乳腺癌摆位误差及不良反应分析  

Analysis on positioning errors and adverse reactions of breast cancer

作　　者：唐婷婷 钟勇 汤平 胡林 郑雪瑞 陈川 TANG Tingting;ZHONG Yong;TANG Ping;HU Lin;ZHENG Xuerui;CHEN Chuan(Department of Oncology,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院肿瘤科,重庆400042

出　　处：《重庆医学》2024年第22期3469-3472,共4页Chongqing Medical Journal

基　　金：重庆市科卫联合重点项目(2022ZDXM027)。

摘　　要：目的探讨乳腺癌在颈胸一体热塑膜固定下基于锥形束CT(CBCT)放疗摆位误差的影响因素及急性放射性皮炎的发生情况,为个性化靶区外放边界及放疗固定方式的选择和指导放射性皮炎临床实践工作提供依据。方法选取2022年6月至2023年10月该院147例乳腺癌肿瘤患者为研究对象,其中行保乳术患者74例,行改良根治术(切除术)患者73例。治疗期间采取每周1次CBCT扫描获取图像与计划CT图像进行灰度匹配,获取X(左右)、Y(头脚)、Z(腹背)轴的平移误差和X(俯仰)、Y(翻滚)、Z(旋转)轴的旋转误差,同时记录放疗期间近3个月的急性放射性皮炎发生情况。结果与Z轴比较,X轴和Y轴平移误差更大,旋转误差更小,差异有统计学意义(P<0.05)。根据公式计算X、Y、Z轴平移误差的计划靶区(PTV)外扩边界分别为0.70、0.76、0.46 cm。保乳术与切除术及左右乳各个方向的摆位误差比较,差异无统计学意义(P>0.05)。年龄与X、Y、Z轴平移误差的相关性分别为-0.14、0.18和0.10,年龄与X、Y、Z轴旋转误差相关性分别为0.12、<0.01、0.02。保乳术患者发生1级急性放射性皮炎为100.0%(74/74),切除术患者发生1级急性放射性皮炎为13.7%(10/73),2级82.2%(60/73),3级为4.1%(3/73),二者比较差异有统计学意义(P<0.05)。结论乳腺癌在日常摆位和靶区外扩时尤其注意X、Y轴平移方向及Z轴旋转方向,利用颈胸一体热塑膜固定乳腺癌不受手术方式、患侧位置及年龄的影响。Objective To investigate the factors influencing the positioning error of conical beam CT(CBCT)radiotherapy and the occurrence of acute radiation dermatitis in breast cancer fixed by cervical and thoracic integrated membrane in order to provide a basis for personalized out-target external boundary,selection of fixed mode and guidance of radiodermatitis clinical practice work.Methods A total of 147 patients with breast cancer in this hospital from June 2022 to October 2023 were selected as the study subjects,including 74 cases of breast conserving operation and 73 cases of modified radical(excision)operation.During the treatment period,CBCT scanning once a week obtained the image and conducted the grey match with the planned CT images to acquire the translational error of X(left and right),Y(head and foot)and Z(abdominal and dorsal)and the rotational posing error of X(pitch),Y(roll)and Z(yaw)axis,and at the same time,the acute radiodermatitis in nearly 3 months during radiotherapeutic period was recorded.Results Compared with the Z axis,the translation error of X axis and Y axis was greater,the rotation error was smaller,and the differences were statistically significant(P<0.05).The PTV external boundary of X,Y and Z axis calculated by the formula was 0.70,0.76,0.46 cm respectively.There was no statistically significant difference in the positioning error of each direction of left and right breast between breast conservation operation and breast resection operation(P>0.05).The correlation between the age with X,Y and Z axis translation errors was-0.14,0.18 and 0.10 respectively,which of the age with X,Y and Z axis rotation errors was 0.12,<0.01,0.02 respectively.The occurrence of grade 1 acute radiodermatitis in the patients with breast conserving operation was 100.0%(74/74),which in the patients with excision operation was 13.7%(10/73),the occurrence of grade 2 was 82.2%,which of grade 3 was 4.1%(3/73),and the difference between them was statistically significant(P<0.05).Conclusion In the every day positioning an

关 键 词：乳腺癌 放射治疗 摆位误差 锥形束CT 精确放疗 

分 类 号：R737.9[医药卫生—肿瘤]