食管癌放射治疗过程中靶区运动的研究进展

Advances in target volume movement during radiotherapy for esophageal cancer

目的分析影响食管癌患者肿瘤靶区运动因素,综述患者靶区在放射治疗过程中分次内及分次间的运动情况。方法以“食管癌、放射治疗、运动”为中文关键词,“esophageal cancer,radiation therapy,motion”为英文关键词,检索中国知网及PubMed数据库2005-01-01-2023-01-01相关文献。纳入标准:(1)食管癌放射治疗相关文献;(2)食管癌靶区运动研究。排除标准:数据陈旧文献。最终共纳入文献42篇。结果呼吸运动、心脏搏动、摆位误差等均会引起放射治疗过程中食管癌靶区的运动。其中食管癌靶区的运动多以头脚方向运动幅度较大,且食管癌患者的运动在不同部位运动范围不同,其中以食管下段的肿瘤运动幅度最大。在食管癌患者的放射治疗过程中,肿瘤体积也会发生变化,肿瘤体积的退缩与形变也会引起食管癌靶区不同程度的运动。结论食管癌患者不同个体及同一个体在整个放射治疗不同时间里靶区会出现不同幅度的移动,可能导致靶区内照射剂量不足或周围危及器官受照量增大,从而造成疾病的持续、复发或危及器官不良反应的出现。精确了解食管癌患者靶区的运动情况,是食管癌患者放射治疗的关键,能够为患者带来更好预后。

Objective To analyze the factors that affect the movement of tumor target areas in patients with esophageal cancer and to review the intra-fractional and inter-fractional movement of target areas during radiotherapy in patients with esophageal cancer.Method Using"esophageal cancer,radiotherapy,and movement"as keywords,a systematic search was conducted on CNKI and Pubmed databases from January 1st,2005 to January 1st,2023.Inclusion criteria:(1)Literature related to radiotherapy for esophageal cancer;(2)Related literature on target area movement in esophageal cancer.Exclusion criteria:literature with outdated data.A total of 42 articles were ultimately included.Results A large number of studies have found that respiratory movement,heartbeat and positioning errors can cause the movement of the target area of esophageal cancer during radiotherapy,in which the movement of the target area of esophageal cancer is mostly in the direction of head and foot.And the range of movement in different parts of esophageal cancer patients is different,among which the range of movement of the tumor in the lower part of the esophagus is the largest.In the process of radiotherapy for patients with esophageal cancer,the tumor volume of esophageal cancer will also change significantly,and the shrinkage and deformation of tumor volume will also cause different degrees of movement of the target area of esophageal cancer.Conclusion Different individuals and the same individual of patients with esophageal cancer will have different ranges of movement of the target area during the different time of radiotherapy,which may lead to insufficient radiation dose in the target area or increase of radiation exposure to the surrounding endangered organs.resulting in the persistence of the disease,recurrence or the emergence of adverse reactions that endanger organs.Accurate understanding of target movement in patients with esophageal cancer is the key to radiotherapy for patients with esophageal cancer,which can bring better prognosis for patients.