肺肿瘤运动规律及其影响因素的研究

目的 探讨肺肿瘤运动规律及其影响因素,指导精确放疗临床靶区外放.方法 搜集射波刀治疗的原发或转移肺肿瘤患者70例共83个病灶,其中7例患者7个病灶侵犯胸壁.CT引导下将纯金标记(金标)置入肿瘤体内或邻近位置.X线模拟定位机下测量金标(肿瘤)的运动幅度.1周后行层厚为1.25 mm的16层螺旋肺部CT扫描,根据解剖学标志划分肺尖部、中部、底部,记录不同部位的左右(x轴)、前后(y轴)、头脚(z轴)方向移动数据.结果 63例患者的76个病灶肺尖部、中部、底部x轴移动距离分别为(1.6±0.8)、(2.6 4±1.1)、(2.8±1.7)mm(F=1.76,P=0.179),y 轴的分别为(2.0±1.3)、(4.3±2.8)、(4.0.4±2.0)mm(F=2.06,P=0.135),z轴的分别为(2.7±0.8)、(7.3±3.6)、(12.0±5.3)mm(F=16.33,P=0.000).7个侵犯胸壁病灶移动距离很小,分别为(0.9±0.7)、(0.7±0.7)、(2.0±0.6)mm.相关分析显示x、y、z轴方向移动距离与患者性别、年龄、身高、体重和1s呼吸率无关(r=-0.001～0.136,P均>0.05).结论 呼吸导致的肺肿瘤移动距离主要受肿瘤位置和是否侵犯胸壁影响,了解其运动规律及影响因素有利于肺肿瘤放疗内边界的确定.

Abstract：

Objective To investigate the mobility of the lung tumors in order to guide the margin that CTV is to be expanded to PTV during stereotaetic radiotherapy for lung tumors.Methods Eighty-three lung tumom ineluded,in which 7 invaded the chest wall.1-2 gold marker(s)was/were implanted into or nearby the tumor.The motion of lung tumors in x(right-left),y(superior-inferior)and:(anterior-posterior)directions were measured via X-ray simulator system.One week later,1.25 mm thick of 16-slice spiral CT lung scan were taken.Apex,middle,and bottom of the lung were classified according to anatomic boderlines.Results No significant difference was detected among movements of apex,middle and bottom of the lung lesions in x axis direction((1.6±0.8),(2.6±1.1),(2.8±1.7)mm,respectively(F=1.76,P=0.179))and,y axis direction((2.0±1.3),(4.3±2.8),(4.0±2.0)mm,respectively(F=2.06,P=0.135))in 76 lesions of 63 patients.Significant differences were detected in:axis((2.7±0.8),(7.3±3.6),(12.0±5.3)mm(F=16.33,P=0.000)).The mobilities of the 7 lesions of 7 patients invading the chest wall were very small in all directions(0.9±0.7,0.7±0.7.and 2.0±0.6 mm,respectively).Motion amplitude did not correlate with the sex,age,height,weight and FEV1/FVC(r=-0.001-0.136.all P>0.05).Conclusions Motion amplitude of lung tumor due to breathing is associated with tumor loeation and status of chest wall invoivement.Identification of the mobile rules and the influencing factors is important for the internal margin set-up in lung tumor radiotherapy.

The study in the mobility of lung tumors and impact factors

Objective To investigate the mobility of the lung tumors in order to guide the margin that CTV is to be expanded to PTV during stereotaetic radiotherapy for lung tumors.Methods Eighty-three lung tumom ineluded,in which 7 invaded the chest wall.1-2 gold marker(s)was/were implanted into or nearby the tumor.The motion of lung tumors in x(right-left),y(superior-inferior)and:(anterior-posterior)directions were measured via X-ray simulator system.One week later,1.25 mm thick of 16-slice spiral CT lung scan were taken.Apex,middle,and bottom of the lung were classified according to anatomic boderlines.Results No significant difference was detected among movements of apex,middle and bottom of the lung lesions in x axis direction((1.6±0.8),(2.6±1.1),(2.8±1.7)mm,respectively(F=1.76,P=0.179))and,y axis direction((2.0±1.3),(4.3±2.8),(4.0±2.0)mm,respectively(F=2.06,P=0.135))in 76 lesions of 63 patients.Significant differences were detected in:axis((2.7±0.8),(7.3±3.6),(12.0±5.3)mm(F=16.33,P=0.000)).The mobilities of the 7 lesions of 7 patients invading the chest wall were very small in all directions(0.9±0.7,0.7±0.7.and 2.0±0.6 mm,respectively).Motion amplitude did not correlate with the sex,age,height,weight and FEV1/FVC(r=-0.001-0.136.all P>0.05).Conclusions Motion amplitude of lung tumor due to breathing is associated with tumor loeation and status of chest wall invoivement.Identification of the mobile rules and the influencing factors is important for the internal margin set-up in lung tumor radiotherapy.