The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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The evaluation of image guide system in case of rectal cancer

직장암 치료시 영상유도 시스템의 유용성 평가

  • Jang, Sewuk (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Ahn, Seungkwon (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Lee, Sangkyoo (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Kim, Jooho (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Lee, Wonju (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Cho, Jeonghee (Department of Radiation Oncology, Yonsei Cancer Center)
  • 장세욱 (연세암병원 방사선종양학과) ;
  • 안승권 (연세암병원 방사선종양학과) ;
  • 이상규 (연세암병원 방사선종양학과) ;
  • 김주호 (연세암병원 방사선종양학과) ;
  • 이원주 (연세암병원 방사선종양학과) ;
  • 조정희 (연세암병원 방사선종양학과)
  • Published : 2017.06.30
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Abstract

purpose: Image Guide System offers therapy precise, especially Intensity Modulated Radiation Therapy. However, organs at pelvis have variation and uncertainties each therapy. it brings IG system for verifying patient's position. In this study, analysis the variation at pelvis during rectal cancer radiation therapy. Moreover design the patient re-setup technique and apply to patients. Material and Method: 40 rectal cancer patient who have radiation therapy. The 530 image which acquired from IG system are analyzed. The bone structure, bladder, gas in the rectum, small bowel, soft tissue, weigh loss are evaluated by the criterion. The criterion are classified by best, good, bad and figure out the ratio with count. The re-setup proceed in case of one or over the two get the bad criterion and figure out the ratio of re-setup results: The ideal of therapy ratio is 19.2 % each criterion. And the good for therapy ratio is 54.9 %, the cases of bad for therapy is 25.8 %. The bad cases are have therapy after re-setup with post process. conclusion: Each pre-treatment image that acquired IG system has different results despite of same patients. The 25.8 % need to re-setup in order to unsuitable therapy. It is implies that the IG system is necessary establishing precise treatment plan like IMRT especially rectal cancer.

목 적: 세기조절방사선치료(Intensity Modulated Radiation Therapy; IMRT)에서 영상유도 시스템은 치료의 정확성 확보에 유리하다. 특히 골반치료의 경우 장기들의 위치와 모양이 환자상태 및 외부적 환경에 따라 변형이 발생하여 치료 전 확인이 필요하다. 따라서 본 연구에서는 직장암 치료 시 골반 내 변화요인을 분석하였고, 자세의 재조정 방법을 고안해 적용하고자 하였다. 대상 및 방법: 본원에서 시행한 직장암 환자 40명을 대상으로 하였고, 환자들의 치료 전 영상 530건을 분석하였다. 평가 항목으로 골격구조, 방광, 직장 내 가스, 소장, 연부조직, 체중감소 여부를 매우 좋음, 좋음, 나쁨 3단계로 구분하였고 각각의 건수와 비율을 산출하였다. 나쁨의 경우가 1개 이상 시 각각의 방법으로 해당 항목에 대해 재조정을 시행하였으며 그 비율을 구하였다. 결 과: 각각의 평가조건에서 치료하기에 매우 좋은 경우는 19.2 %였다. 치료에 적절한 경우는 54.9 %, 치료에 부적절한 경우는 25.8 %였으며, 치료에 부적절한 경우에는 재조정을 시행하여 치료 진행을 하였다. 결 론: 골반 내 장기의 변화는 같은 환자일지라도 치료 시 마다 다른 결과를 나타냈다. 평가 지표에 따라 진행이 부적절한 경우는 25.8 %였으며 재조정을 통하여 환자 자세 재현성을 확보 후 치료가 가능하였다. 따라서 정밀하게 계획되는 IMRT의 직장암 치료 시에는 영상유도시스템을 이용하여 정확한 치료가 필요하다 사료된다.

Keywords

References

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