Shi Jinming,Jin Jing,Chen Huan,et al.Impact of status determined by comprehensive geriatric assessment on setup error during rectal cancer radiotherapy for elderly patients[J].Chinese Journal of Radiological Medicine and Protection,2022,42(1):7-11
Impact of status determined by comprehensive geriatric assessment on setup error during rectal cancer radiotherapy for elderly patients
Received:October 14, 2021  
DOI:10.3760/cma.j.cn112271-20211014-00414
KeyWords:Elderly patients  Rectal cancer  Radiotherapy  Setup error  Comprehensive geriatric assessment
FundProject:国家自然科学基金(82073352);深圳市医学重点学科建设基金(SZXK013);深圳市医疗卫生三名工程(SZSM201612063);深圳市高水平医院建设专项基金;北京希望马拉松专项基金(LC2018A24)
Author NameAffiliationE-mail
Shi Jinming Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Jin Jing Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Shenzhen 518116, China  
Chen Huan Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Tang Yuan Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Li Ning Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Wang Shulian Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Song Yongwen Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Liu Yueping Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Qi Shunan Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Lu Ningning Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Jing Hao Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Chen Bo Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Fang Hui Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Li Yexiong Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China  
Liu Wenyang Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China liuwenyang@cicams.ac.cn 
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Abstract::
      Objective To explore the impacts of comprehensive geriatric assessment (CGA) on setup errors during the radiotherapy of elderly patients with rectal cancer.Methods A total of 45 patients over 70 years of age and receiving radiotherapy were enrolled in the study.A comprehensive geriatric assessment was conducted before the radiotherapy. The enrolled patients had a median age of 77 years, including 28 male and 17 female cases. Meanwhile, 31 patients were determined to be in a good CGA status and 14 were determined to be in a poor CGA status, and 35 patients received radiotherapy in the prone position and 10 in the supine position. Cone beam CT (CBCT) was used for setup correction during radiotherapy. CBCT was performed daily in the first week and once a week from the second week. By fusing and aligning the CBCT images with simulation CT images according to the lumbar vertebra, setup errors in the left-right (x axis), cranio-caudal (y axis), and anterior-posterior (z axis) directions were obtained.A total of 338 CBCT images were obtained.A generalized linear model was used to evaluate the effects of multiple factors on the setup errors.Results During the radiotherapy, setup errors of all patients were (0.24±0.19) cm in the left-right direction, (0.33±0.25) cm in the cranio-caudal direction, and (0.19±0.15) cm in the anterior-posterior direction. The setup error in the cranio-caudal direction was more than that in the left-right direction and that in the anterior-posterior direction (Z=-4.86, -7.72, P < 0.001). The setup error in the left-right direction was greater than that in the anterior-posterior direction (Z=-2.79, P=0.005). The mean setup errors of the good and poor status groups in the left-right direction were (0.21 ±0.17) and (0.30 ±0.22) cm, respectively (Z=2.16, P=0.031). There was no statistically significant difference in the setup errors between cranio-caudal direction and anterior-posterior direction (P > 0.05). The setup errors in the anterior-posterior direction were (0.17 ±0.13) and (0.27 ±0.19) cm, respectively for the prone and supine positions during the radiotherapy (Z=2.85, P=0.004). There was no statistically significant difference in the setup errors between the left-right direction and the cranio-caudal direction (P > 0.05).Conclusion The status of CGA elderly patients with rectal cancer affects the setup error in the left-right direction. It may be necessary to clinically adjust the PTV margin.
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