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- 期刊
Speculation of Intrafractional Motion Errors in Patients with Prostate Cancer during Pelvis RapidArc Radiotherapy
接受骨盆銳速刀放射治療的治療中移動誤差之研究
摘要
目的：分析攝護腺癌病患接受骨盆銳速刀（RapidArc）放射治療時，治療中的移動誤差。材料與方法：本研究共收納18位接受骨盆銳速刀放射治療合併電腦刀（Cyberknife）加強劑量的高危險群攝護腺癌病患。治療期間的前三次治療日，病患躺床後做第一次的錐狀放射電腦斷層掃描（kV cone beam computerized tomography），並利用其來與治療計畫的臨床腫瘤體積範圍（CTV）比對，矯正擺位誤差。接著在矯正後放射治療前與放射治療後做第二次與第三次的錐狀放射電腦斷層掃描。利用這些錐狀放射電腦斷層掃描影像比對，紀錄出治療前後的三個軸（左右－上下－前後）的位移誤差。結果：在治療時間短（約三分鐘）的銳速刀放射治療技術下，治療前後residual systemic和random errors是較小的。利用第二次與第三次錐狀放射電腦斷層（分別為治療前與治療後）影像比對，治療中誤差（mean ± SD）在三個軸（左右－上下－前後）分別為-0.4 ± 0.8, -0.2 ± 1.0, 0.1 ± 0.8 mm，除了左右方向，其餘無統計上顯著差異。另外利用這些誤差值，在兩個不同公式（linear與quadrature margin）計算下，其臨床腫瘤體積（CTV）形成腫瘤治療體積（PTV）的範圍各為3.6, 4.4, 4.5 mm；2.5, 3.2, 3.3 mm（左右－上下－前後）。結論：攝護腺癌病患接受骨盆放射治療時，利用較快速的銳速刀放射治療搭配錐狀放射電腦斷層掃描作為治療前矯正，其治療中的骨盆移動是比較少的。本篇所觀察的這些誤差經驗，可以用來提升日後放射治療準確性的參考。
並列摘要
Purpose: To evaluate the intrafractional motion errors in patient with prostate cancer received pelvis irradiation during RapidArc radiotherapy.Materials and Methods: A total of eighteen high risk group prostate cancer patients were treated prostate and pelvis lymph nodes by RapidArc radiotherapy then boost dose by Cyberknife. All patients had kV cone beam computerized tomography (CBCT) scans in their first three fractions of treatment. During these treatments, the CBCT scans were registered to planning CT simulation images as reference to perform registration procedure based on soft tissue windows matched with clinical tumor volume (CTV). The errors of isocenter position were corrected by couch shifted. The second and third CBCT images were immediately acquired before and after RapidArc treatment. These errors of isocenter position on the left-right (LR), superior–inferior (SI) and anterior–posterior (AP) directions were analyzed retrospectively.Results: Under RapidArc technique with a shortened treatment delivery time (about 3 min), the residual systemic and random errors in pre and post-radiation treatment revealed limited. Based on the paired 2^(nd) and 3^(rd) CBCT images, the intrafractional errors (mean ± SD) in LR-SI-AP directions were -0.4 ± 0.8, -0.2 ± 1.0, 0.1 ± 0.8 mm. No intrafractional error differences in three axes, except borderline significant in LR direction (p= 0.046). Isotropic planning margins created with the linear addition of internal margin to clinical tumor volume was respectively 3.6, 4.4, 4.5 mm in LR-SI-AP axes and 2.5, 3.2, 3.3 mm if generated with quadrature addition.Conclusion: Use of the faster RapidArc technique with accurate kV CBCT images online verification for prostate cancer pelvis radiotherapy, the intrafractional motion errors were limited. These speculated intrafractional errors could be applied to improve the accuracy of radiation delivery and a smaller PTV margin might be adopted.
延伸閱讀
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