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目的研究在肺癌放射治疗过程中呼吸运动对靶体积的影响。方法选择52例肺癌患者,其中男性38例,女性14例;年龄38～86岁,中位年龄60岁。进行三维适形放射治疗(3D-CRT)定位时通过训练患者自主控制呼吸,分别在平静呼吸吸气末屏气和呼气末屏气及不控制呼吸(平静自主呼吸)3种情况下,用螺旋CT快速扫描采集图像,将3组图像传输至计划系统,将前两组进行图像融合,勾画个体化放射治疗靶区,并与第3组不控制呼吸情况下所勾画的个体化放射治疗靶区进行靶体积比对。结果有41例成功进行图像融合,勾画出个体化放射治疗靶区。肺部病变随呼吸运动产生的靶体积变化差异有显著统计学意义(P=0.000<0.01),其中上肺野35.55%,中肺野19.17%,下肺野45.73%。结论应用CT-CT图像融合后进行靶区计划设计能有效避免在肺癌放射治疗中因呼吸运动所造成的靶区遗漏。
Objective To study the influence of respiratory motion on target volume during radiotherapy of lung cancer. Methods Fifty-two patients with lung cancer were selected, including 38 males and 14 females, aged from 38 to 86 years old with a median age of 60 years. Three-dimensional conformal radiotherapy (3D-CRT) positioning by training patients to control their own breathing, respectively, at the end of calm breathe breathing breath-hold breath and breath-hold breath and uncontrolled breathing (calm spontaneous breathing) three cases, with spiral CT The images were quickly scanned and the three images were transmitted to the planning system. The first two groups were fused, the individualized radiotherapy target areas were sketched, and compared with the individualized radiotherapy targets outlined in group 3 without breathing restriction The target volume ratio. Results 41 patients successfully fused the images and delineated the target of personalized radiotherapy. There were significant differences in lung volume (P = 0.000 <0.01) between the changes of target lung volume and respiratory motion, including 35.55% in the upper lung field, 19.17% in the middle lung field and 45.73% in the lower lung field. Conclusion The design of the target area after CT-CT image fusion can effectively avoid the omission of the target area caused by respiratory motion in radiotherapy of lung cancer.