内镜下钛夹标记在早期食管癌精确放疗中应用

摘要

Objective To evaluate the application of the placement of titanium clips in the upper and lower tumor margins in precision radiotherapy for early esophageal cancer. Methods:Seventeen patients with early esophageal cancer underwent endoscopy-guided implantation of titanium clips to mark the upper and lower tumor margins. CT-based simulation was performed to delineate the gross tumor volume ( GTV) . The application value of this technology in precision radiotherapy was evaluated. Results:For all patients (including 13 cases with initial treatment and 4 patients requiring radiotherapy after endoscopic resection), the esophageal tumors were not explicitly displayed on CT and barium meal images and the GTV range could not be accurately determined. The esophageal tumors were marked by successful placement of at least one titanium clip in the upper and lower tumor margins. Subsequently, the esophageal tumors were successfully displayed on CT simulation and the target area was accurately delineated. No grade 3-4 adverse events, such as bleeding and perforation occurred. Conclusion Endoscopy-guided titanium clip placement is convenient and feasible for early esophageal cancer, which is of clinical significance for determining the target area of radiotherapy.%目的 介绍内镜下钛夹标记病变上、下界位置在早期食管癌精确放疗中的应用.方法 17例早期食管癌患者,通过内镜下钛夹标记病变上、下界,再行CT模拟定位勾画大体肿瘤体积(GTV),评估该项技术在精确放疗中的应用价值.结果 所有患者(包括13例初治、4例经内镜下切除后需放疗者)在CT和常规钡餐造影片上肿瘤显示不明显,无法准确确定GTV范围,内镜下在病变上下界均成功置入至少一个钛夹,标记肿瘤位置,在模拟定位CT上都能成功显示,并以此为依据准确勾画靶区,且未发生出血穿孔等3-4级不良反应.结论 早期食管癌在内镜下置入钛夹定位简便易行,对放疗靶区的确定有重要的临床价值.