发泡胶联合头颈肩面罩的固定方式在鼻咽癌放疗中的优化探索  

Optimization exploration of polyurethane foam combined with head-neck-shoulder mask immobilization in nasopharyngeal carcinoma radiotherapy

作　　者：周丹 张振宇[4] 管西寅 尤丹 梁洪娇 夏天 ZHOU Dan;ZHANG Zhenyu;GUAN Xiyin;YOU Dan;LIANG Hongjiao;XIA Tian(Department of Medical Physics,Shanghai Proton and Heavy Ion Center,Shanghai 201315,China;Shanghai Key Laboratory of Radiation Oncology,Shanghai 201315,China;Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy,Shanghai 201315,China;Department of Radiotherapy,Fudan University Zhongshan Hospital,Shanghai 200032,China;Department of Radiotherapy,Shanghai Proton and Heavy Ion Center,Shanghai 201315,China;Department of Medical Physics,Shanghai Proton and Heavy Ion Center,Department of Radiotherapy,Fudan University Cancer Hospital,Shanghai 201315,China)

机构地区：[1]上海市质子重离子医院放射物理科,上海201315 [2]上海市放射肿瘤学重点实验室,上海201315 [3]上海质子重离子放射治疗工程技术研究中心,上海201315 [4]复旦大学附属中山医院放射治疗科,上海200032 [5]上海市质子重离子医院放射治疗科,上海201315 [6]上海市质子重离子医院放射物理科,复旦大学附属肿瘤医院放射治疗科,上海201315

出　　处：《现代肿瘤医学》2024年第21期4139-4142,共4页Journal of Modern Oncology

摘　　要：目的:讨论发泡胶联合头颈肩面罩固定方式在鼻咽癌放疗中优化的可能性。方法:随机选取20例需要照射颈部淋巴结的初治鼻咽癌患者分成2组各10例,A组采用通用型头枕+发泡胶+头颈肩面罩的固定方式,B组采用发泡胶+头颈肩面罩的固定方式。前3次放疗前进行CBCT扫描,后每周进行一次,扫描之后以颅底为中心进行位置验证,作为图像引导放疗的数据依据。对于头部和颈部位置偏差超过3 mm的患者重新摆位后再一次进行CBCT扫描并治疗。利用每次首次扫描的CBCT图像,采用离线的方式分别以头部和颈部为中心配准获得X(左右)、Y(头脚)、Z(垂直)三个方向的摆位误差值,作为本次研究的数据。结果:A组头部和颈部X、Y、Z方向上的摆位误差分别为(0.12±0.10)cm与(0.17±0.13)cm、(0.17±0.14)cm与(0.19±0.16)cm、(0.18±0.15)cm与(0.22±0.16)cm,差异有统计学意义(P<0.05);A组和B组头部X、Y、Z方向上的摆位误差分别为(0.12±0.10)cm与(0.15±0.16)cm、(0.17±0.14)cm与(0.17±0.16)cm和(0.18±0.15)cm与(0.22±0.16)cm,差异无统计学意义(P>0.05);A组和B组颈部X、Y、Z方向上的摆位误差分别为(0.17±0.13)cm与(0.25±0.21)cm、(0.19±0.16)cm与(0.22±0.16)cm和(0.22±0.16)cm与(0.22±0.16)cm,X方向差异有统计学意义(P<0.05),Y、Z方向差异无统计学意义(P>0.05)。结论:对鼻咽癌放疗患者使用通用型头枕+发泡胶+头颈肩面罩的固定方式提高了颈部的位置重复性,但未能解决颈部相较于头部误差更大的问题。Objective:To discuss the possibility of optimizing the immobilization of polyurethane foam combined head-neck-shoulder mask in nasopharyngeal carcinoma radiotherapy.Methods:20 patients with primary nasopharyngeal carcinoma requiring irradiation of cervical lymph nodes were randomly selected and divided into 2 groups of 10 patients each.Patients in group A were immobilized by general headrest+polyurethane foam+head-neck-shoulder mask.Patients in group B were immobilized by polyurethane foam+head-neck-shoulder mask.CBCT scans were performed before the first 3 radiotherapy sessions and once a week thereafter.The position verification centered on the skull base after scanning served as the data basis for IGRT.For patients with head and neck set-up errors exceeding 3 mm,repositioned and CBCT scanned again for treatment.Using the CBCT images from each initial scan,offline registration was used to obtain the set-up errors in the X(lateral),Y(longitudinal),and Z(vertical)directions with the head and neck as the center,which were used as the data for this study.Results:Set-up errors in the X,Y,and Z directions of head and neck in group A were(0.12±0.10)cm&(0.17±0.13)cm,(0.17±0.14)cm&(0.19±0.16)cm,and(0.18±0.15)cm&(0.22±0.16)cm,and the differences were all statistically significant(P<0.05).Set-up errors in the X,Y,and Z directions of head in group A and B were(0.12±0.10)cm&(0.15±0.16)cm,(0.17±0.14)cm&(0.17±0.16)cm,and(0.18±0.15)cm&(0.22±0.16)cm,and none of the differences were statistically significant(P>0.05).Set-up errors in the X,Y,and Z directions of neck in group A and B were(0.17±0.13)cm&(0.25±0.21)cm,(0.19±0.16)cm&(0.22±0.16)cm,and(0.22±0.16)cm&(0.22±0.16)cm.The difference in the X direction was statistically significant(P<0.05),and the differences in the Y and Z directions were not statistically significant(P>0.05).Conclusion:The use of general headrest+polyurethane foam+head-neck-shoulder mask immobilization system for nasopharyngeal carcinoma radiotherapy patients improved the positional reprodu

关 键 词：发泡胶 头颈肩面罩 鼻咽癌 锥形束CT 摆位误差 

分 类 号：R739.6[医药卫生—肿瘤]