锥形束CT引导下乳腺癌保留乳房术后调强放疗摆位误差临床分析
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摘要
目的摆位误差是影响乳腺癌保留乳房术后调强放疗的主要因素,合适的体位固定技术能有效地降低摆位误差。本研究利用锥形束CT(cone-beam computed tomography,CBCT)探讨体膜联合乳腺托架与体膜联合体板2种固定技术在乳腺癌保留乳房术后调强放疗前的摆位误差,从而得出较优的体位固定方式。方法选取2017-11-01-2018-02-25新疆医科大学附属肿瘤医院收治的34例接受保留乳房术后调强放疗的乳腺癌患者,将其平均分为A和B 2组,A组使用体膜联合乳腺托架,B组使用体膜联合体板固定装置,在CBCT引导下对IMRT治疗前摆位进行验证,患者首次及以后每周1次均行CBCT扫描。将重建好的CBCT图像与计划CT图像行自动匹配,得到患者在左右(X)、前后(Y)和头脚(Z)3个方向上的摆位误差,并进行比较。结果 2组34例患者共获得196组CBCT验证图像,A组摆位误差的绝对值中位数X(左右)为1.0mm,Y(上下)为1.0mm,Z(前后)为2.0mm,B组摆位误差的绝对值中位数X(左右)为2.0mm,Y(上下)为1.5mm,Z(前后)为3.0mm;2组比较X方向Z=-2.081,P=0.037;Y方向Z=-2.537,P=0.011;Z方向Z=-2.791,P=0.005;差异均有统计学意义;A组X方向的位移分布<3mm为91.8%,3～5mm为7.1%,>5mm为1.0%;Y方向<3mm为99.0%,3～5mm为1.0%,>5mm为0;Z方向<3 mm为81.6%,3～5 mm为15.3%,>5mm为3.1%。B组X方向的位移分布<3mm为82.7%,3～5mm为9.2%,>5mm为8.2%;Y方向<3mm为88.8%,3～5mm为7.1%,>5mm为4.1%;Z方向<3mm为55.1%,3～5mm为34.7%,>5mm为10.2%,2组位移分布比较X方向(P=0.043),Y方向(P=0.003),Z方向(P<0.001),差异均有统计学意义。结论乳腺癌保留乳房术后调强放疗中采用2种不同固定技术,应用体膜联合乳腺托架固定技术在3个方向上均优于体膜联合体板。
OBJECTIVE The set-up errors is an important factor which affects intensity modulated radiation therapy(IMRT)after breast conserving surgery of breast cancer.Significant Set-up errors reduction can be achieved with the use of Suitable fixation devices.This study investigated the set-up errors between the body film combined with the breast bracket and the body holder before intensity modulated radiation therapy after Breast Conserving Surgery of Breast Cancer based on Cone-beam CT to get a better position immobilization.METHODS The clinical data of 34 patients from November 1 st,2017 to February 25 th,2018 received IMRT after breast conserving surgery in the Affiliated Tumor Hospital of Xinjiang Medical University were enrolled in the study.Then they were randomly divided into two groups.Group A was applied with breast bracket for positioning and group B with body holder.Based on the onboard CBCT set-up verification was performed for the first time and per week after that for each patient before IMRT treatment.The CBCT image was automatically matched with the CT simulation image.The set-up variations in three dimension,X(left and right),Y(upper and lower)and Z(front and rear)axes were measured.RESULTS All 34 cases were given 196 times of CBCT scanning before treatment,the median absolute value of the set-up errors of group A was 1.0 mm on X axes(left and right),1.0 mm on Y axes(upper and lower),2.0 mm on Z axes(front and rear).By the same token,the value of group B was 2.0 mm on X axes(left and right),1.5 mm on Y axes(upper and lower),3.0 mm on Z axes(front and rear).The Z-value on X axes were-2.081,P=0.037,the Z-value on Y axes were-2.537,P=0.011,the Z-value on Z axes were-2.791,P=0.005,compared the two groups had a significant difference.The displacement distributions of group A on X axes were 91.8%in<3 mm,7.1%in 3-5 mm,and 1.0%in >5 mm.Y axes were 99.0%in <3 mm,1.0%in 3-5 mm,and 0%in>5 mm.Z axes were 81.6%in<3 mm,15.3%in 3-5 mm,and 3.1%in>5 mm.Similarly,the displacement distributions of group B on X axes were 82.7%in<3 mm,9.2%in 3-5 mm,8.2%in>5 mm.Y axes were88.8%in<3 mm,7.1%in 3-5 mm,4.1%in>5 mm.Z axes were 55.1%in<3 mm,34.7%in 3-5 mm,10.2%in>5 mm.Compared the two groups,the displacement distributions on X axes(P=0.043),Y axes(P=0.003)and Z axes(P<0.001)had a significant difference.CONCLUSION With two different fixation devices,breast bracket is superior to the body holder on three dimensions for IMRT after breast conserving surgery of breast cancer.
