探讨不同固定方式在鼻咽癌放疗中的应用  

Application of Different Immobilization Techniques in Cone Beam CTguided Radiotherapy for Nasopharyngeal Carcinoma

作　　者：薛青 陆维[1] 张艳俊[1] 许青[1] Xue Qing;Lu Wei;Zhang Yanjun;Xu Qing(Department of Radiology,Fudan University Shanghai Cancer Center,Shanghai 200032,China)

机构地区：[1]放射治疗科,上海复旦大学附属肿瘤医院200032

出　　处：《肿瘤预防与治疗》2019年第1期67-71,共5页Journal of Cancer Control And Treatment

摘　　要：目的:比较通用型头枕+头颈肩面罩与个性化负压真空垫+头颈肩面罩两种固定方式,在CBCT引导下进行头+上颈部配准和下颈部配准误差的比较,探讨其在鼻咽癌放疗中的应用。方法:选取30例2017年1月～2017年6月在我院Varian Trilogy下接受调强放疗(Intensity Modulated Radiation Therapy,IMRT)且需下颈部治疗的鼻咽癌患者,均采用仰卧位,将患者随机分成A、B两组,各15例。A组患者采用通用型头枕+头颈肩面罩固定方式,B组患者采用个性化定制负压真空垫+头颈肩面罩固定方式。每位患者治疗前5次由病房护士监测晨起空腹体重。每次放疗前与治疗后均行CBCT一次,再使用Varian加速器OBI系统自动配准。配准范围:1.头+上颈部(眉骨上缘至第五颈椎下缘);2.下颈部(第五颈椎下缘至锁骨头上缘)。对摆位误差超过3 mm的患者均进行校正后重新扫CBCT。结果:30例患者在CBCT下头+上颈部和下颈部获得X、Y、Z方向摆位误差数据,分别为:(0.21±0.45)mm vs(0.52±0.64)mm、(0.25±0.48)mm vs(0.49±0.64)mm和(0.26±0.52)mm vs(0.81±0.94)mm,差异有统计学意义(P<0.001);A组vs B组两种固定方式在CBCT下比较,头+上颈部X、Y、Z方向的摆位误差分别为(0.28±0.53)mm vs(0.13±0.34)mm、(0.35±0.56)mm vs(0.16±0.37)mm和(0.43±0.64)mm vs(0.09±0.29)mm,差异有统计学意义(P<0.05);下颈部X、Y、Z方向的摆位误差分别为(0.76±0.63)mm vs(0.28±0.56)mm、(0.61±0.68)mm vs(0.36±0.58)mm和(1.24±1.05)mm vs(0.38±0.54)mm,差异有统计学意义(P<0.05)。结论:对于鼻咽癌放疗患者,下颈部摆位误差大于头+上颈部整体误差,对于需颈部放疗的鼻咽癌建议首选个性化负压真空垫+头颈肩面罩固定模式。Objective:To compare the set-up errors of head and upper neck registration and lower neck registration under the guidance of cone beam computed tomography (CBCT)by two immobilization techniques-the general head pillow with head-neck-shoulder mask and the individualized vacuum bag with head-neck-shoulder mask,and to explore its application in radiotherapy for nasopharyngeal carcinoma (NPC)at different stages.Methods:We selected 30 patients with NPC who received intensity modulated radiotherapy (IMRT)using Varian Trilogy and needed lower neck treatment in Fudan University Shanghai Cancer Center from January 2017 to June 2017.Patients in supine position were randomly divided into two groups : group A (n =15)and group B (n =15).Patients in group A were immobilized by the general head pillow and head-neckshoulder mask,while patients in group B by the individualized vacuum bag and head-neck-shoulder mask.Each patient was monitored for morning empty body weight 5 times before treatment by ward nurses.CBCT was performed every time before and after radiotherapy,and then the OBI system by Varian accelerator was used to automatically register.Registration range :1.Upper head and neck (upper border of the brow to lower edge of the fifth cervical vertebra);2.Lower neck (from the lower edge of the fifth cervical vertebra to the superior edge of the clavicle).CRCT was required once more if set-up error was more than 3mm.Results:1.The set-up errors obtained in the head and upper neck and in the lower neck by CBCT were (0.21±0.45)mm vs (0.52±0.64)mm in the lateral direction,(0.25±0.48)mm vs (0.49±0.64)mm in the longitudinal direction and (0.26±0.52)mm vs (0.81± 0.94)mm in the vertical direction,respectively.The differences were statistically significant (P <0.001).2.The set-up errors in the head and upper neck in group A were (0.28+0.53)mm in the lateral direction,(0.35+0.56)mm in the longitudinal direction,and (0.43±0.64)mm in the vertical direction,respectively,while those in group B were (0.13±0.34)mm in the lateral di

关 键 词：鼻咽癌 放射治疗 锥形束CT 摆位误差 头颈肩固定 

分 类 号：R739.62[医药卫生—肿瘤] R739.63[医药卫生—临床医学]