| 罗学臣,于佳磊,朱琳,等.乳腺癌保乳术后放疗不同固定方式的比较[J].中华放射医学与防护杂志,2022,42(7):522-526.Luo Xuechen,Yu Jialei,Zhu Lin,et al.Comparison of different immobilization methods in breast cancer radiotherapy after breast-conserving surgery[J].Chin J Radiol Med Prot,2022,42(7):522-526 |
| 乳腺癌保乳术后放疗不同固定方式的比较 |
| Comparison of different immobilization methods in breast cancer radiotherapy after breast-conserving surgery |
| 投稿时间：2021-12-14 |
| DOI：10.3760/cma.j.cn112271-20211214-00482 |
| 中文关键词: 摆位误差 乳腺癌 放射治疗 多功能体板 |
| 英文关键词:Setup errors Breast cancer Radiotherapy Multifunction body board |
| 基金项目:国家自然科学基金项目(11865011);内蒙古自治区自然科学基金项目(2019MS08073);内蒙古自治区自然科学基金项目(2020MS08207) |
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| 中文摘要: |
| 目的 分析比较乳腺癌保乳术后放疗不同固定方式的摆位精度差异。方法 回顾性选取北京医院2021年1—8月乳腺癌保乳术后接受放疗的患者60例,其中30例采用多功能体板联合改良型体膜固定(改良型体膜组),30例采用真空垫固定(真空垫组)。比较两组的摆位误差、三维矢量误差、>5 mm误差的比例,以及计划靶区(PTV)和临床靶区(CTV)在模拟移床前后的剂量差异(包括PTV_V100、PTV_V95、CTV_V95和模拟移床以后的PTV_V100S、PTV_V95S、 CTV_V95S),并进一步分析改良型体膜组不同放疗时间的摆位误差变化。结果 60例患者共行锥形束CT扫描369次,其中改良型体膜组195次,真空垫组174次。两组x、y、z方向(左右、头脚、腹背)的摆位误差分别为(2.59±1.98)、(2.38±2.04)、(1.45±1.16)mm和(2.24±1.63)、(2.78±2.17)、(2.70±1.88)mm,三维矢量误差分别为(4.32±2.28)、(5.13±2.14)mm。其中,改良型体膜组在z方向和三维矢量上误差小于真空垫组(t=-7.77、-3.41, P＜0.05)。 >5 mm误差出现的比例,真空垫组在x方向低于改良型体膜组(χ2 =7.13,P＜0.05),改良型体膜组在z方向低于真空垫组(χ2=5.90,P＜0.05)。模拟移床后,改良型体膜组的PTV_V100S优于于真空垫组(t=2.47,P＜0.05)。且改良型体膜组第1周的x方向误差大于第2~3周和第4~5周(P＜0.05)。结论 使用多功能体板联合改良型体膜固定总体效果优于单纯使用真空垫固定,但应特别注意放疗第1周x方向的误差。 |
| 英文摘要: |
| Objective To compare and analyze the differences in the setup accuracy of different immobilization method in breast cancer radiotherapy after breast-conserving surgery. Methods A retrospective study was conducted on 60 patients who received radiotherapy after breast-conserving surgery from January to August, 2021. These patients were divided into two groups. One group consisted of 30 cases who were immobilized using a modified body thermoplastic membrane combined with a multifunction body board during the breast cancer radiotherapy and was called the modified body thermoplastic membrane group. The other group comprised 30 cases immobilized using a vacuum cushion during breast cancer radiotherapy and was referred to as the vacuum cushion group. The setup errors, 3D vector errors, the proportion of errors of ＞ 5 mm, and the dosimetric differences in the planning target volume (PTV) and the clinical target volume (CTV) before and after simulated treatment bed moving (including the PTV_V100, PTV_V95, and CTV_V95 before simulated treatment bed moving and the PTV_V100S, PTV_V95S, and CTV_V95S after simulated treatment bed moving) were compared between two groups. Moreover, for the modified body thermoplastic membrane group, the changes in the average setup errors at different radiotherapy stages were also analyzed. Results A total of 369 cone-beam CT scans were conducted for 60 patients, including 195 CT scans for the modified body thermoplastic membrane group and 174 CT scans for the vacuum cushion group. The setup errors in the x, y, and z directions (right-left, anterior-posterior, and superior-inferior, respectively) of the modified body thermoplastic membrane group were (2.59±1.98) mm, (2.38±2.04) mm, and (1.45±1.16) mm, respectively, while those of the other group were (2.24±1.63) mm, (2.78±2.17) mm, and (2.70±1.88) mm, respectively. The 3D vector errors of both groups were (4.32±2.28) mm and (5.13±2.14) mm, respectively. Therefore, the setup error in direction z and the 3D vector error of the modified body thermoplastic membrane group were less than those of the vacuum cushion group (t = -7.77, -3.41, P＜0.05). Moreover, the proportion of setup errors of ＞ 5 mm in the x direction of the vacuum cushion group was lower than that of the modified body thermoplastic membrane group (χ2 = 7.13, P＜0.05), while such proportion in the z direction of the modified body thermoplastic membrane group was lower than that of the vacuum cushion group (χ2= 5.90, P＜0.05). After the simulated treatment bed moving, the PTV_V100S of the modified body thermoplastic membrane group was better than that of the vacuum cushion group (t = 2.47, P ＜ 0.05). Furthermore, for the modified body thermoplastic membrane group, the setup errors in the x direction in the first week were higher than those in the 2-3 weeks and 4-5 weeks (P＜0.05). Conclusions The modified body thermoplastic membrane combined with a multifunction body board yield better immobilization effects than a vacuum cushion. However, it produces high setup errors in the x direction in the first week of the radiotherapy, to which special attention should be paid. |
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