enrolled in this study.After the initial positioning with thermoplastic membrane,the online registration between MVCT images and original kVCT positioning image was performed,and the setup errors in left-right,anterior-posterior,and superior-inferior directions were recorded.Meanwhile,the aspect ratio were also recorded in every faction and then compared with the setup error using Pearson correlation analysis.Results The aspect ratio of 18 patients(aspect ratio stability>0.8)had significant negative correlations with setup errors in superior-inferior and anterior-posterior directions,age and body mass index;and the correlation coefficients were-0.621,-0.488,-0.560,-0.552(P=0.006,0.040,0.016,0.017).For the other 12 patients(aspect ratio stability<0.8),the corresponding correlation coefficients betweenδ_(aspect ratio)and age,body mass index were-0.796,-0.566(P=0.002,-0.055).Conclusion For cervical cancer patients treated with Tomotherapy,the aspect ratio can be used as a clinical observation index to assess the setup error.
Objective To evaluate the correlation between the characteristic variation(the aspect ratio)of superior margin of pubic symphysis and setup errors during Tomotherapy for cervical cancer.Methods Thirty cervical cancer patients treated with Tomotherapy were enrolled in this study.After the initial positioning with thermoplastic membrane,the online registration between MVCT images and original kVCT positioning image was performed,and the setup errors in left-right,anterior-posterior,and superior-inferior directions were recorded.Meanwhile,the aspect ratio were also recorded in every faction and then compared with the setup error using Pearson correlation analysis.Results The aspect ratio of 18 patients(aspect ratio stability>0.8)had significant negative correlations with setup errors in superior-inferior and anterior-posterior directions,age and body mass index;and the correlation coefficients were-0.621,-0.488,-0.560,-0.552(P=0.006,0.040,0.016,0.017).For the other 12 patients(aspect ratio stability<0.8),the corresponding correlation coefficients betweenδ_(aspect ratio)and age,body mass index were-0.796,-0.566(P=0.002,-0.055).Conclusion For cervical cancer patients treated with Tomotherapy,the aspect ratio can be used as a clinical observation index to assess the setup error.
引文
[1]朱滔,朱笕青,高永良.宫颈癌诊治现状与进展[J].中国肿瘤,2013,22(12):970-974.ZHU T,ZHU J Q,GAO Y L.The present status and progress in diagnosis and treatment for cervical cancer[J].China Cancer,2013,22(12):970-974.
[2]刘慧强.我国宫颈癌流行病学特征和高危因素分析[J].中国妇幼保健,2016,31(6):1258-1260.LIU H Q.Epidemiologic features and cervical cancer in China and analysis of its high risk factors[J].Maternal&Child Health Care of China,2016,31(6):1258-1260.
[3]李隆玉,乔志强,张燕玲.不同病理类型宫颈癌发病年龄趋势的初步观察[J].中国肿瘤临床,2007,34(6):338-340.LI L Y,QIAO Z Q,ZHANG Y L.Age of onset tendency for cervical squamous cell carcinoma and adenocarcinoma[J].Chinese Journal of Clinical Oncology,2007,34(6):338-340.
[4]孙晓欢,周咏春,谭丽娜,等.容积旋转调强与固定野调强在宫颈癌术后放疗中的剂量学比较[J].中国医学物理学杂志,2014,31(1):4604-4607.SUN X H,ZHOU Y C,TAN L N,et al.Dosimetric comparison of volumetric modulated arc therapy with fixed field intensity-modulated radiotherapy for postoperative of cervical carcinoma[J].Chinese Journal of Medical Physics,2014,31(1):4604-4607.
[5]MUTRIKAH N,WINARNO H,AMALIA T,et al.Conventional and conformal technique of external beam radiotherapy in locally advanced cervical cancer:dose distribution,tumor response,and side effects[J].J Phys,2017,884:012122.
[6]HSIEH C H,WEI M C,LEE H Y,et al.Whole pelvic helical tomotherapy for locally advanced cervical cancer:technical implementation of IMRT with helical tomothearapy[J].Radiat Oncol,2009,4(1):1-9.
[7]LEUNG S W,LEE T F.Treatment of nasopharyngeal carcinoma by tomotherapy:five-year experience[J].Radiat Oncol,2013,8(1):1-6.
[8]方临明,颜桂明,张飞燕,等.宫颈癌放疗患者体重指数变化对摆位误差的影响[J].中国现代医生,2018,56(8):28-31.FANG L M,YAN G M,ZHANG F Y,et al.Effect of body mass index changes on setup error in the patients with cervical cancer after radiotherapy[J].China Modern Doctor,2018,56(8):28-31.
