| 罗江妍,岳海振,刘嘉城,等.放疗前超声监测膀胱充盈度对宫颈癌患者摆位误差的影响[J].中华放射医学与防护杂志,2025,45(4):290-295.Luo Jiangyan,Yue Haizhen,Liu Jiacheng,et al.Influence of pre-radiotherapy ultrasonic monitoring of bladder filling levels on setup errors in cervical cancer patients[J].Chin J Radiol Med Prot,2025,45(4):290-295 |
| 放疗前超声监测膀胱充盈度对宫颈癌患者摆位误差的影响 |
| Influence of pre-radiotherapy ultrasonic monitoring of bladder filling levels on setup errors in cervical cancer patients |
| 投稿时间：2024-01-11 |
| DOI：10.3760/cma.j.cn112271-20240111-00012 |
| 中文关键词: 宫颈癌 摆位误差 超声 膀胱充盈程度 靶区外放边界 |
| 英文关键词:Cervical cancer Setup error Ultrasound Bladder filling level Margin of planning target volume (MPTV) |
| 基金项目:国家重点研发计划(2023YFF0613501);国家自然科学基金(12375335);北京市自然科学基金(1202009) |
| 作者 | 单位 | E-mail | | 罗江妍 | 北京大学医学部医学技术研究院, 北京 100191
北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 岳海振 | 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 刘嘉城 | 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 蒲亦晨 | 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 卢子红 | 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 胡鉴颀 | 北京大学医学部医学技术研究院, 北京 100191
北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | | | 吴昊 | 北京大学医学部医学技术研究院, 北京 100191
北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科, 恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142 | hao.wu@bjcancer.org |
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| 中文摘要: |
| 目的 对比宫颈癌患者分次放疗前有无超声监测膀胱充盈程度对摆位误差的影响,并进一步研究该方法对于临床靶区(CTV)外扩范围的改善情况。方法 回顾性分析2019年1月至2023年10月北京大学肿瘤医院放疗科收治的172例宫颈癌患者共计1 284次有效采用锥形束CT和六维床校位方法的摆位误差数据,其中有超声监测膀胱的患者87例(659次),无超声监测膀胱的患者85例(625次);比较两组病例在左右(Lat)、进出(Lng)、升降(Vrt)、俯仰角(Pitch)、翻滚角(Roll)、偏转角(Rtn)6个维度的摆位误差、误差分布以及异常摆位次数,并进一步计算两组数据在三维方向的CTV-计划靶区(PTV)边界值,评估分次放疗前使用超声监测膀胱充盈程度的临床价值。结果 超声检测组的摆位误差中位数在6维方向上均小于无超声监测组,上、下四分位数范围均小于无超声监测组(Z = -10.86 ~ -6.34,P＜0.05);超声监测组在各方向上的摆位误差均较无超声监测组分布更为集中。超声监测组的异常摆位次数较无超声监测组显著降低,差异具有统计学意义(χ2=15.33,P＜0.05)。超声监测组的CTV-PTV边界值相较于无超声监测组在Vrt、Lng和Lat方向上分别缩小了0.55、1.52和1.26 mm。结论 宫颈癌患者放疗前采用超声监测膀胱充盈程度可在较大程度上提高分次间的摆位重复性,显著降低异常摆位的发生率,理论上可以缩小CTV外扩到PTV的范围,从而减少正常组织的照射范围,最终达到提高宫颈癌放疗精度和降低辐射损伤的目的。 |
| 英文摘要: |
| Objective To investigate the influence of ultrasonic monitoring of bladder filling levels on setup errors before fractionated radiotherapy for cervical cancer patients through a comparative analysis, and its effectiveness in improving clinical target volume (CTV) margins. Methods A retrospective study was conducted on 1 284 error data of setup via cone beam CT (CBCT) and 6D setup error correction system from 172 cervical cancer patients treated in the Radiotherapy Department of Peking University Cancer Hospital from January 2019 to October 2023. These patients were classified into two groups: 87 (659 times of setup) with ultrasonic monitoring of bladder filling levels and 85 (625 times of setup) without ultrasonic monitoring. The setup errors, error distributions, and numbers of abnormal setups between the two groups were compared in the lateral (Lat), longitudinal (Lng), vertical (Vrt), pitch (Pitch), roll (Roll), and rotational (Rtn) dimensions. Moreover, the CTV to planning target volume(PTV) margin values in the three-dimensional direction were calculated for both groups to assess the clinical value of ultrasonic monitoring of bladder filling levels before fractionated radiotherapy. Results Compared to the group without ultrasonic monitoring, the group with ultrasonic monitoring exhibited lower median values of setup errors in all six-dimensional directions and smaller upper and lower interquartile ranges (Z= -10.86 to -6.34, P＜0.05). The group with ultrasonic monitoring manifested more concentrated setup errors in various directions and statistically significantly reduced numbers of abnormal setups (χ2=15.33,P＜0.05). Moreover, CTV-PTV margins of the group with ultrasonic monitoring displayed reduced CTV-PTV margin values by 0.55, 1.52, and 1.26 mm in the Vrt, Lng, and Lat directions, respectively. Conclusions Pre-radiotherapy ultrasonic monitoring of bladder filling levels in cervical cancer patients can significantly improve the repeatability of setup, thus notably reducing the incidence of abnormal setups. Theoretically, it can narrow the range from the CTV to the PTV, thereby minimizing radiation exposure to healthy tissues and ultimately enhancing radiotherapy precision for cervical cancer and reducing radiation damage. |
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