乳腺癌两种不同固定方式的摆位误差研究
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摘要
目的探讨头颈部固定方式F枕加真空袋和去F枕、真空袋两种方式对乳腺癌放射治疗的摆位误差的影响。方法选择2017年2月至12月在武汉大学人民医院进行调强放射治疗的乳腺癌女性患者30例,年龄25~65岁,中位年龄45岁。随机分为2组,每组15例。A组头颈部固定方式为F枕加真空袋,B组头颈部固定方式为去F枕、真空袋头部内陷固定。配准设备使用Varian 23Ⅸ直线加速器,对每例患者行锥形束CT(CBCT)图像引导,频率为每周1次,骨配准并结合人工校对获得患者左右方向(x轴)、头脚方向(y轴)、前后方向(z轴)摆位误差。结果 A组、B组分别行CBCT 75例次。A组在y轴、z轴的绝对摆位误差大于B组(P=0.046、0.029);两组在x轴的绝对摆位误差比较,差异无统计学意义(P> 0.05)。A组在y轴的相对摆位误差大于B组(P=0.024);两组在x轴、z轴相对摆位误差比较,差异无统计学意义(P> 0.05)。结论两种固定方式对乳腺癌的摆位误差差异有统计学意义,宜选择去F枕、真空袋头部内陷固定方式进行治疗。
Objective To explore the effect of two different fixation methods on the set-up error of breast cancer during radiotherapy. Methods From February to December in 2017, a total of 30 breast cancer patients performed intensive radiation therapy were enrolled, which aged 25-65 years old with median age of 45 years old. All patients were randomly divided into2 groups(n = 15). In group A, patients' head and neck were fixed with F-pillow and vacuum bag, while in group B, F-pillow was removed and their heads were inset in vacuum bag. The Varian 23 Ⅸ linear accelerator was used to guide three dimensional conformal radiation therapy(CBCT) once a week. The set-up errors data in left-right(x-axis), cranio-caudal(y-axis) and anterior-posterior(z-axis) were obtained by bone registration and manual proofing. Results Two groups were performed 75 times of CBCT, respectively. The absolute error of group A in y-axis and z-axis were greater than that of group B(P = 0.046 and P = 0.029),while absolute error difference on x-axis was no statistically significant between 2 groups. The relative error of group A on yaxis was significantly larger than that of group B(P = 0.024). However, there was no significant difference in x-axis and z-axis errors between 2 groups(P > 0.05). Conclusion It is demonstrated that two fixation methods showed statistic significance for breast cancer set-up errors. It is advisable to choose removal F-pillow and inset head fixation method for treatment.
Objective To explore the effect of two different fixation methods on the set-up error of breast cancer during radiotherapy. Methods From February to December in 2017, a total of 30 breast cancer patients performed intensive radiation therapy were enrolled, which aged 25-65 years old with median age of 45 years old. All patients were randomly divided into2 groups(n = 15). In group A, patients' head and neck were fixed with F-pillow and vacuum bag, while in group B, F-pillow was removed and their heads were inset in vacuum bag. The Varian 23 Ⅸ linear accelerator was used to guide three dimensional conformal radiation therapy(CBCT) once a week. The set-up errors data in left-right(x-axis), cranio-caudal(y-axis) and anterior-posterior(z-axis) were obtained by bone registration and manual proofing. Results Two groups were performed 75 times of CBCT, respectively. The absolute error of group A in y-axis and z-axis were greater than that of group B(P = 0.046 and P = 0.029),while absolute error difference on x-axis was no statistically significant between 2 groups. The relative error of group A on yaxis was significantly larger than that of group B(P = 0.024). However, there was no significant difference in x-axis and z-axis errors between 2 groups(P > 0.05). Conclusion It is demonstrated that two fixation methods showed statistic significance for breast cancer set-up errors. It is advisable to choose removal F-pillow and inset head fixation method for treatment.
