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目的:基于胸中段食管癌三维CT(3DCT)模拟定位扫描图像,在原发肿瘤大体肿瘤体积(GTV)勾画的基础上,比较手动勾画与系统生成原发肿瘤临床靶体积(CTV)及计划靶体积(PTV)的差异。方法:选择在山东省肿瘤医院放疗科拟行三维适形放疗(3DCRT)的胸中段食管癌患者10例,基于3DCT扫描图像勾画原发肿瘤GTV,在GTV勾画基础上,计划系统自动上下外扩3cm、左右及前后外扩1cm生成CTVauto,按相同外扩范围由放疗医生手动勾画生成CTVmanu;基于CTVauto及CTVmanu系统自动上下外扩1.5cm、左右及前后外扩0.5cm生成PTVauto及PTVmanu。比较CTVauto与CTVmanu、PTVauto与PTVmanu的体积大小、靶区重合度及相对位移。结果:10例患者系统自动生成的CTVauto体积为(384.51±92.21)cm3,手动勾画生成的CTVmanu体积为(286.0±56.19)cm3,差异有统计学意义,t=7.265,P=0.005;PTVauto的体积为(653.17±141.63)cm3,PTVmanu的体积为(583.56±122.84)cm3,差异有统计学意义,t=4.390,P=0.005;CTVauto与CTVmanu的重合度为(75.08±5.49)%,PTVauto与PTVmanu的重合度为(89.46±7.51)%,两者差异有统计学意义,t=9.640,P=0.005;CTVauto与CTVmanu中心点在x、y轴方向上的偏移分别为(0.57±0.19)cm和(0.86±0.52)cm。PTVauto与PTVmanu中心点在x、y轴方向上的偏移分别为(0.52±0.24)cm和(0.99±0.48)cm。结论:由于食管头脚方向走行的非直线性,计划系统自动外扩生成食管原发肿瘤的CTV是不可靠的,胸中段食管癌头脚方向外扩均应基于GTV手动勾画形成。
OBJECTIVE: To compare and analyze the clinical target volume (CTV) and planned target of primary tumor manually based on GTO outline of primary tumor based on 3DCT CT scan of middle and upper esophagus. Differences in volume (PTV). Methods: Ten patients with thoracic esophageal cancer who underwent 3DCRT at the Radiation Oncology Department of Shandong Cancer Hospital were enrolled in this study. The primary tumor GTV was sketched based on 3DCT scan images. Based on GTV sketching, the system was planned to automatically scale up and down 3cm, and around 1cm before and after the expansion of CTVauto generated, according to the same range of external expansion by the radiotherapy doctor manually sketched to generate CTVmanu; based on CTVauto and CTVmanu system automatically up and down outside the expansion of 1.5cm, around and before and after the expansion of 0.5cm to generate PTVauto and PTVmanu. Comparing CTVauto with CTVmanu, the volume of PTVauto and PTVmanu, the coincidence of target area and relative displacement. Results: The volume of CTVauto automatically generated by the system was (384.51 ± 92.21) cm3 in 10 patients, and the volume of CTVmanu was (286.0 ± 56.19) cm3 in manual drawing. The difference was statistically significant (t = 7.265, P = 0.005) (653.17 ± 141.63) cm3, the volume of PTVmanu was (583.56 ± 122.84) cm3, the difference was statistically significant, t = 4.390, P = 0.005; The coincidence degree of CTVauto and CTVmanu was (75.08 ± 5.49)%; PTVauto and PTVmanu (T = 9.640, P = 0.005). The deviations of CTVauto and CTVmanu in the x and y axes were (0.57 ± 0.19) cm And (0.86 ± 0.52) cm. The deviations of PTVauto and PTVmanu in the x and y axes were (0.52 ± 0.24) cm and (0.99 ± 0.48) cm, respectively. Conclusion: Due to the non-linearity of esophageal head-and-toe movement, it is not reliable for the planned system to automatically expand the CTV of the primary esophageal tumor. The extension of the esophageal head and foot in the middle and upper esophagus should be based on the GTV manual outline.