基于MR加速器的MR引导放疗在食管癌患者中的临床应用

国际肿瘤学杂志››2024,Vol. 51››Issue (1): 37-42.doi:10.3760/cma.j.cn371439-20230730-00004

基于MR加速器的MR引导放疗在食管癌患者中的临床应用

高新雨¹^,³, 李振江², 孙洪福³, 韩丹³, 赵倩³, 刘成新³, 黄伟³()

1.潍坊医学院临床医学院，潍坊 261053
2.山东省肿瘤防治研究院（山东省肿瘤医院）放射物理技术科，betway必威登陆网址（betway.com ），济南 250117
3.山东省肿瘤防治研究院（山东省肿瘤医院）胸部放疗5病区，betway必威登陆网址（betway.com ），济南 250117

收稿日期:2023-07-30修回日期:2023-11-20出版日期:2024-01-08发布日期:2024-01-23
通讯作者:黄伟 E-mail:alvinbird@126.com
基金资助:
泰山学者青年专家项目(tsqn201909187)

Clinical application of MR-guided radiotherapy based on MR-linac in esophageal cancer patients

Gao Xinyu¹^,³, Li Zhenjiang², Sun Hongfu³, Han Dan³, Zhao Qian³, Liu Chengxin³, Huang Wei³()

1. School of Clinical Medicine， Weifang Medical University， Weifang 261053， China
2. Department of Medical Physics， Shandong Cancer Hospital and Institute， Shandong First Medical University and Shandong Academy of Medical Sciences， Jinan 250117， China
3. Department of Radiation Oncology （Chest Section 5）， Shandong Cancer Hospital and Institute， Shandong First Medical University and Shandong Academy of Medical Science， Jinan 250117， China

Received:2023-07-30Revised:2023-11-20Online:2024-01-08Published:2024-01-23
Contact:Huang Wei E-mail:alvinbird@126.com
Supported by:
Foundation of Taishan Scholars Young Expert(tsqn201909187)

摘要/Abstract

摘要：目的初步探讨基于MR加速器的MR引导放疗在食管癌中的应用流程、疗效及安全性。方法回顾性分析2021年9月至2022年7月于山东省肿瘤防治研究院应用MR加速器治疗的食管癌患者的临床数据，探讨食管癌应用MR加速器的治疗流程，分析患者的疗效及安全性。全组患者均接受MR引导放疗，接受CT和MR定位、靶区勾画、Monaco治疗计划系统计划设计，MR加速器下摆位并调整计划。全组患者中位分割次数25次，计划靶体积中位单次剂量1.8 Gy，中位总剂量50.2 Gy，中位随访时长为16个月。结果全组12例患者包括颈部食管癌1例，胸上段食管癌3例，胸中段食管癌4例，胸下段食管癌4例。其中新辅助放疗3例，根治性放疗9例。所有患者治疗过程顺利，分次中位治疗时长为33 min，依从性良好。根治性放疗患者放疗后1个月客观有效例数为3例，疾病控制例数为9例，放疗后6个月客观有效例数为3例，疾病控制例数为6例。新辅助放疗的患者均在2个月内接受了手术，1例患者达病理完全缓解。最常见的急性不良反应为放射性食管炎（7例）和骨髓抑制中的白细胞计数减少（8例），晚期不良反应为放射性肺炎（1例），放疗不良反应轻微，未见4级及以上不良反应。结论基于MR加速器的MR引导放疗应用于食管癌的临床治疗流程可行，疗效良好且不良反应轻微。