[9]PRISCIANDARO J I,FRECHETTE C M,HERMAN M G,et al.Amethodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices[J].Med Phys,2004,31(11):2978-2988.
[10]HSIEH C H,WEI M C,HSU Y P,et al.Should helical tomotherapy replace brachytherapy for cervical cancer?Case report[J].BMCCancer,2010,10(1):637.
[11]KWAK Y K,LEE S W,KAY C S,et al.Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose[J].PLoS One,2017,12(8):e0183339.
[12]李奕彤,王雅棣,张富利,等.宫颈癌调强放疗中靶区变化与剂量分析[J].中华放射医学与防护杂志,2015,35(10):751-755.LI Y T,WANG Y D,ZHANG F L,et al.Variation of organ position and dose for cervical cancer patients treated with helical tomotherapy[J].Chinese Journal of Radiological Medicine and Protection,2015,35(10):751-755.
[13]KADOYA N,MIYASAKA Y Y,YAMAMOTO T,et al.Evaluation of rectum and bladder dose accumulation from external beam radiotherapy and brachytherapy for cervical cancer using two different deformable image registration techniques[J].J Radiat Res,2017,58(5):720-728.
[14]林寰东,颜红梅,饶圣祥,等.经脐水平测定腹围与腹内脂肪体积关系的研究[J].中华内分泌代谢杂志,2012,28(2):121-125.LIN H D,YAN H M,RAO S X,et al.Association between intraabdominal fat volume and waist circumference measured at the umbilicus level[J].Chinese Journal of Endocrinology and Metabolism,2012,28(2):121-125.
[15]赵静,叶书城,刘孝伟,等.宫颈癌放疗中膀胱充盈程度对靶区位置的影响[J].河北医学,2018,24(7):1068-1072.ZHAO J,YE S C,LIU X W,et al.Effect of bladder filling degree on target location in radiotherapy of cervical cancer[J].Hebei Medicaine,2018,24(7):1068-1072.
[16]NEDELEC B,FORGET N J,HURTUBISE T,et al.Skin characteristics:normative data for elasticity,erythema,melanin,and thickness at 16 different anatomical locations[J].Skin Res Tech,2016,22(3):263-275.
[17]庞皓文,孙小杨,杨波,等.宫颈癌根治性调强放疗期间膀胱直肠体积与其吸收剂量的关系[J].肿瘤防治研究,2016,43(1):63-66.PANG H W,SUN X Y,YANG B,et al.Relationship between bladder and rectum volume and its absorbed dose of radical intensity modulated radiotherapy on cervical cancer[J].Cancer Research on Prevention and Treatment,2016,43(1):63-66.
[18]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.HONG C S,HUA L,GAO K,et al.The impact of different bladder filling degrees to deformation changes of uterus body-cervix[J].China Oncology,2012(11):847-855.
[19]卢渊全.膀胱充盈状态对宫颈癌术后盆腔术后放射治疗的影响研究[J].中国临床实用医学,2009,3(5):7-9.LU Y Q.Study of the status of bladder(full or empty)on the pelvic radiotherapy in posthysterectomy cervical carcinom[J].China Clinical Practical Medicine,2009,3(5):7-9.
[20]EMINOWICZ G,MOTLIB J,KHAN S,et al.Pelvic organ motion during radiotherapy for cervical cancer:understanding patterns and recommended patient preparation[J].Clini Oncol,2016(28):S0936655516300784.
[21]ROSE P G,BUNDY B N,WATKINS E B,et al.Concurrent cisplatinbased radiotherapy and chemotherapy for locally advanced cervical cancer[J].N Engl J Med,1999,340(15):1144-1153.
[2]刘慧强.我国宫颈癌流行病学特征和高危因素分析[J].中国妇幼保健,2016,31(6):1258-1260.LIU H Q.Epidemiologic features and cervical cancer in China and analysis of its high risk factors[J].Maternal&Child Health Care of China,2016,31(6):1258-1260.
[3]李隆玉,乔志强,张燕玲.不同病理类型宫颈癌发病年龄趋势的初步观察[J].中国肿瘤临床,2007,34(6):338-340.LI L Y,QIAO Z Q,ZHANG Y L.Age of onset tendency for cervical squamous cell carcinoma and adenocarcinoma[J].Chinese Journal of Clinical Oncology,2007,34(6):338-340.
[4]孙晓欢,周咏春,谭丽娜,等.容积旋转调强与固定野调强在宫颈癌术后放疗中的剂量学比较[J].中国医学物理学杂志,2014,31(1):4604-4607.SUN X H,ZHOU Y C,TAN L N,et al.Dosimetric comparison of volumetric modulated arc therapy with fixed field intensity-modulated radiotherapy for postoperative of cervical carcinoma[J].Chinese Journal of Medical Physics,2014,31(1):4604-4607.
