头颈部肿瘤精确放射治疗个体化固定技术临床应用
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摘要
目的研究头颈部个体化固定技术对放射治疗摆位误差的影响,探讨它在头颈部肿瘤精确放射治疗中临床应用价值。方法选择2017年1月至2018年4月头颈部肿瘤患者40例,其中男性25例,女性15例;年龄22～75岁,平均年龄48岁。根据头颈部固定方式的不同分为2组,采用个体化头枕固定为个体化组,采用常规塑料头枕固定为标准化组,每组20例。在日常放射治疗摆位后,均应用锥形束CT(CBCT)进行摆位线性误差和旋转误差的测量,每组均采集100组数据。结果个体化组和标准化组在左右、头脚和前后方向摆位线性误差分别为(0.25±1.06) mm、(0.17±1.12) mm、(-0.52±2.06) mm和(-0.65±1.68) mm、(0.81±1.49) mm、(-0.29±1.31) mm;两组在头脚方向比较,差异有显著统计学意义(P=0.000 041 <0.01)。个体化组和标准化组绕左右、头脚和前后方向的摆位旋转误差分别为0.31°±0.58°、0.42°±0.53°、0.22°±0.76°和0.92°±1.29°、0.51°±0.71°、0.86°±1.43°;两组绕左右、前后方向比较,差异有显著统计学意义(P=0.000 15、0.000 43 <0.01)。结论与标准化固定技术相比,个体化固定技术的摆位误差更小,对于提高头颈部放射治疗摆位精度具有临床应用价值。
Objective To evaluate individualized fixation of head and neck system for setup error, and discuss its clinical application in precise radiotherapy of patients with head and neck tumors. Methods From January 2017 to April 2018, 40 patients with head and neck tumor were enrolled, which included 25 males and 15 females, aged 22-75 years old with mean age of 48 years old. According to different fixation system, all of them were divided into individualized group(20 cases, with individualized headrest) and standardization group(20 cases, with conventional plastic headrest). After routine radiotherapy setup, the cone beam CT(CBCT) was used to measure linear error and rotation error, and collected 100 sets of data were collected in each group. Results The linear errors of the individualized group and standardized group in left-right(LR), superior-inferior(SI) and anterior-posterior(AP) were(0.25 ± 1.06) mm,(0.17 ± 1.12) mm,(-0.52 ± 2.06) mm and(-0.65 ± 1.68) mm,(0.81 ±1.49) mm,(-0.29 ± 1.31) mm, respectively. There was statistically significant difference in AP between 2 groups(P = 0.000 041 <0.01). The setup rotation error of LR, SI and AP of individualized group and standardized group were 0.31° ± 0.58°, 0.42° ±0.53°, 0.22° ± 0.76° and 0.92° ± 1.29°, 0.51° ± 0.71°, 0.86° ± 1.43°, respectively. There were statistically significant difference in rotation SI and AP between 2 groups(P = 0.000 15, 0.000 43 < 0.01). Conclusion It is demonstrated that setup error of individualized fixation is lower than that of standardized fixation, and it has clinical application value for improving the setup accuracy of head and neck radiation therapy.
Objective To evaluate individualized fixation of head and neck system for setup error, and discuss its clinical application in precise radiotherapy of patients with head and neck tumors. Methods From January 2017 to April 2018, 40 patients with head and neck tumor were enrolled, which included 25 males and 15 females, aged 22-75 years old with mean age of 48 years old. According to different fixation system, all of them were divided into individualized group(20 cases, with individualized headrest) and standardization group(20 cases, with conventional plastic headrest). After routine radiotherapy setup, the cone beam CT(CBCT) was used to measure linear error and rotation error, and collected 100 sets of data were collected in each group. Results The linear errors of the individualized group and standardized group in left-right(LR), superior-inferior(SI) and anterior-posterior(AP) were(0.25 ± 1.06) mm,(0.17 ± 1.12) mm,(-0.52 ± 2.06) mm and(-0.65 ± 1.68) mm,(0.81 ±1.49) mm,(-0.29 ± 1.31) mm, respectively. There was statistically significant difference in AP between 2 groups(P = 0.000 041 <0.01). The setup rotation error of LR, SI and AP of individualized group and standardized group were 0.31° ± 0.58°, 0.42° ±0.53°, 0.22° ± 0.76° and 0.92° ± 1.29°, 0.51° ± 0.71°, 0.86° ± 1.43°, respectively. There were statistically significant difference in rotation SI and AP between 2 groups(P = 0.000 15, 0.000 43 < 0.01). Conclusion It is demonstrated that setup error of individualized fixation is lower than that of standardized fixation, and it has clinical application value for improving the setup accuracy of head and neck radiation therapy.
