胸段食管癌放疗四种体位固定方式对锁骨上区域动度的比较研究  

Comparison of Kinematic Displacement Errors of Supraclavicular Region with Four Posture Fixation Methods for Thoracic Esophageal Carcinoma

作　　者：万宝 黄键兵 覃仕瑞 芦凤玉 张文博 张焜 赵宇 洪天航 杨博宇 侯露 刘帆 周宗玫 肖泽芬 陈东福 冯勤付 王健仰 毕楠 Wan Bao;Huang Jianbing;Qin Shirui;Lu Fengyu;Zhang Wenbo;Zhang Kun;Zhao Yu;Hong Tian-hang;Yang Boyu;Hou Lu;Liu Fan;Zhou Zongmei;Xiao Zefeng;Chen Dongfu;Feng Qinfu;Wang Jianyang;Bi Nan(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,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：《肿瘤预防与治疗》2022年第6期538-543,共6页Journal of Cancer Control And Treatment

基　　金：国家自然科学基金(编号:82071759)。

摘　　要：目的:胸段食管癌放疗过程中,多数情况下使用胸腹平架进行体位固定。在放疗实施过程中,还要考虑到手臂位置对射野设计的影响,以及手臂本身所受的辐射剂量。本研究意在探讨对胸段食管癌需要锁骨上联合纵隔放疗时,不同体位固定方式对锁骨上区域动度和重复性的影响。方法:前瞻性入组80例胸段食管癌患者,放疗野包括纵隔和锁骨上区域。在CT定位时,分别使用如下4种不同的固定方式,即胸腹平架固定上肢置于体侧、胸腹平架固定双手上举、颈胸一体架固定手臂置于体侧和颈胸一体架固定双手上举。放疗期间第一周行5次锥形束CT(cone beam CT,CBCT)验证体位,之后每周行一次CBCT验证。根据CBCT图像评价四种体位固定方式的系统误差和随机误差,以及胸锁关节和肩锁关节的位移误差。结果:CBCT数据结果显示四种固定方式对整体靶区(医生勾画靶区)系统误差∑(个体病例误差平均值的标准差)和随机误差σ(个体病例误差标准差的均方根)都小于0.5 cm。颈胸一体架上举组在Z、Rx、Rz方向的摆放误差小于胸腹平架上举组,在X、Rx方向的摆放误差小于胸腹一体架体侧组,在Z方向的摆放误差小于颈胸一体架体侧组,差异均有统计学意义(P<0.05)。对于肩锁关节空间位移,颈胸一体架上举组(0.21±0.13)cm的肩锁关节动度的误差都小于胸腹平架体侧组(0.24±0.17)cm、胸腹平架上举组(0.28±0.16)cm及颈胸一体架体侧组(0.23±0.13) cm。结论:对于胸段食管癌,采用颈胸一体架固定双臂上举置于臂托架的体位,锁骨上区域摆位误差最小、重复性最优。Objective:During radiation for thoracic esophageal cancer,thoracic and abdominal flat frame fixation de vices are used in most cases,and the effect of arm position on field design and the dose on arm itself should also be taken into account.This study aimed to compare the effects of four fixation methods on kinematic displacement errors of the supraclavicular zone in the radiation in thoracic esophageal cancer involving the mediastinum and supraclavicular zone,and the reproducibility of the radiation.Methods:80 patients with middle thoracic esophageal cancer were prospectively enrolled,with the radiation field in the mediastinum and supraclavicular zone.In CT-guided localization,patients were fixed by thoraco-ab-dominal fixation with arms placed on two sides of the body(the TAASB group),thoraco-abdominal fixation with hands raised and crossed in front of the forehead(the TAHF group),cervico-thoracic fixation with arms placed on two sides of the body(the CTASB group),and cervico-thoracic fixation with hands raised on arm brackets(the CTHB group).During radiotherapy,cone beam CT(CBCT)was performed five times for each patient in the first week and once a week in the following weeks.Systematic and random errors of the above four fixation modes,and displacement errors in sternoclavicular and acromioclavicular joints were evaluated based on CBCT images.Results:CBCT results showed that both the systematic error ∑(standard deviation of the mean error value of individual cases)and the random error σ(root mean square of the standard deviation of error in individual cases)by the four fixation methods were within 5 mm for the overall target area(the target area delineated by doctors).The CTHB group reported significantly smaller positioning errors in Z,Rx and Rz directions compared to the TAHF group(P<0.05);it reported smaller positioning errors in Z and Rx directions compared to the TAASB group(P<0.05);and it reported smaller positioning errors in Z direction compared to the CTASB group(P<0.05).The spatial displacement o

关 键 词：食管癌 体位固定 锁骨上区 摆位误差 

分 类 号：R730.55[医药卫生—肿瘤] R815.6[医药卫生—临床医学]