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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Image-guided radiotherapy of bladder cancer: bladder volume variation and its relation to margins.
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Image-guided radiotherapy of bladder cancer: bladder volume variation and its relation to margins.

机译：膀胱癌的影像引导放疗：膀胱体积变化及其与切缘的关系。

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BACKGROUND AND PURPOSE: To control and account for bladder motion is a major challenge in radiotherapy (RT) of bladder cancer. This study investigates the relation between bladder volume variation and margins in conformal and image-guided RT (IGRT) for this disease. MATERIALS AND METHODS: The correlation between the relative bladder volume (RBV, defined as repeat scan volume/planning scan volume) and the margins required to account for internal motion was first studied using a series of 20 bladder cancer patients with weekly repeat CT scanning during treatment. Both conformal RT (CRT) and IGRT were simulated; in the latter translational movement of the bladder was accounted for by isocentre shifting. Further analysis of bladder volumes and margins was performed using a second series of eight patients with twice-weekly repeat CT scanning. In an attempt to control bladder volume variation these patients were given fluid intake restrictions on alternating weeks during treatment. RESULTS: IGRT gave the strongest correlation between the RBV and margin size (R(2)=0.75; p<0.001). Using IGRT, isotropic margins >10mm were required in only 1% of the situations when the RBV1, whereas isotropic margins >10mm were required in 55% of the situations when the RBV>1. Less marked correlation was found using CRT (R(2) in the range 0.43-0.53, p<0.001) for four different methods used to assess the margins required in the six directions, although a strong correlation was found for the superior margin (R(2)=0.63; p<0.001). Fluid intake restriction gave a small reduction in both bladder volume (average absolute volume reduced from 126 to 121cm(3); RBV from 0.83 to 0.80) and bladder volume variation, but not sufficient to translate into margin reduction. CONCLUSIONS: The study showed the potential for a large margin reduction in bladder RT if the bladder volume is controlled and this potential was even greater for IGRT. An attempt to control the bladder volume by restricting fluid intake prior to the treatment session failed togive any reduction in the margins required.
机译：背景与目的：控制和解释膀胱运动是膀胱癌放疗（RT）的主要挑战。这项研究调查了这种疾病的保形和图像指导RT（IGRT）中膀胱体积变化与边缘之间的关系。材料与方法：首先使用一系列20例膀胱癌患者进行了研究，研究了相对膀胱体积（RBV，定义为重复扫描体积/计划扫描体积）与解释内部运动所需的余量之间的相关性，并在此期间每周进行一次CT扫描治疗。保形RT（CRT）和IGRT均经过仿真;在后一种情况中，膀胱的平移运动是由等中心点移位引起的。使用第二批8例患者进行第二次每周两次CT扫描，进一步分析了膀胱体积和切缘。为了控制膀胱容量的变化，这些患者在治疗期间每隔几周就受到液体摄入的限制。结果：IGRT在RBV和保证金大小之间具有最强的相关性（R（2）= 0.75; p <0.001）。使用IGRT，在RBV1时只有1％的情况需要各向同性边距> 10mm，而在RBV> 1时有55％的情况需要等向性边距> 10mm。使用CRT（R（2）的范围在0.43-0.53，p <0.001）时，发现四种用于评估六个方向所需边距的方法的相关性较低，尽管上边距（R （2）＝ 0.63; p ＜0.001）。液体摄入的限制使膀胱体积（平均绝对体积从126减少至121cm（3）; RBV从0.83降低至0.80）和膀胱体积的变化均很小，但不足以减少切缘。结论：该研究表明，如果控制膀胱体积，则可能大幅度减少膀胱RT的边缘，而对于IGRT来说，这一潜力甚至更大。在治疗前通过限制液体摄入来控制膀胱体积的尝试未能消除所需的余量。

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