真空垫联合CIVCO俯卧位托架在直肠癌放疗摆位中的应用  

Application of vacuum pad combined with CIVCO prone brackets in rectal cancer radiotherapy positioning

作　　者：邱腾 于大海 赵迪 鹿红 王培 秦亮 王逸君 马珺 QIU Teng;YU Dahai;ZHAO Di;LU Hong;WANG Pei;QIN Liang;WANG Yijun;MA Jun(Department of Radiotherapy,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine(Jiangsu Provincial Hospital of Traditional Chinese Medicine),Jiangsu Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院放射治疗科,江苏南京210029

出　　处：《现代肿瘤医学》2024年第2期316-322,共7页Journal of Modern Oncology

基　　金：江苏省中医药科技发展计划项目(编号:YB2020009);江苏省中医院科技项目(编号:Y2021ZR07);江苏省中医院创新发展基金课题(编号:Y2021CX09)。

摘　　要：目的:改进CIVCO俯卧位托架在直肠癌中应用方法,探究真空垫与CIVCO俯卧位托架联合使用(改进型固定组A)与单独使用CIVCO俯卧位托架(一般型固定组B)摆位误差差异,制定真空垫固定下肢流程与要求。方法:基于CBCT(cone beam CT),采集摆位误差数据,回顾性选取2021年10月至2023年4月行俯卧位直肠癌放射治疗患者。改进型固定组32例,一般型固定组32例;两组中又以BMI(body mass index):24 kg/m^(2)为分界值进行亚组分类(肥胖体态A_(1)、B_(1),普通体态A_(2)、B_(2))。通过统计学方法两独立样本t检验,分别比较两组患者在X(lateral,LAT)、Y(length,LNG)、Z(vertal,VRT)三方向摆位误差均值差异;比较亚组间在X、Y、Z三方向摆位误差均值差异。采用秩和检验比较两组三维空间矢量误差差异;卡方检验展示三维空间矢量误差>0.52 cm占比。采用单因素方差分析探究改进型固定组与放疗摆位时间关系,经事后分析各方向误差均值变化趋势。根据PTV边界公式评估改进型固定在俯卧位直肠癌放射治疗临床应用价值。结果:两组摆位误差均值t检验结果:X(t=2.404,P=0.017),Y(t=4.864,P<0.05),Z(t=3.704,P<0.05),三方向误差均值差异有统计学意义。三维空间矢量误差分析结果:改进型固定组0.35(0.25~0.42)cm,一般型固定组0.42(0.29~0.61)cm(Z=-5.783,P<0.05);其中改进型固定组Δ>0.52 cm占比8.7%,一般型固定组Δ>0.52 cm占比28.2%(Z=-5.718,χ^(2)=32.757,P<0.05),差异具有统计学意义,改进型固定组患者其三位空间矢量误差漂移范围更小。两组在X、Y、Z三方向PTV外放值M PTV分别为A(0.51,0.49,0.58)cm,B(0.73,0.92,0.83)cm。基于BMI指数:在A组中误差均值差异X(t=-2.053,P=0.042),Y(t=-4.621,P<0.05),Z(t=-3.676,P<0.05)差异具有统计学意义;在A、B两组肥胖患者中误差均值差异仅发现在Z(t=3.431,P=0.002)差异具有统计学意义,X(t=1.170,P=0.244),Y(t=1.969,P=0.051)差异无统计学意义。在A、B两组普通BMI患者比Objective:To improve the application method of CIVCO prone brace in rectal cancer,to investigate the difference in positional error between the combined use of vacuum pad and CIVCO prone brace(improved fixation group A)and CIVCO prone brace alone(general fixation group B),and to develop the process and requirements for vacuum pad fixation of the lower extremity.Methods:Based on cone-beam CT(CBCT)acquisition of positional error data,patients undergoing prone rectal cancer radiation therapy from October 2021 to March 2023 were retrospectively selected.There were 32 cases in the modified fixation group and 32 cases in the general fixation group.In both groups,subgroups were classified using body mass index(BMI)=24 kg/m^(2) as the cut-off value(obese body A_(1),B_(1),normal body A_(2),B_(2)).The differences in the mean values of pendulum errors in the X(lateral,LAT),Y(length,LNG),and Z(vertal,VRT)directions were compared between the two groups by the statistical method of two independent samples t-test.The differences in the mean values of pendulum errors in the X,Y and Z directions were compared between the subgroups.The rank sum test was used to compare the differences in three-dimensional space vector errors between the two groups and to analyze whether the differences were correlation tests related to the adoption of the new technology.The chi-square test was used to demonstrate the percentage of three-dimensional space vector errors>0.52 cm.One-way ANOVA was used to explore the relationship between the improved fixation group and the radiotherapy placement time,and the trend of the mean value of error change in each direction was analyzed by post hoc multiple comparisons.The clinical value of improved fixation in prone rectal cancer radiation therapy positioning was evaluated according to the PTV boundary formula.Results:The results of the t-test for the mean value of positional error in both groups:X(t=2.404,P=0.017),Y(t=4.864,P<0.05),and Z(t=3.704,P<0.05),with statistically significant differences in the mean

关 键 词：放射治疗 误差 直肠癌 真空垫 

分 类 号：R735.3[医药卫生—肿瘤]