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研究生:李雅雯
研究生(外文):ya wun li
論文名稱:前列腺癌影像導引放射治療擺位誤差之劑量評估
論文名稱(外文):The dosimetric impact of daily setup error with image-guided radiotherapy for prostate cancer
指導教授:林招膨林招膨引用關係
指導教授(外文):Jao-Perng Lin
學位類別:碩士
校院名稱:元培科技大學
系所名稱:醫學影像暨放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:102
語文別:中文
論文頁數:72
中文關鍵詞:影像導引放射治療全體積調控弧形治療擺位誤差臨床靶體積計畫靶體積
外文關鍵詞:IGRTVMATSet-up errorsCTVPTV
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前列腺癌影像導引放射治療擺位誤差之劑量評估
前列腺癌放射治療,治療間(inter-fraction)的擺位誤差、器官變動和形變,會造成每天治療劑量之改變。本研究應用影像導引放射治療(imaged-guided radiation therapy, IGRT)之離線重新計算劑量和線上重新校正擺位之方式來執行全體積調控弧形治療(volumetric modulated arc therapy, VMAT),評估擺位誤差(set-up error)對臨床靶體積(clinical target volume, CTV)、計畫靶體積(planning target volume, PTV)覆蓋率和周圍危急器官(organ at risk)之劑量影響。
本研究為回溯性實驗,時間為西元2011年5月至2013年4月,收集12位前列腺癌病患,應用Elekta Synergy X-ray cone beam computed tomography system執行校正靶體積定位之影像導引放射治療,總治療劑量為75.6 Gy。IGRT輔以VMAT,擷取每分次的空間座標之再計算劑量後,以Python程式加總。CTV、PTV之包覆率和周圍危急器官之劑量是被重新評估的,因實際之絕對劑量是重新計算、堆疊在每分次之空間座標上,與原始計畫做比擬。
所有病患的平均位移誤差在左右、頭尾、前後各為:2 mm±1 mm、3 mm±3 mm、4 mm±3 mm。系統誤差在左右、頭尾、前後各為:0.8 mm、2.0 mm、1.6 mm。隨機誤差在左右、頭尾、前後分別為:1.22 mm、1.7 mm、2.1 mm。重新計算之CTV劑量包覆率由100%降至96%、PTV包覆率由97.5%降至86.9%,周圍危急器官,在統計上則不具顯著之改變。故影像導引是必須的,雖然CTV劑量包覆率由100%降至96%,但PTV包覆率由97.5%降至86.9%,達顯著之改變。
IGRT對前列腺癌輔以VMAT是有益的,不僅能縮短治療時間,更能降低每分次間之擺位誤差。對於危急器官和腫瘤之具體劑量,更能精確評估,並獲得更佳之腫瘤控制率與較少之併發症,也期望在未來,能有新的隨機臨床試驗驗證。
關鍵詞:影像導引放射治療、全體積調控弧形治療、擺位誤差、臨床靶體積、計畫靶體積。

The dosimetric impact of daily setup error with image-guided radiotherapy for prostate cancer

