摘要
目的:分析在头颈部肿瘤放疗中采用头颈肩塑形垫加热塑膜固定技术时使用标准枕和不使用标准枕在摆位固定精度上的差异,为临床应用提供参考。方法:选取2022年01月01日至2022年12月31日在本院进行放射治疗的167例头颈部肿瘤患者为研究对象。TOMO治疗73例,A1为无枕组26例,A2为有枕组47例;VMAT治疗94例,B1为无枕组37例,B2为有枕组57例。所有患者在TOMO治疗前行兆伏级扇形束CT扫描,采用骨性配准,在VMAT治疗前行机载千伏级锥形束CT扫描,采用骨配准+灰度配准,获得X轴(左右)、Y轴(头脚)、Z轴(腹背)方向上的摆位误差,使用计划靶区外扩边界公式(M_(PTV))=2.5Σ+0.7σ算出对应外扩边界。结果:1 396次摆位误差数据结果:TOMO A1组X轴、Y轴、Z轴分别为(0.08±0.24)mm、(0.14±0.4)mm和(0.15±0.47)mm,A2组分别为(0.49±2.02)mm、(0.22±0.7)mm和(0.12±0.45)mm,其中X轴和Y轴方向上的摆位误差组间比较差异有统计学意义(均P<0.001);VMAT B1组X轴、Y轴、Z轴分别为(0.04±0.24)mm、(0.15±0.3)mm和(-0.2±0.38)mm,B2组分别为(0.19±0.54)mm、(0.1±0.49)mm和(-0.19±0.43)mm,三个方向上的摆位误差组间比较差异均有统计学意义(P<0.05)。外扩边界(M_(PTV)):TOMO A1组X轴、Y轴和Z轴分别为2.36 mm、3.47 mm和1.83 mm;A2组分别为3.04 mm、4.79 mm、1.61 mm;VMAT B1组分别为2.72 mm、2.80 mm、1.95 mm;B2组分别为3.70 mm、3.54 mm、2.92 mm。无枕组X轴和Y轴上M_(PTV)均小于有枕组,且在三个方向上的M_(PTV)均匀性优于有枕组。结论:采用头颈肩塑形垫加热塑膜固定技术中无枕固定方式可减小头颈部肿瘤放疗左右和头脚方向上的摆位误差和外扩边界,提高外扩边界均匀性。
Objective:To analyze the differences in the positioning accuracy of plastic pad combined with head,neck and shoulder membrane fixation in radiotherapy for head and neck cancer with and without standard plastic pillow,to provide reference for clinical decision-making.Methods:Totally 167 patients with head and neck cancer who underwent radiotherapy in our hospital from January 1,2022 to December 31,2022 were selected as the research objects.Among them,73 patients were treated with TOMO,of which 26 patients were treated without standard plastic pillow(A1 group),and 47 patients were treated with standard plastic pillow(A2 group).94 patients were treated with VMAT,of which 37 patients without standard plastic pillow(B1 group),and 57 patients with standard plastic pillow(B2 group).Megavolt fan-beam CT scanning and bone-based registration were performed before TOMO treatment.Similarly,kilovolt cone-beam CT scanning and bone-based&gray-based registration were performed before VMAT treatment.All patients underwent CT scan before radiotherapy to obtain X-axis(left-right),Y-axis(head-to-foot),and Z-axis(anterior-posterior)set-up errors.The margin of planning target volume(M_(PTV))was calculated by formula:M_(PTV)=2.5Σ+0.7σ.Results:Totally 1396 set-up errors were obtained:X-axis(0.08±0.24)mm,Y-axis(0.14±0.4)mm,Z-axis(0.15±0.47)mm for A1 group,X-axis(0.49±2.02)mm,Y-axis(0.22±0.7)mm,Z-axis(0.12±0.45)mm for A2 group.There were significant differences in set-up errors between the two groups in the direction of X and Y ( P <0.001).The set-up errors were X-axis (0.04±0.24) mm,Y-axis (0.15±0.3) mm,Z-axis (-0.2±0.38) mm for B1 group,X-axis (0.19±0.54) mm,Y-axis (0.1±0.49) mm,Z-axis (-0.19±0.43) mm for B2 group.There were significant differences in set-up errors in three directions between the two groups ( P <0.05).M_(PTV) in the X-axis,Y-axis and Z-axis for TOMO A1 group was 2.36 mm,3.47 mm and 1.83 mm respectively,3.04 mm,4.79 mm,1.61 mm for TOMO A2 group,2.72 mm,2.80 mm,1.95 mm for VMAT B1 group,3.70 mm,3.54 mm and 2
作者
吴雨
郭希婧
赵培珠
张瑞
周华
WU Yu;GUO Xijing;ZHAO Peizhu;ZHANG Rui;ZHOU Hua(Department of Oncology Radiotherapy,the First Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650000,China)
出处
《现代肿瘤医学》
CAS
北大核心
2023年第22期4221-4224,共4页
Journal of Modern Oncology
关键词
体位固定
头颈部肿瘤
放射治疗
摆位误差
外扩边界
immobilization
head and neck cancer
radiotherapy
set-up error
margin of planning target volume
