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目的通过非小细胞肺癌(NSCLC)图像引导放射治疗(IGRT)过程中,每次治疗前获取的锥形束CT图像,动态观察肿瘤体积的变化。方法 2009年2月-2010年8月18例周围型NSCLC患者接受IGRT。每次治疗前进行千伏级锥形束CT(KV-CBCT)图像的采集。每周在KV-CBCT图像上勾画肿瘤靶区并计算靶区体积,经统计后分析肿瘤治疗过程中体积的变化。结果治疗开始时平均体积为28.5 cm3(2.5～109.1 cm3),治疗结束时平均体积为17.1 cm(31.4～73.4 cm3)。平均退缩率为35.9%(3.9%～68.9%),平均每天的退缩率为1.5%(0.1%～5.4%)。治疗结束时,0例病灶完全消退,1例部分消退,10例微小消退,7例稳定。结论治疗过程中,NSCLC肿瘤的退缩可以通过KV-CBCT进行观察。当病灶为周围型时,能对肿瘤体积的变化进行客观有效的评价。放射治疗过程中肿瘤的体积改变具有很大的异质性,肿瘤在治疗过程中体积均有一定的退缩,但治疗结束时大多数病灶仅为微小消退或稳定。
Objective To observe the change of tumor volume dynamically by cone beam computed tomography (CT) images acquired before each treatment during non-small cell lung cancer (NSCLC) image guided radiotherapy (IGRT). Methods February 2009-August 2010 18 patients with peripheral NSCLC underwent IGRT. KV-CBCT images were collected before each treatment. The tumor target area was plotted weekly on the KV-CBCT images and the volume of the target area was calculated. The volume changes during the treatment of the tumor were analyzed statistically. Results The average volume at the beginning of treatment was 28.5 cm3 (2.5-109.1 cm3) and the average volume at the end of treatment was 17.1 cm (31.4-73.4 cm3). The average rate of withdrawal was 35.9% (3.9% ~ 68.9%), the average daily rate of retraction was 1.5% (0.1% ~ 5.4%). At the end of treatment, 0 of the lesions completely subsided, 1 subsided partially, 10 subsided slightly and 7 remained stable. Conclusions During the course of treatment, NSCLC tumor regression can be observed by KV-CBCT. When the lesions are of peripheral type, objective and effective evaluation of tumor volume changes can be made. Tumor volume changes during radiotherapy have a great heterogeneity, the tumor volume during treatment have a certain degree of regression, but at the end of the treatment most lesions only slight regression or stability.