OBJECTIVE The set-up errors is an important factor which affects intensity modulated radiation therapy(IMRT)after breast conserving surgery of breast cancer.Significant Set-up errors reduction can be achieved with the use of Suitable fixation devices.This study investigated the set-up errors between the body film combined with the breast bracket and the body holder before intensity modulated radiation therapy after Breast Conserving Surgery of Breast Cancer based on Cone-beam CT to get a better position immobilization.METHODS The clinical data of 34 patients from November 1 st,2017 to February 25 th,2018 received IMRT after breast conserving surgery in the Affiliated Tumor Hospital of Xinjiang Medical University were enrolled in the study.Then they were randomly divided into two groups.Group A was applied with breast bracket for positioning and group B with body holder.Based on the onboard CBCT set-up verification was performed for the first time and per week after that for each patient before IMRT treatment.The CBCT image was automatically matched with the CT simulation image.The set-up variations in three dimension,X(left and right),Y(upper and lower)and Z(front and rear)axes were measured.RESULTS All 34 cases were given 196 times of CBCT scanning before treatment,the median absolute value of the set-up errors of group A was 1.0 mm on X axes(left and right),1.0 mm on Y axes(upper and lower),2.0 mm on Z axes(front and rear).By the same token,the value of group B was 2.0 mm on X axes(left and right),1.5 mm on Y axes(upper and lower),3.0 mm on Z axes(front and rear).The Z-value on X axes were-2.081,P=0.037,the Z-value on Y axes were-2.537,P=0.011,the Z-value on Z axes were-2.791,P=0.005,compared the two groups had a significant difference.The displacement distributions of group A on X axes were 91.8%in<3 mm,7.1%in 3-5 mm,and 1.0%in >5 mm.Y axes were 99.0%in <3 mm,1.0%in 3-5 mm,and 0%in>5 mm.Z axes were 81.6%in<3 mm,15.3%in 3-5 mm,and 3.1%in>5 mm.Similarly,the displacement distributions of group B on X axes were 82.7%in<3 mm,9.2%in 3-5 mm,8.2%in>5 mm.Y axes were88.8%in<3 mm,7.1%in 3-5 mm,4.1%in>5 mm.Z axes were 55.1%in<3 mm,34.7%in 3-5 mm,10.2%in>5 mm.Compared the two groups,the displacement distributions on X axes(P=0.043),Y axes(P=0.003)and Z axes(P<0.001)had a significant difference.CONCLUSION With two different fixation devices,breast bracket is superior to the body holder on three dimensions for IMRT after breast conserving surgery of breast cancer.
引文
[1]再依奴尔·阿布都外力,赵婷,刘志云等.2010-2014年新疆医科大学附属肿瘤医院住院病历主要恶性肿瘤生存分析[J].中华肿瘤防治杂志,2016,23(11):699-703.
[2]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017版)[J].中国癌症杂志,2017,27(9):695-760.
[3]刘旭红,陈晓,艾毅钦,等.左乳腺癌保乳术后混合调强放射治疗计划与单纯调强放射治疗计划剂量学比较与分析[J].中国医学物理学杂志,2015,32(4):572-577.
[4]王文岩,肖志清,王艳强,等.应用4DCT研究乳腺癌根治术后胸壁IMRT的放射物理学优势[J].中华放射肿瘤杂志,2014,23(2):152-155.
[5] Kim HL,Mus A,Wong J,et al.On-line localization of the lumpectomy cavity using surgical clips[J].Int J Radiat Oncol Biol Phys,2007,69(4):1305-1309.
[6] Topolnjak R,van Vliet-Vroegindeweij C,Sonke JJ,et al.Breastconserving therapy:Radiotherapy margins for breast tumor bed boost[J].Inl J Radiat Oncol Biol Phys,2008,72(3):941-948.
[7] Keating NL,Landrum MB,BrooksJM,et al.Outcomes following local therapy for early-stage breast cancer in non-trial populations[J].Breast Cancer Rese Treatment,2011,125(3):803-813.
[8]余子豪,王淑莲.早期乳腺癌保乳术后部分乳腺照射的现状[J].中华乳腺病杂志,电子版,2009,3(6):583-589.
[9]黎艳萍,陈卫东,廖玲霞.早期乳腺癌保乳术及术后治疗的研究进展[J].医学综述,2013,19(1):69-71.
