Dynamic Observation and Clinical Analysis of Tumor Volume Changes during Radiotherapy for Non-small Cell Lung Cancer_West China Medical Journal

Authors：

LIU Yongmei ¹ , DING Zhenyu ¹ , ZHONG Renming ² , JIANG Xiaoqin ² , XU Qingfeng ² ,  LI Ping. ³

1. Department of Thoracic Oncology; 2. Division of Physics Center; 3. Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Ping., Email: lymi75@163.com

Keywords：

非小细胞肺癌; 锥形束CT; 肿瘤体积

DOI：

10.7507/1002-0179.20130055

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目的　通过非小细胞肺癌（NSCLC）图像引导放射治疗（IGRT）过程中，每次治疗前获取的锥形束CT图像，动态观察肿瘤体积的变化。方法　2009年2月－2010年8月18例周围型NSCLC患者接受IGRT。每次治疗前进行千伏级锥形束CT（KV-CBCT）图像的采集。每周在KV-CBCT图像上勾画肿瘤靶区并计算靶区体积，经统计后分析肿瘤治疗过程中体积的变化。结果　治疗开始时平均体积为28.5 cm3（2.5～109.1 cm3），治疗结束时平均体积为17.1 cm3 （1.4～73.4 cm3）。平均退缩率为35.9%（3.9%～68.9%），平均每天的退缩率为1.5% （0.1%～5.4%）。治疗结束时，0例病灶完全消退，1例部分消退，10例微小消退，7例稳定。结论　治疗过程中，NSCLC肿瘤的退缩可以通过KV-CBCT进行观察。当病灶为周围型时，能对肿瘤体积的变化进行客观有效的评价。放射治疗过程中肿瘤的体积改变具有很大的异质性，肿瘤在治疗过程中体积均有一定的退缩，但治疗结束时大多数病灶仅为微小消退或稳定。

Citation： LIU Yongmei,DING Zhenyu,ZHONG Renming,JIANG Xiaoqin,XU Qingfeng,LI Ping.. Dynamic Observation and Clinical Analysis of Tumor Volume Changes during Radiotherapy for Non-small Cell Lung Cancer. West China Medical Journal, 2013, 28(2): 167-171. doi: 10.7507/1002-0179.20130055 Copy

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7.	Willner J, Baier K, Caragiani E, et al. Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung Cancer[J]. Int J Radiat Oncol Biol Phys, 2002, 52(2): 382-389.
8.	Kim DW, Shyr Y, Chen H, et al. Response to combined modality therapy correlates with survival in locally advanced non-small-cell lung Cancer[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4): 1029-1036.
9.	Kupelian PA, Ramsey C, Meeks SL, et al. Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung Cancer: observations on tumor regression during treatment[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4): 1024-1028.
10.	Siker ML, Tomé WA, Mehta MP. Tumor volume changes on serial imaging with megavoltage CT for non-small-cell lung Cancer during intensity-modulated radiotherapy: how reliable, consistent, and meaningful is the effect?[J]. Int J Radiat Oncol Biol Phys, 2006, 66(1): 135-141.
11.	张英杰, 李建斌, 于金明, 等. CBCT影像引导非小细胞肺癌三维适形放疗靶区位置及体积变化分析[J]. 中华放射医学与防护杂志, 2008, 28(6): 626-627.
12.	Britton KR, Starkschall G, Tucker SL, et al. Assessment of gross tumor volume regression and motion changes during radiotherapy for non-small-cell lung Cancer as measured by four-dimensional computed tomography[J]. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1036-1046.
13.	Guckenberger M, Richter A, Wilbert J, et al. Adaptive radiotherapy for locally advanced non-small-cell lung Cancer does not underdose the microscopic disease and has the potential to increase tumor control[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4): 275-282.
14.	陈龙, 谢小妹, 黄江琼, 等. 非小细胞肺癌自适应放疗剂量学研究[J]. 中国癌症防治杂志, 2012, 4(1): 53-56.

1. 　Mcbain CA, Henry AM, Sykes J, et al. X-ray volumetric imaging in image-guided radiotherapy: the new standard in on-treatment imaging[J]. Int J Radiat Oncol Biol Phys, 2006, 64(2): 625-634.
2. 　Mackie TR, Kapatoes J, Ruchala K, et al. Image guidance for precise conformal radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2003, 56(1): 89-105.
3. 　Chappell RJ, Miranpuri SS, Mehta MP. The importance of dimension in defining tumor response[J]. J Clin Oncol, 1998, 16(3): 1234.
4. 　Schulz CA, Miranpuri SS, Chappell RJ, et al. Comparison of methods for response analysis of central nervous system neoplasms[J]. Int J Radiat Oncol Biol Phys, 1998, 42(1): 261.
5. 　Scrimger RA, Tomé WA, Olivera GH, et al. Reduction in radiation dose to lung and other normal tissues using helical tomotherapy to treat lung Cancer, in comparison to conventional field arrangements[J]. Am J Clin Oncol, 2003, 26(1): 70-78.
6. 　Kron T, Grigorov G, Yu E, et al. Planning evaluation of radiotherapy for complex lung Cancer cases using helical tomotherapy[J]. Phys Med Biol, 2004, 49(16): 3675-3690.
7. 　Willner J, Baier K, Caragiani E, et al. Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung Cancer[J]. Int J Radiat Oncol Biol Phys, 2002, 52(2): 382-389.
8. 　Kim DW, Shyr Y, Chen H, et al. Response to combined modality therapy correlates with survival in locally advanced non-small-cell lung Cancer[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4): 1029-1036.
9. 　Kupelian PA, Ramsey C, Meeks SL, et al. Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung Cancer: observations on tumor regression during treatment[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4): 1024-1028.
10. 　Siker ML, Tomé WA, Mehta MP. Tumor volume changes on serial imaging with megavoltage CT for non-small-cell lung Cancer during intensity-modulated radiotherapy: how reliable, consistent, and meaningful is the effect?[J]. Int J Radiat Oncol Biol Phys, 2006, 66(1): 135-141.
11. 　张英杰, 李建斌, 于金明, 等. CBCT影像引导非小细胞肺癌三维适形放疗靶区位置及体积变化分析[J]. 中华放射医学与防护杂志, 2008, 28(6): 626-627.
12. 　Britton KR, Starkschall G, Tucker SL, et al. Assessment of gross tumor volume regression and motion changes during radiotherapy for non-small-cell lung Cancer as measured by four-dimensional computed tomography[J]. Int J Radiat Oncol Biol Phys, 2007, 68(4): 1036-1046.
13. 　Guckenberger M, Richter A, Wilbert J, et al. Adaptive radiotherapy for locally advanced non-small-cell lung Cancer does not underdose the microscopic disease and has the potential to increase tumor control[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4): 275-282.
14. 　陈龙, 谢小妹, 黄江琼, 等. 非小细胞肺癌自适应放疗剂量学研究[J]. 中国癌症防治杂志, 2012, 4(1): 53-56.

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Dynamic Observation and Clinical Analysis of Tumor Volume Changes during Radiotherapy for Non-small Cell Lung Cancer

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