| 不同放疗体位固定方式在胸中段食管癌中摆位误差的比较研究 |
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| 引用本文： | 万宝,李娇,于诺,冯鑫,周科,刘博飞,朱耿强,王鑫. 不同放疗体位固定方式在胸中段食管癌中摆位误差的比较研究[J]. 国际放射医学核医学杂志, 2022, 46(6): 347-353. DOI: 10.3760/cma.j.cn121381-202202006-00189 |
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| 作者姓名： | 万宝 李娇 于诺 冯鑫 周科 刘博飞 朱耿强 王鑫 |
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| 作者单位： | 国家癌症中心，国家肿瘤临床医学研究中心，中国医学科学院北京协和医学院肿瘤医院放疗科，北京 100021 |
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| 摘 要： | 目的 比较胸中段食管癌采用3种不同放疗体位固定方式的摆位误差，分析不同放疗体位固定方式对锁骨上下区摆位误差的影响。 方法 回顾性分析2019年11月至2021年11月在中国医学科学院北京协和医学院肿瘤医院行调强放疗的73例食管癌患者的临床资料，其中男性56例、女性17例，中位年龄63.6（36.5~85.3）岁。73例患者分别采用3种不同的放疗体位固定方式：胸腹平架上举固定（双手交叉置于额头）组24例、胸腹平架体侧固定（双手置于体侧）组25例和颈胸一体架体侧固定（双手置于体侧）组24例。第1周行锥形束CT 5次，后续每周1次。记录配准前后区域内的左右（X）方向、头脚（Y）方向和腹背（Z）方向的平移摆位误差，测量3种不同放疗体位固定方式的肩锁关节平移摆位误差并分别计算肩锁关节的位置移动幅度ΔX、ΔY、ΔZ和三维空间位移d。组间两两比较采用独立样本t检验或Wilcoxon秩和检验。 结果 胸腹平架上举固定组、胸腹平架体侧固定组、颈胸一体架体侧固定组分别共行208、195和195次锥形束CT扫描，3组的平移摆位误差分别为X方向：（0.19±0.15）、（0.16±0.15）、（0.14±0.14） cm；Y方向：（0.30±0.24）、（0.27±0.22）、（0.21±0.20） cm；Z方向：（0.20±0.14）、（0.17±0.18）、（0.16±0.17） cm。颈胸一体架体侧固定组在3个方向上的平移摆位误差均小于另外2组，除与胸腹平架体侧固定组在Y方向的平移摆位误差的差异无统计学意义（t=0.85，P>0.05）外，其余差异均有统计学意义（t=−9.85~5.89，均P<0.05）。3组的肩锁关节的三维空间位移d分别为（0.24±0.17）、（0.28±0.16）、（0.23±0.13） cm。胸腹平架上举固定组与颈胸一体架体侧固定组的肩锁关节的位置移动幅度ΔY的差异有统计学意义[（0.11±0.11） cm对（0.13±0.11） cm，Z=−2.16，P<0.05]；胸腹平架体侧固定组与颈胸一体架体侧固定组的肩锁关节的位置移动幅度ΔZ [（0.18±0.15） cm对（0.12±0.10） cm， Z=−4.19，P<0.001]和肩锁关节的三维空间位移d [（0.28±0.16） cm对（0.23±0.13） cm， Z=−3.63，P<0.001]的差异均有统计学意义。 结论 对于需要行锁骨上下区放疗的胸中段食管癌患者，采用颈胸一体架体侧固定方式在平移摆位误差和肩锁关节的三维空间位移上明显优于胸腹平架固定方式，可以有效提高锁骨上下区的治疗精准度。
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| 关 键 词： | 食管肿瘤 放射疗法 摆位误差 固定装置 三维空间位移 |
| 收稿时间： | 2022-02-14 |
Comparative study of the set-up errors of different radiotherapy immobilization methods for mid-thoracic esophageal cancer patients |
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| Bao Wan,Jiao Li,Nuo Yu,Xin Feng,Ke Zhou,Bofei Liu,Gengqiang Zhu,Xin Wang. Comparative study of the set-up errors of different radiotherapy immobilization methods for mid-thoracic esophageal cancer patients[J]. International Journal of Radiation Medicine and Nuclear Medicine, 2022, 46(6): 347-353. DOI: 10.3760/cma.j.cn121381-202202006-00189 |
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| Authors: | Bao Wan Jiao Li Nuo Yu Xin Feng Ke Zhou Bofei Liu Gengqiang Zhu Xin Wang |
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| Affiliation: | Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Cancer, National Cancer Center, Beijing 100021, China |
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| Abstract: | Objective To compare the set-up errors of mid-thoracic esophageal cancer treated with three different radiotherapy immobilization methods and to analyze its influence on the set-up errors of the supraclavicular and infraclavicular region. Methods A total of 73 mid-thoracic esophageal cancer patients with supraclavicular lymph node metastasis treated from November 2019 to November 2021 at the Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College were retrospectively reviewed. The sample included 56 males and 17 females, with a median age of 63.6 (36.5−85.3) years. Of these, 24 patients were fixed with a thoracoabdominal