[5]MUTRIKAH N,WINARNO H,AMALIA T,et al.Conventional and conformal technique of external beam radiotherapy in locally advanced cervical cancer:dose distribution,tumor response,and side effects[J].J Phys,2017,884:012122.
[6]HSIEH C H,WEI M C,LEE H Y,et al.Whole pelvic helical tomotherapy for locally advanced cervical cancer:technical implementation of IMRT with helical tomothearapy[J].Radiat Oncol,2009,4(1):1-9.
[7]LEUNG S W,LEE T F.Treatment of nasopharyngeal carcinoma by tomotherapy:five-year experience[J].Radiat Oncol,2013,8(1):1-6.
[8]方临明,颜桂明,张飞燕,等.宫颈癌放疗患者体重指数变化对摆位误差的影响[J].中国现代医生,2018,56(8):28-31.FANG L M,YAN G M,ZHANG F Y,et al.Effect of body mass index changes on setup error in the patients with cervical cancer after radiotherapy[J].China Modern Doctor,2018,56(8):28-31.
[9]PRISCIANDARO J I,FRECHETTE C M,HERMAN M G,et al.Amethodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices[J].Med Phys,2004,31(11):2978-2988.
[10]HSIEH C H,WEI M C,HSU Y P,et al.Should helical tomotherapy replace brachytherapy for cervical cancer?Case report[J].BMCCancer,2010,10(1):637.
[11]KWAK Y K,LEE S W,KAY C S,et al.Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose[J].PLoS One,2017,12(8):e0183339.
[12]李奕彤,王雅棣,张富利,等.宫颈癌调强放疗中靶区变化与剂量分析[J].中华放射医学与防护杂志,2015,35(10):751-755.LI Y T,WANG Y D,ZHANG F L,et al.Variation of organ position and dose for cervical cancer patients treated with helical tomotherapy[J].Chinese Journal of Radiological Medicine and Protection,2015,35(10):751-755.
[13]KADOYA N,MIYASAKA Y Y,YAMAMOTO T,et al.Evaluation of rectum and bladder dose accumulation from external beam radiotherapy and brachytherapy for cervical cancer using two different deformable image registration techniques[J].J Radiat Res,2017,58(5):720-728.
[14]林寰东,颜红梅,饶圣祥,等.经脐水平测定腹围与腹内脂肪体积关系的研究[J].中华内分泌代谢杂志,2012,28(2):121-125.LIN H D,YAN H M,RAO S X,et al.Association between intraabdominal fat volume and waist circumference measured at the umbilicus level[J].Chinese Journal of Endocrinology and Metabolism,2012,28(2):121-125.
[15]赵静,叶书城,刘孝伟,等.宫颈癌放疗中膀胱充盈程度对靶区位置的影响[J].河北医学,2018,24(7):1068-1072.ZHAO J,YE S C,LIU X W,et al.Effect of bladder filling degree on target location in radiotherapy of cervical cancer[J].Hebei Medicaine,2018,24(7):1068-1072.
[16]NEDELEC B,FORGET N J,HURTUBISE T,et al.Skin characteristics:normative data for elasticity,erythema,melanin,and thickness at 16 different anatomical locations[J].Skin Res Tech,2016,22(3):263-275.
[17]庞皓文,孙小杨,杨波,等.宫颈癌根治性调强放疗期间膀胱直肠体积与其吸收剂量的关系[J].肿瘤防治研究,2016,43(1):63-66.PANG H W,SUN X Y,YANG B,et al.Relationship between bladder and rectum volume and its absorbed dose of radical intensity modulated radiotherapy on cervical cancer[J].Cancer Research on Prevention and Treatment,2016,43(1):63-66.
[18]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.HONG C S,HUA L,GAO K,et al.The impact of different bladder filling degrees to deformation changes of uterus body-cervix[J].China Oncology,2012(11):847-855.
[19]卢渊全.膀胱充盈状态对宫颈癌术后盆腔术后放射治疗的影响研究[J].中国临床实用医学,2009,3(5):7-9.LU Y Q.Study of the status of bladder(full or empty)on the pelvic radiotherapy in posthysterectomy cervical carcinom[J].China Clinical Practical Medicine,2009,3(5):7-9.
[20]EMINOWICZ G,MOTLIB J,KHAN S,et al.Pelvic organ motion during radiotherapy for cervical cancer:understanding patterns and recommended patient preparation[J].Clini Oncol,2016(28):S0936655516300784.
[21]ROSE P G,BUNDY B N,WATKINS E B,et al.Concurrent cisplatinbased radiotherapy and chemotherapy for locally advanced cervical cancer[J].N Engl J Med,1999,340(15):1144-1153.