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头颈部肿瘤为全球七大常见恶性肿瘤之一,国际流行病学研究机构的数据资料显示,近年来我国头颈部肿瘤的年发病率为15.22/10万,占全身恶性肿瘤的 4.45%[1]。放疗是头颈部肿瘤主要的治疗方式之一[2-5]。由于头颈部肿瘤组织来源丰富、解剖结构复杂,周边存在重要组织器官,因此,对放疗精确度要求更高。头颈部肿瘤调强适形放疗(intensity-modulated radiation therapy,IMRT)已经成为其常规放疗模式[6],要求更精确的剂量分布,这对日常摆位和位置精确度提出了更高的要求,摆位误差的大小直接影响到肿瘤控制效果和不良并发症的发生率[7],合适的体位固定方式可以提高摆位的准确率。本研究采用2种体位固定方式,探讨其对头颈部肿瘤放疗患者的摆位精确度和舒适度的影响。
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50例患者完成了258次EPID验证,其中对照组验证157次,观察组验证101次。由表1可知,以靶区为ROI,观察组患者的左右、头脚和腹背方向的摆位误差均小于对照组,且2组在腹背、左右方向的差异均有统计学意义(t=−2.435,P=0.016;t=2.289,P=0.023)。
组别 腹背方向(mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) −0.599±2.531 0.637±2.239 0.780±1.957 观察组(n=101) 0.057±1.805 0.569±1.611 0.020±2.946 t值 −2.435 0.282 2.289 P值 0.016 0.778 0.023 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 表 1 2组头颈部肿瘤放疗患者靶区不同方向摆位误差的 比较(
,mm)$ \bar{x}\pm s $ Table 1. Comparison of the setup errors in different directions of target area in 2 group of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $ -
由表2可知,2组患者以头部中心为ROI,观察组患者腹背、头脚、左右方向的摆位误差均小于对照组,且2组在腹背方向的差异有统计学意义(t=5.320,P<0.001),头脚、左右方向的差异无统计学意义(均P>0.05)。
组别 腹背方向(mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) 0.975±1.950 0.917±2.245 1.070±1.912 观察组(n=101) −0.327±1.898 0.594±2.089 0.891±1.944 t值 5.320 1.178 0.727 P值 <0.001 0.240 0.468 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 表 2 2组头颈部肿瘤放疗患者以头部中心为感兴趣区不同方向摆位误差的比较(
,mm)$ \bar{x}\pm s $ Table 2. Comparison of the setup errors in different directions of the head center as region of interest in 2 groups of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $ -
由表3可知,2组患者以颈部中心为ROI,观察组患者腹背、头脚、左右方向的摆位误差均小于对照组,且2组在腹背、左右方向的差异均有统计学意义(t=−3.947,P<0.001;t=3.431,P=0.001),头脚方向的差异无统计学意义(P>0.05)。
组别 腹背方向 (mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) 1.217±2.663 0.639±2.397 −0.764±2.600 观察组(n=101) 0.010±2.278 0.554±2.095 −0.574±2.321 t值 −3.947 0.292 3.431 P值 <0.001 0.77 0.001 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 表 3 2组头颈部肿瘤放疗患者以颈部中心为感兴趣区不同方向摆位误差的比较(
,mm)$ \bar{x}\pm s $ Table 3. Comparison of the setup errors in different directions in the neck center as region of interest in 2 groups of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $
塑形垫结合热塑膜在头颈部肿瘤放疗患者体位固定中的应用
Application of shaping pad combined with thermoplastic membrane in postural fixation for radiotherapy patients of head and neck neoplasms
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摘要:
目的 探讨塑形垫结合热塑膜在头颈部肿瘤放疗患者体位固定中的优势。 方法 收集2021年2月至2021年12月于山西医科大学第一医院治疗的50例头颈部肿瘤放疗患者的临床资料,其中男性40例、女性10例,年龄(58.0±8.2)岁。按照不同固定方式将患者分为观察组(30例)和对照组(20例)。观察组采用塑形垫结合头颈肩热塑膜个性化定位方式;对照组采用标准化头枕结合头颈肩热塑膜常规定位方式对头颈部肿瘤患者进行体位固定。患者在治疗过程中每周1次采用MV级电子射野影像系统(EPID)进行摆位验证,对2组头颈部肿瘤患者腹背、头脚、左右方向的摆位误差进行比较。组间比较采用独立样本t检验。 结果 50例患者完成了258次EPID验证,其中观察组验证101次,对照组验证157次。以靶区为感兴趣区(ROI),观察组患者在腹背、头脚、左右方向的摆位误差分别为(0.057±1.805)、(0.569±1.611)、(0.020±2.946) mm,小于对照组的(−0.599±2.531)、(0.637±2.239)、(0.780±1.957) mm,且2组在腹背和左右方向的差异有统计学意义(t=−2.435,P=0.016;t=2.289,P=0.023)。以头部中心为ROI,观察组患者在腹背、头脚、左右方向的摆位误差分别为(−0.327±1.898)、(0.594±2.089)、(0.891±1.944) mm,小于对照组的(0.975±1.950)、(0.917±2.245)、(1.070±1.912) mm,且2组在腹背方向的差异有统计学意义(t=5.320,P<0.001)。以颈部中心为ROI,观察组在腹背、头脚、左右方向的摆位误差分别为(0.010±2.278)、(0.554±2.095)、(−0.574±2.321) mm,小于对照组的(1.217±2.663)、(0.637±2.397)、(−0.764±2.600) mm,且2组在腹背和左右方向的差异有统计学意义(t=−3.947,P<0.001;t=3.431,P=0.001)。 结论 塑形垫结合热塑膜应用于头颈部肿瘤放疗患者的体位固定,可明显提高摆位精确度和患者的舒适度,具有临床推广价值。 