flat frame, with both hands crossed on the forehead and 25 had both of their hands placed on the sides of their bodies. In addition, 24 patients were fixed with integrated cervicothoracic immobilization devices with both their hands on the sides of their bodies. Cone beam CT (CBCT) scans were performed once a day at the first five workdays and once a week in the following treatment time. Translational set-up errors in the (X direction) left and right, (Y direction) cranial and caudal, (Z direction) ventral and dorsal directions within the compared target volumes were recorded. The translational set-up error of the three modes of immobilization were compared, and the amplitudes of movement and the three-dimensional spatial displacement of the acromioclavicular joint were measured. Independent sample t-test or Wilcoxon rank sum test were employed to analyze the error values between groups. Results A total of 208, 195, and 195 CBCT scans were performed in the thoracoabdominal flat frame elevation, the thoracoabdominal flat frame side, and the integrated cervicothoracic immobilization device side groups, respectively. The translational set-up errors of the three groups were recorded for the left and right directions: (0.19±0.15), (0.16±0.15), and (0.14±0.14) cm; the cranial and caudal directions: (0.30±0.24), (0.27±0.22), and (0.21±0.20) cm; and the ventral and dorsal directions: (0.20±0.14), (0.17±0.18), and (0.16±0.17) cm, respectively. The translational set-up errors in the three directions of the integrated cervicothoracic immobilization device side group were better than those of the other two groups. Compared with the integrated cervicothoracic immobilization device side group, all the setup errors showed significant statistical differences (t=−9.85 to 5.89; all P<0.05), except for the thoracoabdominal flat frame side group in the Y direction (t=0.85, P>0.05). The three-dimensional displacement d values of the acromioclavicular joint in the three groups were (0.24±0.17), (0.28±0.16), and (0.23±0.13) cm, respectively. The difference of ΔY between thoracoabdominal flat frame elevation group and integrated cervicothoracic immobilization device side group was statistically significant ((0.11±0.11) cm vs. (0.13±0.11) cm, Z=−2.16, P<0.05). There were also significant differences in ΔZ ((0.18±0.15) cm vs. (0.12±0.10) cm, Z=−4.19, P<0.001) and the three-dimensional spatial displacement d values of the acromioclavicular joint ((0.28±0.16) cm vs. (0.23±0.13) cm, Z=−3.63, P<0.001) between the thoracoabdominal flat frame side and the integrated cervicothoracic immobilization device side groups. Conclusion For mid-thoracic esophageal cancer patients with irradiated supraclavicular and infraclavicular region, shoulder immobilization using integrated cervicothoracic immobilization devices is better in translational set-up errors and three-dimensional spatial displacement of the acromioclavicular joint than thoracoabdominal flat frame, as it can effectively improve the accuracy of a radiotherapy plan. |
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| Keywords: | Esophageal neoplasms Radiotherapy Setup errors Immobilization device Three dimensional displacement |
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