引文
[1] LUO Jian-qi, SI Zheng-chao, ZHANG Liang, et al. Dosimetric study on intensity modulated radiotherapy for breast cancer after the modified radical mastectomy of breast cancer[J].Ningxia Medical Journal, 2017, 39(2):132-134.[罗建奇,思铮超,张亮,等.乳腺癌改良根治术后调强放疗的剂量学研究[J].宁夏医学杂志,2017,39(2):132-134.]
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[4] LI Yan-ping. Research progress of early breast cancer’s conserving surgery and postoperative treatment[J]. Medical Recapitulate, 2013, 19(1):69-71.[黎艳萍.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.]
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[6] TONG Qin, WU Hai-biao, CHEN Zheng-song, et al. Dosimetric study of 3 radiotherapy techniques after modified radical mastectomy for breast cancer[J]. The Journal of Practical Medicine, 2015, 31(18):3016-3018.[童琴,伍海彪,陈政颂,等.乳腺癌改良根治术后3种放疗技术的剂量学研究[J].实用医学杂志,2015,31(18):3016-3018.]
[7] HE Chun-yu, SIMAYILI Maimaitiniyazi, HAN You-xi, et al. Application of bilateral integrated inverse intensity-modulation radiotherapy in the treatment of primary synchronous bilateral breast cancer[J]. Journal of Chinese Practical Diagnosis and Therapy, 2016, 30(5):488-489.[贺春钰,司马义力·买买提尼牙孜,韩有溪,等.双侧整体化逆向调强放疗在双侧乳腺癌术后放疗中应用[J].中华实用诊断与治疗杂志,2016,30(5):488-489.]
[8] WANG Xiao-yang, LIU Jian-hua, YU Hai-dong. An analysis on the application value of intensity modulated radiation therapy in the radiotherapy after radical mastectomy[J]. China Medicine and Pharmacy, 2014, 4(5):79-81.[王晓阳,刘建华,俞海东.调强技术在乳腺癌根治术后放射治疗中的应用价值[J].中国医药科学,2014,4(5):79-81.]
[9] YE Sen-lin, LIANG Ting, RONG Zhi-bi. Setup error analysis with on board imager system for nasopharyngeal carcinoma treated by intensity modulated radiotherapy[J]. Clinical Medical Equipment, 2012, 33(3):64-65.[叶森林,梁廷,荣知璧.应用OBI系统分析鼻咽癌调强放疗的摆位误差[J].医疗卫生装备,2012,33(3):64-65.]
[10] ZHANG Yu-hai, XIA Huo-sheng, GAO Yang. Measurement of the imaging dose for head and neck cancer by different image-guided methods[J]. Chinese Journal of Medical Instrumentation, 2010, 34(6):455-457.[张玉海,夏火生,高杨.不同图像引导方式在头颈部肿瘤中成像剂量测量[J].中国医疗器械杂志,2010,34(6):455-457.]
[11] MA Xiang, MAO Dong-jun, YAO Jia-hong, et al. Application of first setup in intensity modulated radiotherapy for head and neck tumor by cone beam CT[J]. China Medical Devices, 2013, 28(4):114-115.[马翔,茅冬俊,姚家红,等.CBCT在头颈部肿瘤调强放疗首次摆位中的应用[J].中国医疗设备,2013,28(4):114-115.]
[12] TIE Jian, SUN Yan, GONG Jian, et al. Dosimetric study comparing volumetric arc modulation with RapidArc and fixed field dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery[J]. Chinese Journal of Radiology Medicine and Protection, 2011, 31(3):317-321.[铁剑,孙艳,弓健,等.保乳术后固定野动态调强与容积调强放疗的剂量学比较[J].中华放射医学与防护杂志,2011,31(3):317-321.]
[2] Early Breast Cancer Trialists Collaborative Groups(EBCTCG),Correa C, Mcgale P, Taylor C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast[J]. J Natl Cancer Inst Monogr, 2010, 2010(41):162-177.
