Riepl M, Pietsch A, Klautke G, Fehr R, Fietkau R
Klinik und Poliklinik für Strahlentherapie, Universität Rostock.
Strahlenther Onkol. 2000 Nov;176(11):517-23. doi: 10.1007/pl00002319.
In many cases it is not possible to exactly define the extension of carcinoma of the gastrointestinal tract with the help of computertomography scans made for 3-D-radiation treatment planning. Consequently, the planning of external beam radiotherapy is made more difficult for the gross tumor volume as well as, in some cases, also for the clinical target volume.
Eleven patients with macroscopic tumors (rectal cancer n = 5, cardiac cancer n = 6) were included. Just before 3-D planning, the oral and aboral border of the tumor was marked endoscopically with hemoclips. Subsequently, CT scans for radiotherapy planning were made and the clinical target volume was defined. Five to 6 weeks thereafter, new CT scans were done to define the gross tumor volume for boost planning. Two investigators independently assessed the influence of the hemoclips on the different planning volumes, and whether the number of clips was sufficient to define the gross tumor volume.
In all patients, the implantation of the clips was done without complications. Start of radiotherapy was not delayed. With the help of the clips it was possible to exactly define the position and the extension of the primary tumor. The clinical target volume was modified according to the position of the clips in 5/11 patients; the gross tumor volume was modified in 7/11 patients. The use of the clips made the documentation and verification of the treatment portals by the simulator easier. Moreover, the clips helped the surgeon to define the primary tumor region following marked regression after neoadjuvant therapy in 3 patients.
Endoscopic clipping of gastrointestinal tumors helps to define the tumor volumes more precisely in radiation therapy. The clips are easily recognized on the portal films and, thus, contribute to quality control.
在许多情况下，借助为三维放射治疗计划所做的计算机断层扫描，无法精确界定胃肠道癌的范围。因此，对于大体肿瘤体积以及某些情况下的临床靶体积而言，外照射放疗的计划制定变得更加困难。
纳入11例有肉眼可见肿瘤的患者（直肠癌5例，贲门癌6例）。在三维计划前，通过内镜用血管夹标记肿瘤的口侧和肛侧边界。随后进行放疗计划的CT扫描并确定临床靶体积。此后5至6周，进行新的CT扫描以确定用于追加放疗计划的大体肿瘤体积。两名研究者独立评估血管夹对不同计划体积的影响，以及血管夹数量是否足以界定大体肿瘤体积。
所有患者血管夹植入均无并发症。放疗未延迟开始。借助血管夹能够精确界定原发肿瘤的位置和范围。5/11的患者临床靶体积根据血管夹位置进行了调整；7/11的患者大体肿瘤体积进行了调整。血管夹的使用使模拟定位仪对治疗射野的记录和验证更加容易。此外，在3例患者新辅助治疗后肿瘤明显消退时，血管夹有助于外科医生界定原发肿瘤区域。
胃肠道肿瘤的内镜下夹闭有助于在放射治疗中更精确地界定肿瘤体积。血管夹在射野片上易于识别，从而有助于质量控制。