In prostate radiation therapy, inter-fractional set up error and organ motion/deformation has posed significant challenges on reliable daily dose delivery. To evaluate the set-up errors and dose impact at clinical target volume (CTV), planning target volume (PTV) coverage and critical organ with cone beam computed tomography (CBCT), image-guided radiation therapy (IGRT), volumetric modulated arc therapy (VMAT); off-line re-optimization and online re-positioning have been used clinically.
Between 2011 and 2013, 12 patients with prostate cancer were treated with IGRT to a dose of 75.6 Gy with daily correction of the target position based on Elekta Synergy X-ray cone beam computed tomography system, image-guided radiation therapy practiced with VMAT. We captured each space coordinates in every fraction with dose redistribution to form a new dose distribution with the Pyton software. The real dose with recalculation and stacking with new three dimensional coordinates from each fraction were compared with initial plan. The dose at CTV, PTV coverage and critical organ were reevaluated.
The average shift of ML (medial-lateral) , CC (cranio-cauda) and AP (anterior-posterior) were 2 mm±1 mm, 3 mm±3 mm and 4 mm±3 mm. The calculated systematic errors in ML, AP and CC direction were 0.8 mm, 2.0 mm and 1.6 mm. The calculated random errors in ML, AP and CC direction were 1.22 mm, 1.7 mm and 2.1 mm. The coverage of CTV and PTV with recalculation were significantly decreased from 100%to 96% and 97.5% to 86.9% respectively. There was no statistical difference in the dose to organ at risk. IGRT will be necessary in our study. Though CTV coverage decrease from 100% to 96%, but the PTV coverage decrease from 97.5% to 86.9% reaching statistical significance.
IGRT would be beneficial for prostate cancer treatment with VMAT really. CBCT image guide VMAT in radiotherapy to prostate cancer not only shortened the treatment time but also decreased the uncertainty of set-up within each fraction. The specific dose to critical organs and tumor would be more exact compared with radiotherapy without IGRT. The less side effect and better tumor control might be expected in the future after proof of new randomized clinical trial.
Key words: Image-guided radiation therapy (IGRT), Volumetric modulated arc therapy (VMAT), Set-up errors, Clinical target volume (CTV), Planning target volume (PTV).

目 錄
致謝 Ⅰ
中文摘要 Ⅱ
Abstract Ⅲ
目錄 Ⅴ
圖目錄 Ⅵ
表目錄 Ⅶ
第一章 緒論 1
1.1研究動機 1
1.2文獻回顧 5
1.3研究目的 6
1.4研究架構 7
第二章 材料與方法 8
2.1病患選擇 8
2.2 模具製作與模擬定位 9
2.3 治療計畫 11
2.4 每日影像導引驗證與臨床治療 12
2.5 回溯分析 21
2.6 劑量累計、加總與統計 23
2.7 幾何誤差之分析 25
第三章 結果與討論 27
3.1 擺位誤差之分析 27
3.2 整體病患之靶體積等劑量曲線包覆率及p值 27
3.3 整體病患之危急器官劑量體積治療參數及p值 29
3.4 討論 32
第四章 結論 38
第五章 參考文獻 39
附錄1(python) 42
附錄2(臨床試驗文件) 49