[3] Falco G, Rocco N, Procaccini E, et al. Breast conserving treatment for ductal carcinoma in situ in the elderly:can radiation therapy be avoided? Our experience[J]. Int J Surg, 2014,12(Suppl 2):S47-S49.
[4] LI Yan-ping. Research progress of early breast cancer’s conserving surgery and postoperative treatment[J]. Medical Recapitulate, 2013, 19(1):69-71.[黎艳萍.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.]
[5] YU Jin-ming, LI Jian-bin. Advances in radiation therapy following breast conserving therapy for breast cancer[J/CD].Chinese Journal of Breast Disease(Electronic Version), 2007,6(3):13-22.[于金明,李建彬.乳腺癌保乳术后放射治疗进展[J/CD].中华乳腺病杂志(电子版),2007,6(3):13-22.]
[6] TONG Qin, WU Hai-biao, CHEN Zheng-song, et al. Dosimetric study of 3 radiotherapy techniques after modified radical mastectomy for breast cancer[J]. The Journal of Practical Medicine, 2015, 31(18):3016-3018.[童琴,伍海彪,陈政颂,等.乳腺癌改良根治术后3种放疗技术的剂量学研究[J].实用医学杂志,2015,31(18):3016-3018.]
[7] HE Chun-yu, SIMAYILI Maimaitiniyazi, HAN You-xi, et al. Application of bilateral integrated inverse intensity-modulation radiotherapy in the treatment of primary synchronous bilateral breast cancer[J]. Journal of Chinese Practical Diagnosis and Therapy, 2016, 30(5):488-489.[贺春钰,司马义力·买买提尼牙孜,韩有溪,等.双侧整体化逆向调强放疗在双侧乳腺癌术后放疗中应用[J].中华实用诊断与治疗杂志,2016,30(5):488-489.]
[8] WANG Xiao-yang, LIU Jian-hua, YU Hai-dong. An analysis on the application value of intensity modulated radiation therapy in the radiotherapy after radical mastectomy[J]. China Medicine and Pharmacy, 2014, 4(5):79-81.[王晓阳,刘建华,俞海东.调强技术在乳腺癌根治术后放射治疗中的应用价值[J].中国医药科学,2014,4(5):79-81.]
[9] YE Sen-lin, LIANG Ting, RONG Zhi-bi. Setup error analysis with on board imager system for nasopharyngeal carcinoma treated by intensity modulated radiotherapy[J]. Clinical Medical Equipment, 2012, 33(3):64-65.[叶森林,梁廷,荣知璧.应用OBI系统分析鼻咽癌调强放疗的摆位误差[J].医疗卫生装备,2012,33(3):64-65.]
[10] ZHANG Yu-hai, XIA Huo-sheng, GAO Yang. Measurement of the imaging dose for head and neck cancer by different image-guided methods[J]. Chinese Journal of Medical Instrumentation, 2010, 34(6):455-457.[张玉海,夏火生,高杨.不同图像引导方式在头颈部肿瘤中成像剂量测量[J].中国医疗器械杂志,2010,34(6):455-457.]
[11] MA Xiang, MAO Dong-jun, YAO Jia-hong, et al. Application of first setup in intensity modulated radiotherapy for head and neck tumor by cone beam CT[J]. China Medical Devices, 2013, 28(4):114-115.[马翔,茅冬俊,姚家红,等.CBCT在头颈部肿瘤调强放疗首次摆位中的应用[J].中国医疗设备,2013,28(4):114-115.]
[12] TIE Jian, SUN Yan, GONG Jian, et al. Dosimetric study comparing volumetric arc modulation with RapidArc and fixed field dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery[J]. Chinese Journal of Radiology Medicine and Protection, 2011, 31(3):317-321.[铁剑,孙艳,弓健,等.保乳术后固定野动态调强与容积调强放疗的剂量学比较[J].中华放射医学与防护杂志,2011,31(3):317-321.]