| 祝 敏,魏 乐,蒋马伟.基于螺旋断层放疗系统分析儿童髓母细胞瘤全颅全脊髓放疗的靶区外放边界[J].肿瘤学杂志,2024,30(3):220-224. |
| 基于螺旋断层放疗系统分析儿童髓母细胞瘤全颅全脊髓放疗的靶区外放边界 |
| Margins of Planning Target Volume in Tomotherapy with Craniospinal Irradiation for Pediatric Medulloblastoma |
| 投稿时间：2023-12-11 |
| DOI：10.11735/j.issn.1671-170X.2024.03.B007 |
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| 中文关键词: 儿童髓母细胞瘤 螺旋断层放疗 兆伏级图像引导系统 计划靶区 摆位误差 |
| 英文关键词:pediatric medulloblastoma tomotherapy megavoltage computed tomography planning target volume setup errors |
| 基金项目:上海市卫生健康委员会卫生行业临床研究专项项目（202140119） |
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| 中文摘要: |
| 摘 要：［目的］ 基于螺旋断层放疗(tomotherapy，TOMO)兆伏级图像引导系统（megavoltage computed tomography，MVCT），分析不同螺距及配准方式对儿童髓母细胞瘤全颅全脊髓放疗（craniospinal irradiation，CSI）摆位误差的影响，并探索最佳计划靶区（planning target volume，PTV）外放边界。［方法］ 选取25例儿童髓母细胞瘤，行TOMO放疗前每日MVCT图像引导，共计386次，图像采集范围选取头颈段和腰骶段，14例患儿MVCT扫描螺距选择Normal模式，11例选择Course模式，并在14例Normal 螺距组选取Bone和Bone and Tissue两种配准模式进行组内对比。记录各方向的摆位误差进行差异分析，并计算PTV外扩边界。［结果］ Normal螺距组头颈段和腰骶段的摆位误差均在Y 轴和Roll方向小于Course螺距组（P<0.05），X轴和Z轴方向的摆位误差差异无统计学意义；头颈段Bone配准组摆位误差在Z 轴和Roll方向小于Bone and Tissue配准组（P<0.05），X轴和Y轴方向的摆位误差差异无统计学意义；腰骶段Bone配准组摆位误差在X、Y、Z轴和Roll方向均小于Bone and Tissue配准组（P<0.05）。［结论］ 髓母细胞瘤患儿行CSI TOMO放疗时，MVCT选择Normal螺距Bone配准方式可有效地提高摆位误差精度。头颈段X和Z轴方向的建议PTV外放边界分别为2.3 mm和2.0 mm，腰骶段X和Z轴方向的建议PTV外放边界分别为3.2 mm和4.3 mm。CSI Y轴方向的建议PTV外放边界为6.2 mm。 |
| 英文摘要: |
| Abstract： ［Objective］ To explore the optimal margins of planning target volume (PTV) in tomotherapy with craniospinal irradiation(CSI) for pediatric medulloblastoma based on megavoltage computed tomography (MVCT) system. ［Methods］ A total of 386 sets of MVCT images of 25 pediatric patients with medulloblastoma were collected. Among these， The MVCT acquisition registration ranges were chosen as the head and neck segment and the lumbar and sacrum segment， the Normal mode was selected for acquisition pitch in 14 cases and Course mode was selected in 11 cases. Among 14 cases with Normal pitch， two registration modes， Bone， and Bone and Tissue were selected for intra-group comparison. The setup errors in different directions were recorded for differential analysis， and the PTV margins were calculated. ［Results］ Inter-group difference analysis showed that the setup errors of the head and neck segment， and the lumbar and sacrum segment in the Normal pitch group were both smaller than those in the Course pitch group in the Y-axis and Roll direction (P<0.05)， and there was no significant difference in the X-axis and Z-axis directions. In terms of intra-group comparison of registration methods， the Bone registration group exhibited smaller setup errors in the Z direction and roll direction of the head and neck segment， compared to the Bone and Tissue registration group (P<0.05)， there was no significant difference in the X and Y directions. Moreover， the setup errors in the X， Y， Z directions， and roll direction of the lumbar and sacrum segment were all smaller in the Bone registration group than those in the Bone and Tissue group(P<0.05). ［Conclusion］ For children with medulloblastoma receive CSI treatment with TOMO system， MVCT acquisition select Normal pitch and Bone registration method can effectively improve the accuracy of setup errors. For the head and neck segment， the recommended margins of the PTV in the X and Z axes is 2.3 mm and 2.0 mm. For the lumbar and sacrum segment， the recommended margins of the PTV in the X and Z axes is 3.2 mm and 4.3 mm. The recommended margins of PTV for the Y axis of the CSI is 6.2 mm. |
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