Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Technical Review of Target Volume Delineation on the Posterior Fossa Tumor : An Optimal Head and Neck Position

후두와 종양의 방사선치료 시 표적용적의 결정을 위한 적절한 치료자세 연구

  • Yoon Sang Min (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee Sang-wook (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ahn Seung Do (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim Jong Hoon (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan) ;
  • YE Byong Yong (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ra Young Shin (Neurosurgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim Tae Hyung (Fediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Choi Eun Kyung (Department of Radiation Oncology Asan Medical Center, College of Medicine, University of Ulsan)
  • 윤상민 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 김종훈 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 이병용 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 나영신 (울산대학교 의과대학 서울아산병원 신경외과) ;
  • 김태형 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학과)
  • Published : 2003.03.01
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Abstract

Purpose : To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy. Materials and Methods :A CT simulator and 3D conformal radiotherapy Planning system was used for the posterior fossa boost treatment on a 13-year-old medulloblastoma patient. He was placed In the prone position and Immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning peformed using non-coplanar conformal beams. Results : The CT scans, and treatment In the prone position, were peformed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium, In audition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. Conclusion : .A posterior fossa boost, in the prone position, Is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.

목적 : 전산화단층촬영모의치료기를 이용한 후두와(posterio fossa) 종양의 방사선치료 시 어떤 자세로 치료하는 것이 치료범위 결정 및 치료계획에 유리한지에 대한 논의는 거의 이루어지지 않았다. 따라서 저자들은 후두와 치료의 적절한 치료자세를 설정하고 이를 이용한 치료계획을 소개하고자 본 연구를 시행하였다. 대상 및 방법 본 연구는 소뇌 충부에 발생한 수모세포종으로 수술 후 방사선치료를 받은 13세 남자 환아를 대상으로 하였다. 환아는 두개척수방사선치료를 일일선량 1.8 Gy로 30.6 Gy 시행 받은 후 후두와 영역에 추가방사선치료계획을 위해 전산화단층촬영모의치료를 받았다. 전산화단층촬영 시 복와위로 두부고정틀을 이용하여 자세를 고정하고 조영제를 주입하면서 두개골에서 경부 하방까지 촬영하였다. 단층 영상에 정상조직과 치료영역을 표시하였고 3차원 입체치료계획시스템을 이용해 비동일평면 입체조형 빔을 이용하여 치료계획을 세웠다 결과 : 전산화단층영상 촬영이 진행되는 동안 환아는 안정되고 편안한 자세를 유지할 수 있었고, 이 후 치료 중에도 자세를 재현하는데 큰 어려움이 없었다. 복와위 자세로 얻은 전산화단층영상에서 천막과일부 정맥동의 조영증강이 잘 관찰되어 후두와의 해부학적 범위를 결정하기가 용이하였다. 또 복와위 자세에서 후두와가 환아의 전면에 위치하게 되어 3차원 입체치료계획 시 방사선의 방향의 제약을 받지 않았고 치료 침대에 의한 선량분포의 불확실성이 없어서 보다 정확한 치료계획이 가능하였다. 결론 : 본 연구에서 후두와 치료 시 적절한 치료자세는 복와위임을 알 수 있었고, 안정되고 치료계획이 용이한 자세를 찾아내기 위해, 마취(sedation)가 필요하지 않거나 의식상태가 명료한 소아 환자를 통하여, 지속적인 연구가 이루어져야 할 것이다.

Keywords

References

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