Mitsuhashi Norio, Tominaga Daichi, Ikeda Hajime, Shiina Fumiya, Fukaya Keiko, Nemoto Yoshitaka
Radiation Therapy Center, Hitachinaka General Hospital, Hitachinaka, Japan.
Department of Radiotherapy, Hitachinaka General Hospital, Hitachinaka, Japan.
Rep Pract Oncol Radiother. 2024 Oct 3;29(4):468-477. doi: 10.5603/rpor.101531. eCollection 2024.
Recent advances in stereotactic body radiation therapy (SBRT) technology for early-stage peripheral lung cancer have been remarkable and are becoming a viable alternative to surgery. However, the most important problem in performing SBRT correctly is minimizing the respiratory motion of the tumor.
Thirty-eight patients treated with SBRT were evaluated to clarify factors affecting respiratory motion of early-stage peripheral lung cancer in the management of restrictive breathing technique (abdominal compression) to reduce respiratory tumor motion in SBRT. We investigated age, gender, body mass index (BMI), Brinkman index (BI), forced expiratory volume in 1 second (FEV 1.0), and type of ventilatory impairment as patient factors, and T-factor, stage, tumor-bearing lung lobe, and tumor pathology as tumor factors. Respiratory motion was assessed by volume differences between clinical target volume (CTV) and internal target volume (ITV). The degree of tumor motion due to respiration was compared using the formula of (ITV-CTV)/CTV as an index.
In the results, univariate analyses showed that only age was a significant predictor of respiratory tumor motion (p = 0.048). In multi-variate analyses, only T factor was an independent significant predictor of respiratory tumor motion (p = 0.045), while there was a significant trend for age (p = 0.061), and tumor location (p = 0.067).
In late elderly patients or T1a tumor, respiratory motion in early-stage peripheral lung cancer was significantly large. However, it is not predictable by patient and tumor characteristics. Therefore, respiratory motion of the tumor should be measured in all patients in some way.
立体定向体部放射治疗（SBRT）技术在早期周围型肺癌治疗方面取得了显著进展，正成为一种可行的手术替代方案。然而，正确实施SBRT最重要的问题是将肿瘤的呼吸运动降至最低。
对38例接受SBRT治疗的患者进行评估，以明确在限制性呼吸技术（腹部压迫）管理中影响早期周围型肺癌呼吸运动的因素，从而在SBRT中减少呼吸性肿瘤运动。我们调查了年龄、性别、体重指数（BMI）、 Brinkman指数（BI）、一秒用力呼气容积（FEV1.0）以及通气障碍类型作为患者因素，还调查了T因子、分期、肿瘤所在肺叶和肿瘤病理作为肿瘤因素。通过临床靶体积（CTV）与内靶体积（ITV）之间的体积差异评估呼吸运动。使用（ITV - CTV）/CTV公式作为指标比较因呼吸引起的肿瘤运动程度。
结果显示，单因素分析表明只有年龄是呼吸性肿瘤运动的显著预测因素（p = 0.048）。多因素分析中，只有T因子是呼吸性肿瘤运动的独立显著预测因素（p = 0.045），而年龄（p = 0.061）和肿瘤位置（p = 0.067）有显著趋势。
在老年晚期患者或T1a期肿瘤中，早期周围型肺癌的呼吸运动明显较大。然而，无法通过患者和肿瘤特征预测。因此，应以某种方式对所有患者测量肿瘤的呼吸运动。