关键词:食管肿瘤,磁共振成像,放射疗法, 影像引导,治疗结果

Abstract:ObjectiveTo explore the application process， efficacy and safety of MR-guided radiotherapy based on MR-linac in esophageal cancer.MethodsThe clinical data of patients with esophageal cancer treated with MR-linac at Shandong Cancer Hospital and Institute from September 2021 to July 2022 were retrospectively analyzed， to investigate the treatment process of esophageal cancer with MR-linac， and to analyze the efficacy and safety of patients. All patients received MR-guided radiotherapy， underwent CT and MR localization， target area delineation， and design of the Monaco treatment planning system plan. Adaptation-to-position adjustment was conducted during the pre-treatment evaluation. The median number of fractions was 25， the median single dose of planning target volume was 1.8 Gy， and the median total dose was 50.2 Gy. Median follow-up was 16 months.ResultsAmong the 12 patients in the whole group， there were 1 case of cervical esophageal cancer， 3 cases of upper thoracic esophageal cancer， 4 cases of middle thoracic esophageal cancer and 4 cases of lower thoracic esophageal cancer， including 3 cases of neoadjuvant radiotherapy and 9 cases of radical radiotherapy. All patients had a smooth treatment process. The median treatment time was 33 min， and the patients had good compliance. For patients with radical radiotherapy， one month after radiotherapy， the number of objective remission cases was 3， and the number of disease-control cases was 9； six months after radiotherapy， the number of objective remission cases was 3， and the number of disease-control cases was 6. All patients treated with neoadjuvant radiotherapy underwent surgery within 2 months， and one patient achieved pathological complete remission. The most common acute adverse reactions were radiation esophagitis （7 cases） and leukopenia in bone marrow suppression （8 cases）， with late-stage adverse reactions being radiation pneumonia （1 case）. The adverse reactions to radiotherapy were slight， and no grade 4 or above adverse reactions were observed.ConclusionThe clinical treatment process for esophageal cancer under MR-guided radiotherapy based on MR-linac is feasible， with good curative effects and mild adverse reactions.

Key words:Esophageal neoplasms,Magnetic resonance imaging,Radiotherapy, image-guided,Treatment outcome

高新雨, 李振江, 孙洪福, 韩丹, 赵倩, 刘成新, 黄伟. 基于MR加速器的MR引导放疗在食管癌患者中的临床应用[J]. 国际肿瘤学杂志, 2024, 51(1): 37-42.

Gao Xinyu, Li Zhenjiang, Sun Hongfu, Han Dan, Zhao Qian, Liu Chengxin, Huang Wei. Clinical application of MR-guided radiotherapy based on MR-linac in esophageal cancer patients[J]. Journal of International Oncology, 2024, 51(1): 37-42.

图/表4

表1

12例行MR加速器治疗食管癌患者的临床特征"

患者	年龄（岁）	性别	KPS评分（分）	肿瘤部位	肿瘤内镜长度（cm）	病理类型	TNM分期	处方剂量	GTV（cm³）	治疗模式
1	70.0	男	80	下段	4.0	鳞状细胞癌	T₃N₁M₀	1.8 Gy×23次	14.3	新辅助放疗
2	73.0	男	80	中段	5.0	鳞状细胞癌	T₃N₀M₀	2.0 Gy×30次	38.6	术后复发后放疗
3	71.0	女	90	颈段	8.0	鳞状细胞癌	T₄N₁M₁	2.0 Gy×30次	48.0	根治性放疗
4	54.0	男	90	下段	9.0	鳞状细胞癌	T₂N₂M₀	1.8 Gy×23次	85.9	根治性放疗
5	89.0	男	80	上段	8.0	鳞状细胞癌	T₃N₀M₀	1.8 Gy×28次	19.8	根治性放疗
6	49.0	男	90	下段	15.0	鳞状细胞癌	T₃N₀M₀	1.8 Gy×23次	67.2	新辅助放疗
7	46.0	男	90	下段	11.0	黑色素瘤	T₄N₃M₀	1.8 Gy×23次	81.7	新辅助放疗
8	73.0	男	90	中段	8.0	鳞状细胞癌	T₃N₁M₀	1.8 Gy×23次	39.1	根治性放疗
9	63.0	男	90	中段	15.0	鳞状细胞癌	T₃N₂M₁	2.0 Gy×28次	71.7	根治性放疗
10	82.0	男	80	中段	4.0	鳞状细胞癌	T₃N₀M₀	2.5 Gy×25次	6.0	根治性放疗
11	81.0	女	80	上段	8.0	鳞状细胞癌	T₃N₂M₀	1.8 Gy×30次	95.4	根治性放疗
12	70.0	男	90	上段	3.0	鳞状细胞癌	T₂N₂M₁	2.0 Gy×25次	6.5	根治性放疗

表1

图1

图2

不良反应	级别	合计
放射性食管炎	7	0	0	7
放射性皮炎	2	0	0	2
白细胞计数减少	1	4	3	8
中性粒细胞计数减少	3	2	1	6
血小板计数减少	4	0	0	4
贫血	3	0	0	3

表2

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