Abstract:Objective To investigate the advantages of shaping pad combined with thermoplastic membrane in postural fixation for radiotherapy patients of head and neck neoplasms. Methods The clinical data of 50 patients with head and neck neoplasms treated by radiotherapy the First Hospital of Shanxi Medical University from February 2021 to December 2021 were collected, including 40 males and 10 females, aged (58.0±8.2) years. The selected patients were divided into the control group (20 cases) and the observation group (30 cases). The observation group was immobilized using individualized shaping pad with thermoplastic membrane, and the control group was fixed with standard plastics pillow with the thermoplastic membrane. The MV electronic portal imaging device (EPID) was carried out for postioning verification once a week, and the setup errors were compared in a vertical (abdominal and dorsal), longitudinal (head and foot), and lateral (left and right) direction. The setup errors were analyzed by independent sample t-test. Results A total of 50 patients completed 258 EPID validations, including 101 validations in the observation group and 157 validations in the control group. With the target area as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((0.057±1.805) mm vs. (0.599±2.531) mm, (0.569±1.611) mm vs. (0.637±2.239) mm; (0.020±2.946) mm vs. (0.780±1.957) mm, respectively), and the differences were statistically significant in a vertical and lateral direction (t=−2.435, P=0.016; t=2.289, P=0.023). With the head center as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((−0.327±1.898) mm vs. (0.975±1.950) mm, (0.594±2.089) mm vs. (0.917±2.245) mm, (0.891±1.944) mm vs. (1.070±1.912) mm, respectively), and the difference was statistically significant in a vertical direction (t=5.320, P<0.001). With the neck center as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((0.010±2.278) mm vs. (1.217±2.663) mm, (0.554±2.095) mm vs. (0.637±2.397) mm, (−0.574±2.321) vs. (−0.764±2.600) mm, respectively). Furthermore, and the differences were statistically significant in a vertical and lateral direction (t=−3.947, P<0.001; t=3.431, P=0.001). Conclusions The application of shaping pad and thermoplastic membrane in postural fixation of head and neck neoplasms during radiotherapy can improve positioning accuracy and patients' comfort, indicating their clinical promotion value. -
表 1 2组头颈部肿瘤放疗患者靶区不同方向摆位误差的 比较(
,mm)$ \bar{x}\pm s $ Table 1. Comparison of the setup errors in different directions of target area in 2 group of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $ 组别 腹背方向(mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) −0.599±2.531 0.637±2.239 0.780±1.957 观察组(n=101) 0.057±1.805 0.569±1.611 0.020±2.946 t值 −2.435 0.282 2.289 P值 0.016 0.778 0.023 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 表 2 2组头颈部肿瘤放疗患者以头部中心为感兴趣区不同方向摆位误差的比较(
,mm)$ \bar{x}\pm s $ Table 2. Comparison of the setup errors in different directions of the head center as region of interest in 2 groups of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $ 组别 腹背方向(mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) 0.975±1.950 0.917±2.245 1.070±1.912 观察组(n=101) −0.327±1.898 0.594±2.089 0.891±1.944 t值 5.320 1.178 0.727 P值 <0.001 0.240 0.468 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 表 3 2组头颈部肿瘤放疗患者以颈部中心为感兴趣区不同方向摆位误差的比较(
,mm)$ \bar{x}\pm s $ Table 3. Comparison of the setup errors in different directions in the neck center as region of interest in 2 groups of radiotherapy patients with head and neck neoplasms (
, mm)$ \bar{x}\pm s $ 组别 腹背方向 (mm) 头脚方向(mm) 左右方向(mm) 对照组(n=157) 1.217±2.663 0.639±2.397 −0.764±2.600 观察组(n=101) 0.010±2.278 0.554±2.095 −0.574±2.321 t值 −3.947 0.292 3.431 P值 <0.001 0.77 0.001 注:对照组为标准化塑料头枕结合头颈肩热塑膜固定;观察组为塑形垫结合头颈肩热塑膜固定 -
[1] Mody MD, Rocco JW, Yom SS, et al. Head and neck cancer[J]. Lancet, 2021, 398(10318): 2289−2299. DOI: 10.1016/S0140-6736(21)01550-6. [2] 葛俊恒, 王占龙. 头颈部肿瘤基础与临床新进展[M]. 北京: 人民军医出版社, 2005.
