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目的:探讨基于四维CT(4DCT)测得的自由呼吸状态下肺内孤立性病灶、隆突及膈肌不同时间段位移的差异,以合理安排定位与治疗时间。方法:将2011-02-22-2012-03-27山东省肿瘤医院放疗科接受适形放疗的26例周围型肺癌或肺转移癌患者随机分成上午组和下午组,14例在9:00~11:00、12例在14:00~16:00行4DCT扫描,分别在呼气末和吸气末时相勾画GTV,比较上、下午组患者GTV中心在左右、头足和前后方向的位移和GTV中心在三维空间的运动矢量及隆突和左、右侧膈肌在头足方向的运动幅度差异。结果:上午组患者GTV中心在左右、头足、前后方向的位移分别为(1.70±2.49)、(6.86±7.10)和(1.92±1.91)mm,下午组分别为(1.24±1.01)、(5.33±4.21)和(1.93±1.26)mm,三维方向上两组间差异无统计学意义,P>0.05;但左右和头足方向,上午组位移略大于下午组。上、下午组患者GTV中心三维运动矢量分别为(7.74±7.32)和(6.13±4.01)mm,差异无统计学意义,P>0.05。上午组隆突及右、左侧膈肌在头足方向的位移为(5.70±2.31)、(15.64±7.54)和(14.11±4.81)mm,下午组为(5.86±1.74)、(14.18±5.87)和(12.08±3.85)mm,差异均无统计学意义,P>0.05。结论:自由呼吸状态下肺内孤立性病灶三维方向的位移及隆突和膈肌头足方向的运动幅度在上、下午间差异均不明显,提示放疗定位与放射治疗的时间可以不同步。
OBJECTIVE: To investigate the differences in the displacement of isolated solitary pulmonary lesions, carina and diaphragm in different periods of time under free breathing condition based on 4-dimensional CT (4DCT), in order to arrange the location and treatment time reasonably. Methods: Twenty-six patients with peripheral lung cancer or lung metastasis undergoing conformal radiotherapy at the Radiation Oncology Department of Shandong Cancer Hospital were randomly divided into morning group and afternoon group, and 14 patients were treated at 9: 00 ~ 11: 00, 12 cases of 4DCT scan 14: 00 ~ 16: 00, respectively, at the end of breath and end of Gens sketch GTV, GTV center in the morning and afternoon, head and fore and aft displacement And GTV center in the three-dimensional motion vector and the movement of the carina and left and right diaphragms in the direction of head and foot movement range. Results: In the morning group, the displacement of GTV center was (1.70 ± 2.49), (6.86 ± 7.10) and (1.92 ± 1.91) mm respectively in the left, right, head and front directions, and (1.24 ± 1.01) and ± 4.21) and (1.93 ± 1.26) mm, respectively. There was no significant difference in three-dimensional directions between the two groups (P> 0.05). The three-dimensional motion vectors of GTV center in the morning and afternoon groups were (7.74 ± 7.32) and (6.13 ± 4.01) mm, respectively, with no significant difference (P> 0.05). (5.70 ± 2.31), (15.64 ± 7.54) and (14.11 ± 4.81) mm in the morning and diaphragms in the right and left diaphragms were (5.86 ± 1.74) and (14.18 ± 5.87) in the afternoon group, respectively And (12.08 ± 3.85) mm respectively, with no significant difference (P> 0.05). CONCLUSION: The displacement of solitary pulmonary lesions in three-dimensional direction and the amplitude of movement in the direction of carina and diaphragmatic head and head during free breathing are not significant at the upper and the afternoon, suggesting that radiotherapy positioning and radiotherapy time may not be synchronized.