图像引导放射治疗在中晚期食管癌的摆位误差分析及临床研究

Analysis and Clinical Study of Positioning Error of Image-guided Radiotherapy in Advanced Esophageal Cancer

目的应用图像引导放射治疗(IGRT)技术测量和分析食管癌调强放射治疗的摆位误差,估算外放边界,分析其临床应用价值。方法收集2016年9月至2021年8月于我院进行根治性放射治疗的食管癌患者112例,按不同放疗方式分为3组:三维适形组31例,普通调强组25例,CBCT引导的调强组56例。观察CBCT引导的调强组不同方向摆位误差及三维适形组、普通调强组和CBCT引导的调强组近期治疗效果和不良反应发生率。结果X、Y和Z方向的摆位误差分别为(-0.09±0.17)cm,(0.01±0.28)cm,(-0.03±0.18)cm。3组患者近期治疗局部缓解率分别为48.39%、52.00%、57.14%,差异无统计学意义(P>0.05);3组不良反应发生率中骨髓抑制有统计学意义(P<0.05),而3组放射性食管炎、放射性气管或肺炎发生率无显著性差异(P>0.05)。结论IGRT技术应用于食管癌调强放射治疗中可以降低骨髓损伤,但其疗效确切与否仍需进一步研究,利用现代技术和成像、靶向治疗和新型化疗药物优化食管癌治疗是一项重大挑战,应成为未来研究和临床试验的目标。

Objective to measure and analyze the positioning error of intensity modulated radiotherapy for esophageal cancer,estimate the external radiation boundary and analyze its clinical application value.Methods 112 patients with esophageal cancer who underwent radical radiotherapy in our hospital from September 2016 to August 2021 were collected,divided into 3 groups according to different radiotherapy methods,including 31 cases in three-dimensional conformal group,25 cases in general intensity modulation group and 56 cases in CBCT guided intensity modulation group.The positioning errors in different directions of CBCT guided intensity modulation group and the short-term treatment effects and adverse reactions of three-dimensional conformal group,ordinary intensity modulation group and CBCT guided intensity modulation group were observed.Results The positioning errors in X,Y and Z directions were(-0.09±0.17)cm,(0.01±0.28)cm and(-0.03±0.18)cm,respectively.The short-term local remission rates of the three groups were 48.39%,52.00%and 57.14%respectively(P>0.05);The comparison of the incidence of adverse reactions among the three groups showed that bone marrow suppression was statistically significant(P<0.05),while there was no significant difference in the incidence of radiation esophagitis,radiation trachea or pneumonia among the three groups(P>0.05).Conclusion The application of IGRT technology in intensity-modulated radiotherapy for esophageal cancer can reduce bone marrow injury,but its efficacy still needs further research.Optimizing the treatment of esophageal cancer by using modern technology,imaging,targeted therapy and new chemotherapeutic drugs is a major challenge and should become the goal of future research and clinical trials.