OSMS在左侧乳腺癌根治术后放疗中的临床应用  

Clinical application of optical surface monitoring system in radiotherapy after radical mastectomy for left breast cancer

作　　者：邝倍 刘忠强 王惠[1] 吴振明 叶锡渠 林耿贤 KUANG Bei;LIU Zhongqiang;WANG Hui;WU Zhenming;YE Xiqu;LIN Gengxian(Department of Radiation Oncology,Nanfang Hospital,Southern Medical University,Guangzhou 510515 China)

机构地区：[1]南方医科大学南方医院放疗科,广东广州510515

出　　处：《中国辐射卫生》2023年第1期40-45,共6页Chinese Journal of Radiological Health

摘　　要：目的 研究基于光学表面监测系统(optical monitoring system,OSMS)引导左侧乳腺癌根治术后深吸气屏气(deep inspiration breath-hold,DIBH),自由呼吸FB1(free breathing,FB)以及自由呼吸FB2(不经过OSMS引导,直接通过激光灯摆好身体标记线)3种状态下放疗的摆位误差,为主管医生勾画靶区提供个体化CTV-PTV外扩依据。方法 选取36例左侧乳腺癌根治术后患者,分为3组,分别进行DIBH、FB1和FB2 3种状态下拍摄CBCT,与CT图像进行分析配准并记录腹背、头脚、左右方向上的线性位移绝对误差数据,并计算外扩边界。结果 DIBH组的腹背、头脚、左右方向平移误差为(0.06±0.22) cm、(0.05±0.23) cm、(0.01±0.24) cm;FB1组为(0.07±0.21) cm、(0.02±0.23) cm、(0.02±0.21) cm;FB2组为(0.07±0.24) cm、(0.07±0.34) cm、(0.25±0.09) cm。DIBH组与FB1组在腹背、RTN、ROLL方向统计结果有统计学意义(t=3.98、t=3.79、t=4.06,P <0.05),FB1组与FB2组在腹背方向统计结果有统计学意义(t=-3.25,P <0.05),其他方向差异均无统计学意义。在腹背、头脚方向上,3组的计划靶区外扩边界(margin of planning target volum,MPTV)值大小关系是DIBH <FB1 <FB2,在左右方向上是FB1 <DIBH <FB2。结论 使用OSMS引导左侧乳腺癌根治术后患者DIBH放疗,能减小摆位误差,给主管医生勾画靶区提供了个体化CTV-PTV外扩重要依据。Objective To study the setup error under deep inspiration breath hold(DIBH) guided by optical surface monitoring system(OSMS) and free breathing(FB) FB1 and FB2(without OSMS guidance,directly set up the body marker line by laser lamp) in radiotherapy after radical mastectomy for left breast cancer,and to provide a basis for individualized clinical target volume-planning target volume(CTV-PTV) expansion for the doctor in charge to delineate the target volume.Methods A total of 36 patients with left breast cancer after radical mastectomy were selected and divided into three groups,in which cone beam computed tomography(CBCT) images were taken in three states:DIBH,FB1,and FB2,respectively.CBCT and CT images were analyzed for registration;the absolute error data of linear displacement in the ventro-dorsal,cranio-caudal,and left-right directions were recorded,and the expanding margin was calculated.Results The translation errors in the ventro-dorsal,cranio-caudal,and left-right directions were(0.06 ± 0.22) cm,(0.05 ± 0.23) cm,and(0.01 ± 0.24)cm in the DIBH group,(0.07 ± 0.21) cm,(0.02 ± 0.23) cm,and(0.02 ± 0.21) cm in the FB1 group,and(0.07 ± 0.24) cm,(0.07 ± 0.34) cm,and(0.25 ± 0.09) cm in the FB2 group.The statistical results of the DIBH group and FB1 group in the ventro-dorsal,RTN,and ROLL directions were significantly different(P< 0.05).The statistical results of the FB1 group and FB2 group in the ventro-dorsal direction were significantly different.The relation of three groups in the value of margin of planning target volume was DIBH FB1 FB2 in the ventro-dorsal and cranio-caudal directions and FB1 DIBH FB2 in the left-right direction.Conclusion OSMS-guided DIBH radiotherapy in patients with left breast cancer after radical mastectomy can reduce the setup error and provide an important basis for individualized CTV-PTV expansion for the doctor in charge to delineate the target volume.

关 键 词：光学表面监测系统 左侧乳腺癌 根治术后 自动摆位 摆位误差 外扩边界 

分 类 号：R816[医药卫生—放射医学]