不同体位固定方式对肺部肿瘤主动呼吸控制放疗精准度影响的研究

Study on the impact of different immobilization methods on radiotherapy accuracy using active breathing control for lung tumors

    摘要
  • 摘要:
    目的 探讨不同体位固定方式对肺部肿瘤患者通过主动呼吸控制（ABC）系统放疗时摆位误差的影响，并分析体重指数（BMI）对摆位误差的潜在作用。
    方法 回顾性分析2022年1月至2023年6月于中国医学科学院肿瘤医院接受ABC系统放疗的30例肺部肿瘤患者的临床资料和影像资料，其中男性23例、女性7例，中位年龄66岁，范围47~79岁。根据是否使用体膜固定将患者分为体膜固定组和非体膜固定组。根据BMI分别将体膜固定组和非体膜固定组患者分为BMI正常组（18.5 kg/m2≤BMI≤24 kg/m2）和BMI超重组（>24 kg/m2）。所有患者均在放疗前通过锥形束CT（CBCT）进行靶区位置的校准，将CT定位图像与CBCT图像进行靶区配准，采集左右（LR）、头脚（SI）、腹背（AP）3个方向的摆位误差数据。计量资料的组间比较采用独立样本t检验；计数资料的组间比较采用卡方检验。
    结果 30例患者中，体膜固定组患者15例，其中BMI正常组7例、BMI超重组8例；非体膜固定组患者15例，其中BMI正常组9例、BMI超重组6例。体膜固定组与非体膜固定组LR、SI方向的摆位误差分别为（0.23±0.20） cm 对（0.11±0.18） cm、（0.21±0.29）cm 对（0.23±0.24）cm，且差异均有统计学意义（t=2.045、1.978，均P<0.05）；AP方向的摆位误差的差异无统计学意义（t=0.596，P=0.552）。体膜固定组中，BMI正常组与BMI超重组LR、SI、AP方向摆位误差的差异均无统计学意义（t=0.486、−0.675、0.492，均P>0.05）。非体膜固定组中，BMI超重组SI方向的摆位误差高于BMI正常组（0.15±0.27） cm对（0.14±0.21） cm（t=7.620，P<0.001）；BMI超重组和BMI正常组LR、AP方向摆位误差的差异均无统计学意义（t=1.198、1.259，均P>0.05）。
    结论 体膜固定与BMI对使用ABC系统进行的肺部肿瘤放疗的摆位误差存在影响。

     

    Abstract:
    Objective To investigate the impact of different immobilization methods on setup errors during radiotherapy using active breathing control (ABC) system for patients with lung tumor and analyze the potential influence of body mass index (BMI) on setup errors.
    Methods A retrospective analysis was conducted on the clinical and imaging data of 30 patients with lung tumor who underwent ABC system radiotherapy at the Cancer Hospital, Chinese Academy of Medical Sciences between January 2022 and June 2023. Among these patients, 23 were male and 7 were female, with a median age of 66 years, and an age range of 47–79 years. Patients were divided into a body fram immobilization group and a non-body fram immobilization group on the basis of whether body film fixation was used. Patients in the body fram immobilization and non-body fram immobilization groups were further subdivided into a BMI normal group (18.5 kg/m2≤BMI≤24 kg/m2) and a BMI overweight group (>24 kg/m2) in accordance with BMI. All patients underwent target area position calibration via cone-beam computed tomography (CBCT) before radiotherapy. CT positioning images were registered with CBCT images for target area matching, and setup error data in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were collected. The inter-group comparison of measurement data was conducted using independent sample t-test. The inter-group comparison of counting data was conducted using chi-square test.
    Results Among the 30 patients, 15 were allocated to the body fram immobilization group (7 in the BMI normal group and 8 in the BMI overweight group). The non-body fram immobilization group also comprised 15 patients (9 in the BMI normal group and 6 in the BMI overweight group). The setup errors in the LR and SI directions for the body fram immobilization group and the non-body fram immobilization group were (0.23±0.20) cm vs. (0.11±0.18) cm and (0.21±0.29) cm vs. (0.23±0.24) cm, respectively, with statistically significant differences (t=2.045, 1.978; both P<0.05). The setup error in the AP direction had no statistically significant differences (t=0.596, P=0.552). Within the body fram immobilization group, the setup errors in the LR, SI, and AP directions in the BMI normal group and the BMI overweight group had no statistically significant difference (t=0.486, −0.675, 0.492; all P>0.05). Within the non-body fram immobilization group, the setup error in the SI direction was higher in the BMI overweight group than in the BMI normal group ((0.15±0.27) cm vs. (0.14±0.21) cm, t=7.620, P<0.001). The differences in setup errors in the LR and AP directions between the BMI overweight and BMI normal groups were not statistically insignificant (t=1.198, 1.259; both P>0.05).
    Conclusion Body film fixation and BMI influence setup errors in radiotherapy for lung tumor using the ABC system.

     

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