引文
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[8] YING Wei-liang, YE Xin-qian, WU Jin-ming. Periodic error analysis of radiotherapy for positioning of patients with nasopharyngeal carcinoma by thermoplastic facial mask[J]. Practical Journal of Cancer, 2008, 23(5):525-526.[应惟良,叶新芊,吴金明.热塑面膜固定鼻咽癌患者放疗摆位技术的周期误差分析[J].实用癌症杂志,2008,23(5):525-526.]
[9] FU Xiu-gen, YUAN Xiang-lin, ZHENG Zu-an, et al. Study on customized polyurethane foam head and neck support in intensity-modulated radiotherapy for head and neck neoplasms using cone-beam CT[J]. Radiologic Practice, 2017,32(5):522-525.[付秀根,袁响林,郑祖安,等.锥形束CT分析发泡胶个体化头枕在头颈部肿瘤调强放射治疗中的应用[J].放射学实践,2017,32(5):522-525.]
[10] LI Bao-sheng, ZHU Jian. Individualized radiotherapy for tumor[J]. Chinese Journal of Cancer Prevention and Treatment,2014, 21(23):1845-1850.[李宝生,朱健.肿瘤个体化放射治疗[J].中华肿瘤防治杂志,2014,21(23):1845-1850.]
[2] Petkar I, Rooney K, Roe JW, et al. DARS:a phaseⅢrandomised multicentre study of dysphagia-optimised intensitymodulated radiotherapy(Do-IMRT)versus standard intensitymodulated radiotherapy(S-IMRT)in head and neck cancer[J].BMC Cancer, 2016, 16(1):770-770.
[3] ZHUANG Ting-ting, GUO He-feng, WANG Guo-xi, et al.Analysis of positioning errors and weight variability in the radiation for head and neck cancer based on cone-beam computed tomography[J]. Cancer Research and Clinic, 2015,27(2):91-94, 106-106.[庄婷婷,郭和锋,王国喜,等.基于锥形束CT的头颈部肿瘤精确放疗摆位误差与体质量变化的相关性[J].肿瘤研究与临床,2015,27(2):91-94,106-106.]
[4] Lee AW, Ma BB, Ng WT, et al. Management of nasopharyngeal carcinoma:current practice and future perspective[J]. J Clin Oncol, 2015, 33(29):3356-3364.
[5] Stroom JC, Heijmen BJ. Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report[J]. Radiother Oncol, 2002, 64(1):75-83.
[6] ZU Guo-hong, LI Fu-sheng, SU Chen, et al. Advances in research on positioning errors of precise radiotherapy for head and neck tumors[J]. Chinese Journal of Radiation Health,2016, 25(1):125-128.[祖国红,李福生,苏晨,等.头颈部肿瘤精确放疗摆位误差的研究进展[J].中国辐射卫生,2016,25(1):125-128.]
[7] Liu CHA, Kwong DLW, Lee WYV. EP-2376:Evaluation of dosimetric consequences of setup errors on NPC using VMAT[J]. Radiotherapy and Oncology, 2018, 127:S1244-S1244.
[8] YING Wei-liang, YE Xin-qian, WU Jin-ming. Periodic error analysis of radiotherapy for positioning of patients with nasopharyngeal carcinoma by thermoplastic facial mask[J]. Practical Journal of Cancer, 2008, 23(5):525-526.[应惟良,叶新芊,吴金明.热塑面膜固定鼻咽癌患者放疗摆位技术的周期误差分析[J].实用癌症杂志,2008,23(5):525-526.]
[9] FU Xiu-gen, YUAN Xiang-lin, ZHENG Zu-an, et al. Study on customized polyurethane foam head and neck support in intensity-modulated radiotherapy for head and neck neoplasms using cone-beam CT[J]. Radiologic Practice, 2017,32(5):522-525.[付秀根,袁响林,郑祖安,等.锥形束CT分析发泡胶个体化头枕在头颈部肿瘤调强放射治疗中的应用[J].放射学实践,2017,32(5):522-525.]
[10] LI Bao-sheng, ZHU Jian. Individualized radiotherapy for tumor[J]. Chinese Journal of Cancer Prevention and Treatment,2014, 21(23):1845-1850.[李宝生,朱健.肿瘤个体化放射治疗[J].中华肿瘤防治杂志,2014,21(23):1845-1850.]