第五章 參考文獻

1. 台灣大百科全書。2013年3月30號取自於台灣大百科全書之網址
http://taiwanpedia.culture.tw/web/content?ID=26376
2. 中華民國99年癌症登記報告。2013年10月9號取自行政院衛生福利部國民健康署之網址http://www.hpa.gov.tw/BHPNet/Portal/File/StatisticsFile/201305061037065219/99%E5%B9%B4%E7%99%8C%E7%97%87%E7%99%BB%E8%A8%98%E5%A0%B1%E5%91%8A.pdf
3. National Cancer Institute at the National Institutes of health
treatment. Treatment choices for men with early-stage prostate
cancer.January 8, 2014 from
http://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page1/AllPages
4. American Joint Committee on Cancer, 7th edition. Prostate cancer staging. October 15, 2013 from
http://www.google.com.tw/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CDAQFjAA&url=http%3A%2F%2Fcancerstaging.org%2Freferences-tools%2Fquickreferences%2FDocuments%2FProstateSmall.pdf&ei=kKlcUuKhHJHpkAWgp4GAAQ&usg=AFQjCNHl1kZd9OG6m-MlYOM02f4-g9nRRQ
5. 國家衛生研究院 攝護腺(前列腺)癌診治共識。2013年3月31日取自於國家衛生研究院之網址
https://www.nhri.org.tw
6. Crook JM, Raymond Y, Salhani D, et al.: Prostate motion during standard radio radiotherapy as assessed by fiducial markers. Radiother Oncol 1995; 37: 35-42.
7. Fu W, Yang Y, Li X, et al.: Dosimetric effects of patient rotational setup errors on prostate IMRT treatments. Phys Med Biol 2006; 51: 5321-5331.
8. Olsen JR, Noel CE, Baker K, et al.: Practical method of adaptive radiotherapy for prostate cancer using real-time electromagnetic tracking. Int J Radiat Oncol Biol Phys 2011; 82: 1903-1911.
9. Rudat V, Schraube P, Oetzel D, et al.: Combined error of patient positioning variability and prostate motion uncertainty in 3D conformal radiotherapy of localised prostate cancer. Int J Radiat Oncol Biol Phys 1996; 35: 1027-1034.
10. Ten Haken RK, Forman JD, Heimburger DK, et al.: Treatment planning issues related to prostate movement in response to differential filling of the rectum and bladder. Int J Radiat Oncol Biol Phys 1991; 20: 1317-1324.
11. Algan O, Jamgade A, Ali I, et al.: The dosimetric impact of daily setup error on target volumes and surrounding normal tissue in the treatment of prostate cancer with intensity-modulated radiation therapy. Med Dosim 2012; 37(4): 406-411.
12. Eade TN, Hanlon AL, Horwitz EM, et al.: What dose of external-beam radiation is high enough for prostate cancer? Int J Radiat Oncol Biol Phys 2007; 68: 682-689.
13. Kuban DA, Levy LB, Cheung MR, et al.: Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? Int J Radiat Oncol Biol Phys 2010; 77: 1-8.
14. Zelefsky MJ, Yamada Y, Fuks Z, et al.: Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008; 71: 1028-1033.
15. Sharma NK, Li T, Pollack A, et al.: Intensity-modulated radiotherapy reduces gastrointestinal toxicity in patients treated with androgen deprivation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010; 80: 437-444.
16. van Herk M: Errors and margins in radiotherapy. Semin Radiat Oncol 2004; 14(1): 52-64.
17. Thongphiew D, Wu QJ, Lee WR, et al.: Comparison of online IGRT techniques for prostate IMRT treatment: adaptive vs repositioning correction. Med Phys 2009; 36(5): 1651-1662.
18. Panchal A, Keyes R: SU‐GG‐T‐260: Dicompyler: An open source radiation therapy research platform with a plugin architecture. Med Phys 2010; 37: 3245.
19. Kutcher GJ, Mageras GS, Liebel SA: Control, correction, and modeling of setup errors and organ motion. Semin Radiat Oncol 1995; 5(2): 134-145.
20. Marks LB, Yorke ED, Jackson A, et al.: Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76(3): 10-19.
21. Bentzen SM, Constine LS, Deasy JO, et al.: QUANTITATIVE analyses of normal tissue effects in the clinic (QUANTEC): An introduction to the scientific issues. Int J Radiat Oncol Biol Phys 2010; 76(3): 3-9.
22. Kang CL, Tasi CH, Chang HM, Chen WK, Liao TY, Juan KJ: Measurement and analysis of setup error in image guided radiation therapy for prostate cancer patients. Chin J Radiol Tech 2008; 32(2): 173-180.
23. Roach M 3rd, Faillace-Akazawa P, Malfatti C: Prostate volumes and organ movement defined by serial computerized tomographic scans during three-dimensional conformal radiotherapy. Radiat Oncol Investig 1997; 5(4):187-194.
24. Chen PY , Cheng YT , Lin CS, et al.: Estimation of interfraction and intrafraction errors of prostate cancer patients with implanted fiducial markers by radiotherapy imaging guided system. Chin J Radiol Tech 2010; 34(4): 244-251.
25. Landoni V, Saracino B, Marzi S, et al.: A study of the effect of setup errors and organ motion on prostate cancer treatment with IMRT. Int J Radiat Oncol Biol Phys 2006; 65(2): 587-594.
26. Ahunbay EE, Peng C, Holmes S, Godley A, Lawton C, Li XA: Online adaptive replanning method for prostate radiotherapy. Int J Radiat Oncol Biol Phys 2010; 77: 1561-1572.
27. Deutschmann H, Kametriser G, Steininger P, et al.: First clinical release of an online, adaptive, aperture-based image-guided radiotherapy strategy in intensity-modulated radiotherapy to correct for inter- and intrafractional rotations of the prostate. Int J Radiat Oncol Biol Phys 2012; 83: 1624-1632.

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