The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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Study of Dynamic Variation Aspect in Lung Volume due to Respiration in Stereotactic Body Radiotherapy Using Abdominal Compressor

복부압박장치를 이용한 정위적방사선치료 시 호흡에 따른 폐암 용적의 동적변이 양상에 대한 연구

  • Park, Kwang Soon (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) ;
  • Park, Hyo Kook (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System) ;
  • Beak, Jong Geal (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) ;
  • Yoon, Jong Won (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)
  • 박광순 (연세암센터 방사선종양학과) ;
  • 김주호 (연세암센터 방사선종양학과) ;
  • 박효국 (연세암센터 방사선종양학과) ;
  • 백종걸 (연세암센터 방사선종양학과) ;
  • 이상규 (연세암센터 방사선종양학과) ;
  • 윤종원 (연세암센터 방사선종양학과) ;
  • 조정희 (연세암센터 방사선종양학과)
  • Received : 2013.05.30
  • Accepted : 2013.09.02
  • Published : 2013.09.30
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Abstract

Purpose: Abdominal compressor is used to control breathing in stereotactic body radiotherapy for lung tumors frequently. We evaluated the dynamic variation aspect of internal tumor volume by breathing. Materials and Methods: We reviewed 20 lung cancer patients (7 upper lung patients, 4 middle lung patients, 9 lower lung patients) who received stereotactic body radiotherapy using abdominal compressor between April 2012 to April 2013. Coordinate shift values were obtained by using four-dimensional cone-beam CT (4D-CBCT) to investigate treatment set-up error and moving tumor position error. To investigate how much difference of each part, we compared 95% confidence interval, maximum values and minimum values of three-dimensional vector value and analyzed conformity degree through the Pearson square correlation coefficient. Results: 95% confidence interval of three-dimensional vector value of each part is 1.8~2.9 mm in upper lobe, 2.3~5.4 mm in middle lobe and 2.2~4.0 mm in lower lobe. Conformity degree was the result that respectively is LR direction 0.75, SI direction 0.68 and AP direction 0.63 in upper lobe, LR direction 0.82, SI direction 0.51 and AP direction 0.92 in middle lobe and LR direction 0.63, SI direction 0.50 and AP direction 0.34 in lower lobe. Conclusion: We showed difference by each site in lung tumor due to respiration by using abdominal compressor. Therefore, we must correct treatment set-up error as well as moving tumor position error by breathing. It is also considered to be useful that it is the use of 4D-CBCT when correcting the error due to various dynamic variation.

목적: 복부압박장치를 적용한 정위적방사선치료 시 환자 호흡에 기인하는 내부종양용적의 동적변이 양상을 연구하고자 하였다. 대상 및 방법: 2012년 4월부터 2013년 4월까지 복부압박장치를 이용하여 정위적방사선치료를 받은 폐암 환자 20명(상엽 7명, 중엽 4명, 하엽 9명), 총 67건을 대상으로 하였다. 치료 자세의 변동과 호흡에 의해 움직이는 종양 위치 변동을 알아보기 위해 4차원 cone- beam CT (4D-CBCT)를 사용하여 좌표 이동 값을 얻었다. 각 부위별로 LR (좌우), SI (상하), AP (전후) 방향의 벡터의 95% 신뢰구간(95% Confidence interval, 95% CI), 최대값, 그리고 최소값을 통하여 비교하였으며 자세변동 보정 값과 호흡변동 보정 값 간의 피어슨 곱 상관계수를 통하여 일치도를 분석하였다. 결과: 호흡에 의한 종양용적의 각 부위별로 변동은 폐 상엽에서 1.8~2.9 mm, 중엽과 하엽에서 2.3~5.4 mm, 2.2~4.0 mm로 분석되었다(95%CI, P<0.001). 자세변동 보정 값과 호흡변동 보정 값 간의 일치도($R^2$)를 살펴보면 상엽은 LR방향, SI방향, AP 방향에서 각각 0.75, 0.68, 0.63으로 나타났고, 중엽은 각각 0.82, 0.51, 0.92로 나타났으며, 하엽은 각각 0.63, 0.50, 0.34로 나타났다. 결론: 폐암의 정위적방사선 치료 시 복부압박장치의 사용으로 폐에 위치하는 종양은 환자 호흡에 의해 각 부위별로 각기 다른 양상을 보였다. 따라서 치료 자세에 대한 보정뿐만 아니라 호흡에 의한 변동을 보정해야만 한다. 또한 이러한 각기 다른 동적변이로 인한 오차의 보정 시 4D-CBCT의 사용은 매우 유용한 것으로 사료된다.

Keywords

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