Ge JH, Wang ZL. Basic and clinical advances in head and neck cancer[M]. Beijing: People's Military Medical Press, 2005.[3] Chow LQM. Head and neck cancer[J]. N Engl J Med, 2020, 382(1): 60−72. DOI: 10.1056/NEJMra1715715. [4] 赖建军, 苏志伟, 蒋璐, 等. ExacTrac X线系统二种不同图像配准序列在头颈部肿瘤放疗中的应用研究[J]. 实用肿瘤杂志, 2021, 36(3): 263−267. DOI: 10.13267/j.cnki.syzlzz.2021.054.
Lai JJ, Su ZW, Jiang L, et al. Application of two different image registration sequences in ExacTrac X-ray system for head and neck cancer radiotherapy[J]. J Practi Oncol, 2021, 36(3): 263−267. DOI: 10.13267/j.cnki.syzlzz.2021.054.[5] 张超, 杨健. 调强放疗摆位误差的研究进展[J]. 重庆医学, 2021, 50(4): 684−688. DOI: 10.3969/J.issn.1671-8348.2021.04.032.
Zhang C, Yang J. Advances in setup errors of intensity modulated radiation therapy[J]. Chongqing Med, 2021, 50(4): 684−688. DOI: 10.3969/J.issn.1671-8348.2021.04.032.[6] 刘晓斌, 沈文. 影像组学在头颈部肿瘤放疗的研究进展[J]. 中华放射肿瘤学杂志, 2021, 30(1): 98−101. DOI: 10.3760/cma.j.cn113030-20191009-00408.
Liu XB, Shen W. Research progress on application of radiomics in radiotherapy of head and neck cancer[J]. Chin J Radiat Oncol, 2021, 30(1): 98−101. DOI: 10.3760/cma.j.cn113030-20191009-00408.[7] 科安昂, 加登. 头颈部肿瘤放射治疗[M]. 潘建基, 李建成, 付杰, 译. 长春: 吉林科学技术出版社, 2011.
Ke AA, Jia D. Radiotherapy for head and neck cancer[M]. Pan JJ, Li JC, Fu J, trans. Changchun: Jilin Science and Technology Press, 2011.[8] 陆维, 许婷婷, 许青, 等. 应用CBCT、EPID研究鼻咽癌2种体位固定方式摆位误差的比较分析[J]. 中国癌症杂志, 2014, 24(7): 535−539. DOI: 10.3969/j.issn.1007-3969.2014.07.011.
Lu W, Xu TT, Xu Q, et al. Comparison of set-up errors detected by EPID and CBCT using two different immobilization techniques for patients with nasopharygeal carcinoma[J]. China Oncol, 2014, 24(7): 535−539. DOI: 10.3969/j.issn.1007-3969.2014.07.011.[9] Hridya VT, Khanna D, Raj A, et al. Dosimetric importance of the implementation of daily image guidance in radiotherapy practice[J]. Asian Pac J Cancer Prev, 2022, 23(1): 355−361. DOI: 10.31557/APJCP.2022.23.1.355. [10] Tachibana H, Motegi K, Moriya S. Impact of shoulder deformation on volumetric modulated arc therapy doses for head and neck cancer[J]. Phys Med, 2018, 53: 118−128. DOI: 10.1016/j.ejmp.2018.08.015. [11] Contesini M, Guberti M, Saccani R, et al. Setup errors in patients with head-neck cancer (HNC), treated using the intensity modulated radiation therapy (IMRT) technique: how it influences the customised immobilisation systems, patient's pain and anxiety[J/OL]. Radiat Oncol, 2017, 12(1): 72[2022-09-13]. https://ro-journal.biomedcentral.com/articles/10.1186/s13014-017-0807-y. DOI: 10.1186/s13014-017-0807-y. [12] Li YH, Wei ZF, Liu ZB, et al. Quantifying the dosimetric effects of neck contour changes and setup errors on the spinal cord in patients with nasopharyngeal carcinoma: establishing a rapid estimation method[J]. J Radiat Res, 2022, 63(3): 443−451. DOI: 10.1093/jrr/rrac009. [13] Alabedi H. Assessing setup errors and shifting margins for planning target volume in head, neck, and breast cancer[J]. J Med Life, 2023, 16(3): 394−398. DOI: 10.25122/jml-2022-0241. [14] Bell K, Licht N, Rübe C, et al. Image guidance and positioning accuracy in clinical practice: influence of positioning errors and imaging dose on the real dose distribution for head and neck cancer treatment[J/OL]. Radiat Oncol, 2018, 13(1): 190 [2022-09-13]. https://ro-journal.biomedcentral.com/articles/10.1186/s13014-018-1141-8. DOI: 10.1186/s13014-018-1141-8. [15] 牛保龙, 曲宝林, 金丽媛, 等. 发泡剂泡沫垫与头颈肩低温热塑膜在放射治疗中体位固定稳定性的比较[J]. 中国医学装备, 2017, 14(7): 32−36. DOI: 10.3969/J.ISSN.1672-8270.2017.07.008.
