| 李捷,姚晓伟,李博,等.颈部肌群锻炼提高头颈癌术后放疗摆位可重复性的随机对照研究[J].中华放射医学与防护杂志,2025,45(10):979-985.Li Jie,Yao Xiaowei,Li Bo,et al.A randomized controlled study on improving the repeatability of setup in postoperative radiotherapy for head and neck cancers through neck muscle group exercise[J].Chin J Radiol Med Prot,2025,45(10):979-985 |
| 颈部肌群锻炼提高头颈癌术后放疗摆位可重复性的随机对照研究 |
| A randomized controlled study on improving the repeatability of setup in postoperative radiotherapy for head and neck cancers through neck muscle group exercise |
| 投稿时间：2024-09-18 |
| DOI：10.3760/cma.j.cn112271-20240918-00357 |
| 中文关键词: 颈部肌群训练 头颈部肿瘤 放射治疗 摆位误差 |
| 英文关键词:Neck muscle group exercise Head and neck cancer Radiotherapy Setup error |
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| 中文摘要: |
| 目的 探讨颈部肌群锻炼对头颈部肿瘤术后放疗摆位误差的影响。方法 前瞻性选取空军军医大学第一附属医院2021年2月至2022年10月拟放疗的头颈部肿瘤术后患者126例，其中4例患者因个人原因中断治疗，其余122例患者按随机数表法分为试验组和对照组，每组61例。试验组采用颈部肌群锻炼干预，对照组常规治疗无干预。使用锥形束CT(CBCT)每周扫描1次，分别在斜坡、C4和C7椎骨的水平处测量摆位误差的幅度。计算每个水平的三维位移、系统误差和随机误差。使用Van Herk公式确定适当的计划靶区(PTV)边界。结果 两组患者的基线特征都很均衡，差异无统计学意义(P>0.05)。两组摆位误差比较，试验组在斜坡水平的左右(x)和前后(z)方向，C4和C7水平的z方向均小于对照组，差异均有统计学意义(t=2.30、5.29、4.07、2.40，P＜0.05)。z方向所需的PTV边界，试验组和对照组分别从斜坡的2.4和2.8 mm均增加到C7的4.0 mm。相关性分析显示，所有患者斜坡和C4水平x方向与床角(RTN)呈强负相关(r=-0.548、-0.452，P＜0.001)；C4和C7水平的头脚(y)方向与z方向呈中等负相关(r=-0.160、-0.222，P＜0.001)。结论 颈部肌群训练可以降低头颈部肿瘤术后放疗患者前后方向的摆位误差和PTV边界。 |
| 英文摘要: |
| Objective To explore the effect of neck muscle group exercise on setup errors in postoperative radiotherapy for head and neck cancers. Methods A total of 126 head and neck cancer patients scheduled for radiotherapy at the First Affiliated Hospital, Air Force Medical University from February 2021 to October 2022 were prospectively enrolled. Among these patients, four patients discontinued treatment due to personal reasons, and the remaining 126 patients were randomly divided into an experimental group and a control group, with 61 patients in each group. The experimental group received neck muscle group exercise, while the control group received routine treatment without intervention. Cone-beam CT (CBCT) scans were performed weekly to measure setup errors at the levels of the clivus and the 4th and 7th cervical vertebrae (C4 and C7, respectively). Three-dimensional displacement, systematic errors, and random errors were calculated for each level. The appropriate margins of planning target volumes (PTVs) were determined using the Van Herk formula. Results Baseline characteristics were well-balanced between the two groups, with no statistically significant differences (P > 0.05). Compared to the control group, the experimental group showed significantly smaller setup errors in the left-right (x) and anterior-posterior (z) directions at the clivus level, as well as in the z direction at the C4 and C7 vertebral levels (t = 2.30, 5.29, 4.07, 2.40, P < 0.05). The required PTV margin in the z direction increased to 4.0 mm at C7 from 2.4 mm and 2.8 mm at the clivus in the experimental and control groups, respectively. Correlation analysis revealed a strong negative correlation between the x-direction at the clivus and C4 vertebral levels and the couch angle (RTN) among all patients (r = -0.548, -0.452, P < 0.001). A moderate negative correlation was observed between the inferior-superior (y) direction and the z-direction at the C4 and C7 vertebral levels (r = -0.160, -0.222, P < 0.001). Conclusions Neck muscle group exercise can reduce setup errors and PTV margins in the anterior-posterior direction in postoperative radiotherapy for head and neck cancer patients. |
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