대한방사선치료학회지 (The Journal of Korean Society for Radiation Therapy)
- 제24권2호
- /
- Pages.157-165
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- 2012
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- 1598-8449(pISSN)
토모테라피를 이용한 간암환자의 정위적 방사선치료시 복부압박장치의 유용성 평가
Usefulness of Abdominal Compressor Using Stereotactic Body Radiotherapy with Hepatocellular Carcinoma Patients
- 우중열 (연세암센터 방사선종양학과) ;
-
김주호
(연세암센터 방사선종양학과) ;
- 김준원 (연세암센터 방사선종양학교실) ;
- 백종걸 (연세암센터 방사선종양학과) ;
- 박광순 (연세암센터 방사선종양학과) ;
- 이종민 (연세암센터 방사선종양학과) ;
- 손동민 (연세암센터 방사선종양학과) ;
- 이상규 (연세암센터 방사선종양학과) ;
- 전병철 (연세암센터 방사선종양학과) ;
- 조정희 (연세암센터 방사선종양학과)
- Woo, Joong-Yeol (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
-
Kim, Joo-Ho
(Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Kim, Joon-Won (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Baek, Jong-Geal (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Park, Kwang-Soon (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Lee, Jong-Min (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Son, Dong-Min (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Lee, Sang-Kyoo (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Jeon, Byeong-Chul (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
- Cho, Jeong-Hee (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System)
- 투고 : 2012.06.19
- 심사 : 2012.08.23
- 발행 : 2012.09.30
초록
목 적: 간에 발생한 절제 불가능한 원발성 및 전이성 종양에서 토모테라피를 이용한 정위적 방사선치료를 시행하기 위해 사용된 복부압박장치의 유용성을 평가하고자 하였다. 대상 및 방법: 2011년 11월부터 2012년 3월까지 토모테라피(Hi-Art Tomotherapy, USA)를 시행받기 위해 본원에 내원한 간암환자 중 복부압박장치(diaphragm control, elekta, sweden)를 사용하였을 때 움직임이 1 cm 이상 줄어든 환자를 대상으로 하였다. 4D CT (somatom sensation, siemens, germany)를 통해 치료계획영상과 4차원 단층촬영영상을 촬영하고, 육안적으로 보이는 종양과 종양의 움직임을 고려하여 육안적 종양체적(gross tumor volume, GTV)으로 설정하였고, GTV 주변으로 균일하게 5~7 mm의 여유를 주어 치료계획용 종양체적(planning target volume, PTV)으로 설정하였다. 손상위험장기(organs at risk) 중 십이지장, 위, 대장의 거리가 종양으로부터 최소 1 cm 이상인 환자들을 1군(
Purpose: We evaluated usefulness of abdominal compressor for stereotactic body radiotherapy (SBRT) with unresectable hepatocellular carcinoma (HCC) patients and hepato-biliary cancer and metastatic liver cancer patients. Materials and Methods: From November 2011 to March 2012, we selected HCC patients who gained reduction of diaphragm movement >1 cm through abdominal compressor (diaphragm control, elekta, sweden) for HT (Hi-Art Tomotherapy, USA). We got planning computed tomography (CT) images and 4 dimensional (4D) images through 4D CT (somatom sensation, siemens, germany). The gross tumor volume (GTV) included a gross tumor and margins considering tumor movement. The planning target volume (PTV) included a 5 to 7 mm safety margin around GTV. We classified patients into two groups according to distance between tumor and organs at risk (OAR, stomach, duodenum, bowel). Patients with the distance more than 1 cm are classified as the 1st group and they received SBRT of 4 or 5 fractions. Patients with the distance less than 1 cm are classified as the 2nd group and they received tomotherapy of 20 fractions. Megavoltage computed tomography (MVCT) were performed 4 or 10 fractions. When we verify a MVCT fusion considering priority to liver than bone-technique. We sent MVCT images to Mim_vista (Mimsoftware, ver .5.4. USA) and we re-delineated stomach, duodenum and bowel to bowel_organ and delineated liver. First, we analyzed MVCT images to check the setup variation. Second we compared dose difference between tumor and OAR based on adaptive dose through adaptive planning station and Mim_vista. Results: Average setup variation from MVCT was
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