乳腺癌改良根治术后放疗两种固定方式在锁骨上下区摆位误差的比较  

Comparison of the setup errors of two mask systems for immobilizing supra/infraclavicular nodal region of breast cancer patients received postmastectomy radiotherapy

作　　者：张彦新 郇福奎 耿松松 张焜 王宏 房辉 唐玉 景灏 王淑莲 戴建荣 Zhang Yanxin;Huan Fukui;Geng Songsong;Zhang Kun;Wang Hong;Fang Hui;Tang Yu;Jing Hao;Wang Shulian;Dai Jianrong(Department of Radiation Oncology,Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,National Clinical Research Center for Cancer,National Cancer Center,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《国际放射医学核医学杂志》2021年第6期348-356,共9页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：中国癌症基金会北京希望马拉松课题基金(LC2019L02);北京协和医学院“中央高校基本科研业务费”(3332019054);北京市希思科临床肿瘤学研究基金会希思科-赛生肿瘤研究基金(Y-2019Sciclone-022)。

摘　　要：目的比较使用头颈肩热塑网罩和颈胸一体热塑体膜固定的乳腺癌改良根治术后放疗患者锁骨上下区的摆位误差。方法回顾性分析2019年6至12月中国医学科学院北京协和医学院肿瘤医院放疗科收治的40例女性乳腺癌改良根治术后患者[中位年龄46(29~68)岁]的锁骨上下区靶区的锥形束CT(CBCT)图像,其中19例使用头颈肩热塑网罩进行体位固定(头颈肩网罩组,128次CBCT图像),21例使用颈胸一体架膜进行体位固定(颈胸一体膜组,143次CBCT图像)。分析2组患者锁骨上下区的摆位误差,并分别测量肩锁关节的位置移动幅度ΔX、ΔY、ΔZ和三维空间位移d。应用公式计算临床靶区至计划靶区(PTV)的外放边界值。将所有患者分成体重指数(BMI)<24 kg/m^(2)组(13例,86次CBCT扫描)和BMI≥24 kg/m^(2)组(27例,185次CBCT扫描),分析比较2组的摆位误差。2组之间的比较采用独立样本t检验。结果头颈肩网罩组和颈胸一体膜组在锁骨上下区的平移摆位误差分别为左右方向:(1.78±2.40)mm和(2.26±1.91)mm(t=0.687,P=0.496)、头脚方向:(2.88±2.44)mm和(2.29±1.89)mm(t=2.249,P=0.030)、腹背方向:(2.48±1.79)mm和(1.66±2.00)mm(t=0.998,P=0.325);在矢状面的旋转摆位误差分别为(0.91±0.61)度和(0.67±0.53)度,差异有统计学意义(t=3.555,P=0.001)。头颈肩网罩组和颈胸一体膜组在肩锁关节的位置移动幅度ΔX、ΔY、ΔZ的平均值分别为3.65、4.61、3.11 mm和2.32、1.97、1.63 mm,三维空间位移d的平均值分别为7.36 mm和4.03 mm。头颈肩网罩组和颈胸一体膜组锁骨上下区在左右方向、头脚方向和腹背方向的PTV外放边界值分别为6.1、8.9、7.5 mm和7.0、7.0、5.5 mm。BMI<24 kg/m^(2)组和BMI≥24 kg/m^(2)组患者在3个方向的平移和旋转摆位误差的差异均无统计学意义(t=−1.103~0.938,均P>0.05)。结论对于乳腺癌改良根治术后行锁骨上下区放疗的患者,相比头颈肩网罩固定,使用颈胸一体膜固定在头脚Objective To compare the setup errors of breast cancer patients who received postmastectomy radiotherapy(PMRT)with head/neck and shoulder thermoplastic mask and integral cervicothoracic mask.Methods A retrospective analysis was performed on 40 female breast cancer patients(median age 46(29–68)years)who treated with PMRT in Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College from June to December 2019.The supra/infraclavicular nodal region was irradiated with intensity-modulated radiotherapy technique and chest wall±internal mammary chain were irradiated with electrons.A total of 271 cone beam CT(CBCT)images of the supra/infraclavicular nodal region were analyzed retrospectively.One hundred and twenty eight CBCT images were from 19 patients immobilized with head/neck and shoulder thermoplastic mask,and 143 CBCT images were from 21 patients immobilized with integral cervicothoracic thermoplastic mask.The setup errors of the two groups were analyzed,and the movement amplitudeΔX,ΔY,ΔZ and three-dimensional displacement d of acromioclavicular joint were measured.According to van Herk's formula,MPTV=2.5Σ+0.7σ,the margin from clinical target volume to planning target volume(PTV)is calculated.According to whether body mass index(BMI)≥24 kg/m^(2),the patients were divided into two groups to analyze whether there was statistical difference of the setup errors.The differences were compared by independent sample t test.Results The translational setup errors of the supra/infraclavicular nodal region for head/neck and shoulder and integral cervicothoracic thermoplastic mask groups in the left–right,superior–inferior,and anterior–posterior directions were as follows:(1.78±2.40)mm and(2.26±1.91)mm(t=0.687,P=0.496);(2.88±2.44)mm and 2.29±1.89 mm(t=2.249,P=0.030);(2.48±1.79)mm and(1.66±2.00)mm(t=0.998,P=0.325),respectively;the rotational setup errors in the sagittal directions were(0.91±0.61)°and(0.67±0.53)°,and the difference was statistically significant(t=3.555,P=0.001).The

关 键 词：乳腺肿瘤 乳房切除术 改良根治性 放射疗法 计算机辅助 体位固定 摆位误差 

分 类 号：R737.9[医药卫生—肿瘤]