Guan Yong, Wang Jing, Cao Fuliang, Chen Xi, Wang Yuwen, Jiang Shengpeng, Zhang Daguang, Zhang Wencheng, Guo Zhoubo, Wang Ping, Pang Qingsong
Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Preventing and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Ann Transl Med. 2020 Sep;8(18):1144. doi: 10.21037/atm-20-4030.
We aimed to analyze the value of metal clip markers guided and placed by endoscopic ultrasonography (EUS) in the delineation of gross tumor volume (GTV) for thoracic esophageal squamous cell carcinoma.
From September 2016 to September 2018, patients with thoracic esophageal squamous cell carcinoma in Tianjin Medical University Cancer Institute and Hospital were recruited in the prospective trial, NCT02959385. They underwent titanium clips placement on tumor superior and inferior boundaries under EUS by a single expert endosonographer before radiotherapy computed tomography (CT) simulation. According to the clip markers, the reference GTVs were contoured by one experienced radiation oncologist. With the help of the Eclipse treatment planning system, clip markers on CT were concealed. Afterward, two other radiation oncologists with expertise in esophageal cancer delineated GTVs, defined as conventional GTVs, based on endoscopy and barium radiography findings. The two GTVs were compared and analyzed. Subgroup analysis was conducted in different T stage [early (T1 + T2) . advanced (T3 + T4)], focus location (upper . middle . lower segment), and tumor length (<5 . >5 cm) groups.
The trial recruited 55 patients with 60 thoracic esophageal cancer foci. A total of 111 titanium clips were guided and implanted by EUS. Before CT simulation, two titanium clips at two foci fell off. After the procedure, no case of intolerable esophageal pain, hemorrhage, or perforation occurred. Compared to reference GTVs', discrepancies of conventional GTVs' superior borders were 0.91±0.82 cm (P<0.001), while differences of inferior borders were 0.74±0.63 cm (P<0.001). On the contrary, conventional GTVs' lengths were not significantly different from reference GTVs' with discrepancies 0.08±1.30 cm (P=0.64). Regardless of T stage, tumor location, and tumor length, conventional GTVs' superior and inferior borders were significantly different from reference GTVs', while GTVs' lengths differed insignificantly.
This study confirmed that EUS-placed titanium clips could correct contouring of GTVs in thoracic esophageal cancer in different T stages, tumor locations, and lengths.
我们旨在分析内镜超声引导下放置金属夹标记物在勾画胸段食管鳞状细胞癌大体肿瘤体积（GTV）中的价值。
2016年9月至2018年9月，天津医科大学肿瘤医院的胸段食管鳞状细胞癌患者被纳入前瞻性试验，试验编号为NCT02959385。在放疗计算机断层扫描（CT）模拟前，由一名专业内镜超声医师在超声内镜引导下于肿瘤上下边界放置钛夹。根据夹标记，由一名经验丰富的放射肿瘤学家勾勒出参考GTV。借助Eclipse治疗计划系统，将CT上的夹标记隐藏。随后，另外两名擅长食管癌勾画的放射肿瘤学家根据内镜检查和钡剂造影结果勾勒出GTV，即传统GTV。对这两种GTV进行比较和分析。在不同T分期[早期（T1 + T2）、晚期（T3 + T4）]、病灶位置（上段、中段、下段）和肿瘤长度（<5 cm、>5 cm）组中进行亚组分析。
该试验招募了55例患者，共60个胸段食管癌病灶。超声内镜引导并植入了总共111个钛夹。在CT模拟前，两个病灶处的两个钛夹脱落。术后，未发生无法耐受的食管疼痛、出血或穿孔病例。与参考GTV相比，传统GTV上边界的差异为0.91±0.82 cm（P<0.001），而下边界的差异为0.74±0.63 cm（P<0.001）。相反，传统GTV的长度与参考GTV无显著差异，差异为0.08±1.30 cm（P = 0.64）。无论T分期、肿瘤位置和肿瘤长度如何，传统GTV的上、下边界与参考GTV均有显著差异，而GTV的长度差异不显著。
本研究证实，超声内镜放置的钛夹可校正不同T分期、肿瘤位置和长度的胸段食管癌GTV的勾画。
