基于锥形束CT的乳腺癌保乳术后调强放疗中使用真空垫与乳腺托架的摆位误差分析  

Analysis of positioning error of vacuum pad and breast bracket in base note radiotherapy for breast conserving surgery for breast cancer based on cone beam CT

作　　者：周春[1] 李伟[1] 成俊[1] 姜玉玲 李明[2] Zhou Chun;Li Wei;Cheng Jun;Jiang Yuling;Li Ming(Department of Radiotherapy,Nantong Third People's Hospital(Nantong Third Hospital Affiliated to Nantong University),Nantong 226006,China;Department of radiotherapy,Nantong Cancer Hospital Nantong 226361,China)

机构地区：[1]南通市第三人民医院(南通大学附属南通第三医院)放疗科,南通226006 [2]南通市肿瘤医院放疗科,南通226361

出　　处：《中国医师杂志》2024年第7期1017-1021,共5页Journal of Chinese Physician

基　　金：江苏省重点研发计划(社会发展)项目(BE2020705)。

摘　　要：目的基于锥形束CT(CBCT)分析在乳腺癌保乳术后调强放疗中使用真空垫与乳腺托架的摆位误差。方法回顾性选取2020年4月至2022年4月在南通市肿瘤医院放疗科接受乳腺癌保乳术后行调强放疗的患者120例,根据固定方式将患者分组:A组(n=60)采用真空垫进行固定,B组(n=60)采用乳腺托架进行固定,均采用CBCT技术进行摆位评估,分析各组摆位误差及放射性皮炎发生情况。结果A、B组在左右方向的平移误差分别为(0.33±0.12)cm和(0.34±0.15)cm,组间比较差异无统计学意义(P>0.05)。腹背方向误差分别为0.32(0.11,0.42)cm和0.15(0.09,0.21)cm,头脚方向分别为0.34(0.16,0.34)cm和0.23(0.15,0.37)cm,B组头脚、腹背平移误差小于A组(均P<0.05)。B组患者左右方向[A组:(0.31±0.13)cm,B组:(0.18±0.05)cm,P<0.05]、腹背方向旋转后平移误差均显著小于A组[A组:(0.31±0.11)cm,B组:(0.23±0.08)cm,P<0.05],头脚方向旋转后平移误差比较差异无统计学意义(P>0.05)。B组左右方向旋转误差小于A组[A组:(0.98±0.12)°,B组:(0.67±0.31)°,P<0.05],头脚、腹背旋转误差比较差异无统计学意义(均P>0.05)。B组患者的计划中心点(MIDM),计划中心点水平向左、向右10 cm处(MIDL、MIDR),MIDM向头侧移动8 cm(SM),MIDL向头侧移动8 cm(SL),MIDR点向头侧移动8 cm(SR),MIDM点向足侧移动8 cm(IM),MIDL点向足侧移动8 cm(IL),MIDR点向足侧移动8 cm(IR)处的模体厚度均低于A组(均P<0.05)。在治疗完成时,A组高等级放射性皮炎总发生率为61.67%(37/60),B组高等级放射性皮炎总发生率为41.67%(25/60),B组患者高等级放射性皮炎发生率小于A组(P<0.05)。结论乳腺癌保乳术后使用乳腺托架进行乳房固定,调强放疗中可以减小摆位误差,降低模体厚度及高等级放射性皮炎的发生率,临床应用价值较高。Objective To analyze the positioning error of vacuum pad and breast bracket in base note radiotherapy for breast cancer with breast conserving surgery based on cone beam CT(CBCT).Methods A total of 120 patients who received IMRT after breast conserving surgery for breast cancer in the radiotherapy department of Nantong Cancer Hospital from April 2020 to April 2022 were retrospectively selected.According to the fixation method,the patients were divided into two groups:group A(n=60)was fixed with a vacuum pad,and group B(n=60)was fixed with a breast bracket.CBCT was used to evaluate the placement,and the placement errors and the occurrence of radiation dermatitis in each group were analyzed.Results The translation errors of group A and group B in the left and right directions were(0.33±0.12)cm and(0.34±0.15)cm,respectively,and there was no statistically significant difference between the groups(P>0.05).The errors in the direction of the abdomen and back were 0.32(0.11,0.42)cm and 0.15(0.09,0.21)cm,respectively,while the errors in the direction of the head and foot were 0.34(0.16,0.34)cm and 0.23(0.15,0.37)cm,respectively.The translation errors of the head,foot,and abdomen and back in group B were smaller than those in group A(all P<0.05).Patients in group B had significantly smaller translation errors in the left and right directions[group A:(0.31±0.13)cm,group B:(0.18±0.05)cm,P<0.05],and after rotation in the ventral and dorsal directions[group A:(0.31±0.11)cm,group B:(0.23±0.08)cm,P<0.05].There was no statistically significant difference in translation errors after rotation in the head and foot directions(P>0.05).The rotation error in the left and right directions of group B was smaller than that of group A[A:(0.980.12)°,group B:(0.67±0.31)°,P<0.05].There was no statistically significant difference in the comparison of head foot and abdominal back rotation errors(all P>0.05).The planned center point(MIDM)of group B patients was located 10 cm to the left and right horizontally(MIDL,MIDR),with MIDM moving

关 键 词：锥束计算机体层摄影术 乳腺肿瘤 放射疗法 调强适形 真空垫 乳腺托架 

分 类 号：R737.9[医药卫生—肿瘤]