食管镜下银夹标记在确定食管癌放射治疗靶区勾画中作用的研究

Effect of labeling esophageal carcinoma with sliver clips by esophagoscopy in mapping the target for radiotherapy

目的 探讨食管镜下对病变两端进行银夹标记在食管癌适形放射治疗肿瘤靶区确定中的作用.方法 80例初治拟行根治性放射治疗的食管癌患者（早期28例、中晚期52例）通过单纯CT定位、CT定位＋X线造影及CT定位＋食管镜银夹标记法分别勾画肿瘤大体体积（GTV）,比较三种方法下确定的肿瘤靶区长度的差异以及靶区位置在头脚方向（Y轴方向）上的位置差异.结果 早期食管癌患者通过胸部CT、X线造影及食管镜显示的病变长度均值除乳头型外差异有统计学意义（F=4.07～7.43,P＜0.05）,乳头型病例三种方法确定的病变长度差异无统计学意义（F=1.71,P＞0.05）,单纯CT和CT＋X线造影法确定的靶区在Y轴方向上的位置较CT＋镜下标记法相差0.5～2.0 cm,三种方法确定的靶区头脚位移差异有统计学意义（F=34.36～193.50,P＜0.01）.中晚期食管癌患者通过胸部CT、X线造影及食管镜显示的病变长度均值除菌伞型外差异有统计学意义（F=4.07～30.10,P＜0.05）,菌伞型病例三种方法确定的病变长度差异无统计学意义（F=2.44,P＞0,05）.三种方法确定的靶区头脚位移差异有统计学意义（F=12.00～21.16,P＜0.01）.结论 CT＋食管镜银夹标记与单纯CT定位和CT＋X线造影法相比,前者对靶区勾画更加敏感、准确.

Objective To study the effect of labeling esophageal carcinoma with sliver clips on two sides by esophagoscopy in mapping the target for conformal radiotherapy （CRT）. Methods Eighty patients with esophageal carcinoma （28 patients in early stage, 52 patients in late stage）, who were eligible for CRT, were collected and the tumor volume was detected by three methods： CT （A）,CT combined with X-ray （B） and CT combined with sliver clip labeling by esophagoscopy （C）. The differences of the tumor length and position in head-foot site （Y-axsis） among three methods were compared. Results The comparison of average length of tumor in early stage patients showed significant difference among three methods in all types of tumor （F= 4.07 ～ 7.43, P＜0.05 ） except papillary type （F= 1. 71, P＞0. 05）. There was difference （ranged from 0. 5 cm to 2. 0 cm） in detection of position in head-foot site between A and B methods and C method. Significant difference was found in determining the displacement on head-foot site among three methods （F = 34. 36 ～193.50,P ＜0.01）. The comparison of average length of tumor in middle or terminal stage patients showed significant difference among three methods in all types of tumor （F=4. 07～30.10 ,P＜0.05） except mushroom type （F = 2.44, P＞ 0. 05）. Significant difference was found in determining the displacement on head-foot site among three methods （F= 12.00 ～ 21.16, P ＜ 0. 01 ）. Conclusion These findings indicate that C method is more sensitive and correct in mapping the target for CRT in comparison with other two methods.