[10] Korcum AF,Yavuz MN.Breast and Tumor Bed[M].New York:Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer,Springer New York.2013:163-171.
[11]葛琴,吴建亭,谢国栋.胸部肿瘤放射治疗两种体位固定技术摆位误差比较研究[J].中华肿瘤防治杂志,2012,19(18):1424-1426.
[12]彭庆国,尹勇,余宁莎,等.三种体位固定技术在盆腔肿瘤放疗中的应用比较[J].中华肿瘤防治杂志,2015,22(12):974-977.
[13] Bahig H,RoussinE,Yassa M,et al.Partial Kilovoltage cone beam computed tomography,complete kilovoltage cone computed tomography,and electronic portal images for breast radiation therapy:a dose-comparison study[J].Practical Radiation Oncology,2015,5(5):e521-e529.
[14]付秀根,熊华,郑祖安,等.颈胸-体热塑膜固定下乳腺癌放疗摆位误差分析[J].肿瘤研究与临床,2018,30(6):374-378.
[15]向凤昭.乳腺托架加体模固定在乳腺癌放疗中的应用价值分析[J].中国医药指南,2018,16(4)128-129.
[16]阎华伟,金献测,周永强,等.机载KV-CBCT在乳腺癌调强放射治疗误差分析中的应用[J].实用医学杂志,2013,29(13):2149-2151.
[17]胡乃军,蔡钢,许青,等.早期乳腺癌保乳术后不同固定装置下全乳照射的摆位误差分析[J].中国癌症杂志,2015,25(11):911-916.
[2]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017版)[J].中国癌症杂志,2017,27(9):695-760.
[3]刘旭红,陈晓,艾毅钦,等.左乳腺癌保乳术后混合调强放射治疗计划与单纯调强放射治疗计划剂量学比较与分析[J].中国医学物理学杂志,2015,32(4):572-577.
[4]王文岩,肖志清,王艳强,等.应用4DCT研究乳腺癌根治术后胸壁IMRT的放射物理学优势[J].中华放射肿瘤杂志,2014,23(2):152-155.
[5] Kim HL,Mus A,Wong J,et al.On-line localization of the lumpectomy cavity using surgical clips[J].Int J Radiat Oncol Biol Phys,2007,69(4):1305-1309.
[6] Topolnjak R,van Vliet-Vroegindeweij C,Sonke JJ,et al.Breastconserving therapy:Radiotherapy margins for breast tumor bed boost[J].Inl J Radiat Oncol Biol Phys,2008,72(3):941-948.
[7] Keating NL,Landrum MB,BrooksJM,et al.Outcomes following local therapy for early-stage breast cancer in non-trial populations[J].Breast Cancer Rese Treatment,2011,125(3):803-813.
[8]余子豪,王淑莲.早期乳腺癌保乳术后部分乳腺照射的现状[J].中华乳腺病杂志,电子版,2009,3(6):583-589.
[9]黎艳萍,陈卫东,廖玲霞.早期乳腺癌保乳术及术后治疗的研究进展[J].医学综述,2013,19(1):69-71.
[10] Korcum AF,Yavuz MN.Breast and Tumor Bed[M].New York:Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer,Springer New York.2013:163-171.
[11]葛琴,吴建亭,谢国栋.胸部肿瘤放射治疗两种体位固定技术摆位误差比较研究[J].中华肿瘤防治杂志,2012,19(18):1424-1426.
[12]彭庆国,尹勇,余宁莎,等.三种体位固定技术在盆腔肿瘤放疗中的应用比较[J].中华肿瘤防治杂志,2015,22(12):974-977.
[13] Bahig H,RoussinE,Yassa M,et al.Partial Kilovoltage cone beam computed tomography,complete kilovoltage cone computed tomography,and electronic portal images for breast radiation therapy:a dose-comparison study[J].Practical Radiation Oncology,2015,5(5):e521-e529.
[14]付秀根,熊华,郑祖安,等.颈胸-体热塑膜固定下乳腺癌放疗摆位误差分析[J].肿瘤研究与临床,2018,30(6):374-378.
[15]向凤昭.乳腺托架加体模固定在乳腺癌放疗中的应用价值分析[J].中国医药指南,2018,16(4)128-129.
[16]阎华伟,金献测,周永强,等.机载KV-CBCT在乳腺癌调强放射治疗误差分析中的应用[J].实用医学杂志,2013,29(13):2149-2151.
[17]胡乃军,蔡钢,许青,等.早期乳腺癌保乳术后不同固定装置下全乳照射的摆位误差分析[J].中国癌症杂志,2015,25(11):911-916.