Niu BL, Qu BL, Jin LY, et al. Comparison of stability for immobilization of position between pad of styrofoam and low temperature thermoplastic film of neck and shoulder in radiotherapy[J]. China Med Equip, 2017, 14(7): 32−36. DOI: 10.3969/J.ISSN.1672-8270.2017.07.008.[16] 张雷, 段诗苗, 孙谦. 发泡胶联合热塑膜在头颈部肿瘤放疗中的应用研究[J]. 重庆医学, 2021, 50(12): 2054−2056. DOI: 10.3969/j.issn.1671-8348.2021.12.017.
Zhang L, Duan SM, Sun Q. Study on application of styrofoam combined with thermoplastic film in radiotherapy for head and neck tumor[J]. Chongqing Med, 2021, 50(12): 2054−2056. DOI: 10.3969/j.issn.1671-8348.2021.12.017.[17] 应惟良, 李平英, 黄玉玲, 等. 塑形垫联合头颈肩膜在头颈部肿瘤放疗体位固定中的应用[J]. 实用癌症杂志, 2019, 34(9): 1533−1535, 1549. DOI: 10.3969/j.issn.1001-5930.2019.09.041.
Ying WL, Li PY, Huang YL, et al. Application of plastic pad combined with head and neck membrane in radiotherapy of head and neck tumor[J]. Prac J Cancer, 2019, 34(9): 1533−1535, 1549. DOI: 10.3969/j.issn.1001-5930.2019.09.041.[18] 韩琤波, 贾明轩, 张旭, 等. 兆伏级锥形束CT在鼻咽癌调强放射治疗中的临床应用研究[J]. 中国医科大学学报, 2010, 39(8): 635−638.
Han ZB, Jia MX, Zhang X, et al. Application study of megavolt cone-beam computed tomography to intensity-modulated radiotherapy of nasopharyngeal carcinoma[J]. J China Med Univ, 2010, 39(8): 635−638.[19] 徐森奎, 姚文燕, 胡江, 等. 鼻咽癌发泡胶个体化塑形与标准化头枕放疗体位固定精确度比较[J]. 中华放射肿瘤学杂志, 2015, 24(2): 196−199. DOI: 10.3760/cma.j.issn.1004-4221.2015.02.022.
Xu SK, Yao WY, Hu J, et al. The research of accuracy immobilized using individualized polyurethane scaling agent compared to positioning foam with standard plastics pillow in the radiotherapy of nasopharyngeal carcinoma[J]. Chin J Radiat Oncol, 2015, 24(2): 196−199. DOI: 10.3760/cma.j.issn.1004-4221.2015.02.022.[20] 惠华, 张旭光, 陈宏林, 等. 脊柱后凸头颈部肿瘤患者放疗摆位重复性研究[J]. 肿瘤研究与临床, 2016, 28(6): 399−403. DOI: 10.3760/cma.j.issn.1006-9801.2016.06.009.
Hui H, Zhang XG, Chen HL, et al. Study of radiotherapy positioning repeatability of kyphosis patients with head and neck cancer[J]. Cancer Res Clin, 2016, 28(6): 399−403. DOI: 10.3760/cma.j.issn.1006-9801.2016.06.009.[21] 段巧. 发泡胶用于头颈部肿瘤头颈肩体位固定放疗的临床效果[J]. 医疗装备, 2018, 31(8): 88−89. DOI: 10.3969/j.issn.1002-2376.2018.08.064.
Duan Q. Clinical effect of styrofoam for immobilization of position in radiotherapy of head and neck tumor[J]. Med Equip, 2018, 31(8): 88−89. DOI: 10.3969/j.issn.1002-2376.2018.08.064.