锥形束CT引导下乳腺癌保留乳房术后调强放疗摆位误差临床分析  

Clinical analysis of set-up errors between two fixation devices for IMRT after breast conserving surgery of breast cancer based on cone-beam CT

作　　者：加尔宝·吐尔德 艾秀清[1] 阿迪娜·贾库林 木妮热·木沙江[1] JIAERBAO·Tuerde;Al Xiu-qing;ADINA. Jiakulin;MUNIRE· Mushajiang(Department of Breast Radiotherapy ,Affilicated Tumor Hospital Xinjiang Medical University ,Urumqi 830011, P. R China)

机构地区：[1]新疆医科大学附属肿瘤医院乳腺放疗科

出　　处：《中华肿瘤防治杂志》2019年第10期719-723,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：新疆维吾尔自治区科技支疆项目(2017E0260)

摘　　要：目的摆位误差是影响乳腺癌保留乳房术后调强放疗的主要因素.合适的体位固定技术能有效地降低摆位误差。本研究利用锥形束CT( cone-beam computed tomography, CBCT)探讨体膜联合乳腺托架与体膜联合体板2种固定技术在乳腺癌保留乳房术后调强放疗前的摆位误差,从而得出较优的体位固定方式。方法选取2017-11-01-2018-02-25新疆医科大学附属肿瘤医院收治的34例接受保留乳房术后调强放疗的乳腺癌患者,将其平均分为A和E 2组,A组使用体膜联合乳腺托架,E组使用体膜联合体板固定装置,在CBCT引导下对IMRT治疗前摆位进行验证,患者首次及以后每周1次均行CBCT扫描。将重建好的CBCT图像与计划CT图像行自动匹配,得到患者在左右(X)、前后(Y)和头脚(Z)3个方向上的摆位误差,并进行比较。结果 2组34例患者共获得196组CBCT验证图像,A组摆位误差的绝对值中位数X(左右)为1. 0 mm, Y(上下)为1. 0 mm,Z(前后)为2. 0 mm,B组摆位误差的绝对值中位数X(左右)为2. 0 mm,Y(上下)为 1. 5 mm,Z(前后)为 3. 0 mm;2 组比较 X 方向 Z= 2. 081, P = 0. 037;Y 方向 Z= 2. 537,P = 0. 011;Z 方向Z= 2. 791,P = O. 005;差异均有统计学意义;A组X方向的位移分布<3 mm为91. 8%,3 5 mm为7. 1%,〉5 mm为1.0%;Y 方向 V3 mm 为 99. 0%,3 5 mm 为 1. 0%,> 5 mm 为 0;Z 方向 V 3 mm 为 81. 6%,3 5 mm 为 15.3%,>5 mm为3. 1%。E组X方向的位移分布V3 mm为82. 7 %, 3 5 mm为9. 2%,>5 mm为& 2%;Y方向V3 mm为8& 8%,3 5 mm 为 7. 1 %,>5 mm 为 4. 1%;Z 方向<3 mm 为 55. 1%,3 5 mm 为 34. 7%,〉5 mm 为 10. 2%, 2 组位移分布比较X方向(P = 0. 043),Y方向(P = 0.003),Z方向(P<0. 001),差异均有统计学意义。结论乳腺癌保留乳房术后调强放疗中采用2种不同固定技术,应用体膜联合乳腺托架固定技术在3个方向上均优于体膜联合体板。OBJECTIVE The set-up errors is an important factor which affects intensity modulated radiation therapy (IMRT) after breast conserving surgery of breast cancer. Significant Set-up errors reduction can be achieved with the use of Suitable fixation devices. This study investigated the set-up errors between the body film combined with the breast bracket and the body holder before intensity modulated radiation therapy after Breast Conserving Surgery of Breast Cancer based on Cone - beam CT to get a better position immobilization. METHODS The clinical data of 34 patients from November 1st,2017 to February 25th,2018 received IMRT after breast conserving surgery in the Affiliated Tumor Hospital of Xinjiang Medical University were enrolled in the study. Then they were randomly divided into two groups. Group A was applied with breast bracket for positioning and group B with body holder. Based on the onboard CBCT set-up verification was performed for the first time and per week after that for each patient before IMRT treatment. The CBCT image was automatically matched with the CT simulation image. The set-up variations in three dimension, X ( left and right), Y(upper and lower) and Z( front and rear) axes were measured. RESULTS All 34 cases were given 196 times of CBCT scanning before treatment, the median absolute value of the set-up errors of group A was 1. 0 mm on X axes (left and right), 1. 0 mm on Y axes(upper and lower),2. 0 mm on Z axes(front and rear). By the same token,the value of group B was 2. 0 mm on X axesdeft and right), 1. 5 mm on Y axes( upper and lower), 3. 0 mm on Z axes(front and rear). The Z-value on X axes were - 2. 081 ,P = 0. 037,the Z-value on Y axes were - 2. 537, P = 0. 011, the Z-value on Z axes were 一 2. 791. P = 0. 005 , compared the two groups had a significant difference. The displacement distributions of group A on X axes were 91. 8% in <C3 mm,7. 1 % in 3 - 5 mm,and 1.0% in >5 mm. Y axes were 99. 0% in <3 mm, 1.0% in 3 - 5 mm.and 0% in >5 mm. Z axes were 81. 6% in V3 mm?15. 3% in 3 - 5 mm,

关 键 词：乳腺肿瘤 调强放疗 锥形束CT 摆位误差 

分 类 号：R737.9[医药卫生—肿瘤]