早期乳腺癌保乳术后不同固定装置下全乳照射的摆位误差分析

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英文篇名：Comparison of setup variations between two fixation devices for radiation after breast-conserving surgery 作者：胡乃军 ; 蔡钢 ; 许青 ; 陈佳艺 英文作者：HU Naijun;CAI Gang;XU Qing;CHEN Jiayi;Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University;Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine; 关键词：乳腺托架 ; 手臂托架 ; 摆位误差 ; 乳腺肿瘤 ; 全乳放射治疗 英文关键词：Breast bracket;;Arm support;;Setup variations;;Breast neoplasms;;Whole breast radiation 中文刊名：ZGAZ 英文刊名：China Oncology 机构：复旦大学附属肿瘤医院放疗科复旦大学上海医学院肿瘤学系;上海交通大学医学院附属瑞金医院放疗科; 出版日期：2015-11-30 出版单位：中国癌症杂志 年：2015 期：v.25;No.193 语种：中文; 页：ZGAZ201511015 页数：6 CN：11 ISSN：31-1727/R 分类号：81-86

摘要

背景与目的:准确的靶区位置是乳腺癌精确放疗的重要影响因素。本研究利用电子射野影像系统(electronic portal imaging device,EPID)测量乳腺托架和手臂托架两种不同体位固定状态下全乳放疗前、后的摆位误差,并对比其差别。方法:选择12例接受保乳术后调强放疗的乳腺癌患者,6例体位固定装置使用乳腺托架,6例使用手臂托架,在患者分次放疗前、后拍摄切线野的电子射野影像片(electronic portal imaging,EPI),将得到的EPI和数字重建图像(digitally reconstructed radiograph,DRR)进行配准,计算摆位误差,并进行比较。结果:手臂托架组的水平与垂直方向的位移分布分别为>5 mm:0和0;3~5 mm:6.6%和4.9%;<3 mm:93.4%和95.1%。乳腺托架组的水平与垂直方向的位移分布分别为>5 mm:6.7%和3.3%;3~5 mm:45.0%和23.3%;<3 mm:48.3%和73.3%。手臂托架组在放疗前EPI得到的水平与垂直方向的平均位移值小于乳腺托架组,差异有统计学意义(P=0.000,P=0.006)。两组放疗前、后分次内均存在位移,水平方向的差异有统计学意义(P=0.003,P=0.008),且手臂托架组在放疗前、后分次内的位移差值优于乳腺托架组,水平方向的差异有统计学意义(P=0.000)。结论:乳腺托架、手臂托架均有较好的全乳放疗摆位重复性和准确性,手臂托架在放疗前及分次内的位移优于乳腺托架,更适宜全乳放射治疗的体位固定。
        Background and purpose: Correct target positioning is an important factor affecting precise radiotherapy in patients with breast cancer. We measured the setup variations respectively with breast bracket and arm support for radiation after breast-conserving surgery using electronic portal imaging device(EPID), and analyzed the differences. Methods: Twelve breast cancer patients receiving intensity modulation radiation therapy after breastconserving surgery were enrolled in the study. Six patients were applied with breast brackets for positioning and another six with arm support. Electronic portal imaging(EPI) was performed for each patient before and after fractionated radiation at the position of the two main tangential fields. The EPI image was manually matched with the digitally reconstructed radiograph(DRR) derived from CT simulation image. And the setup variations in vertical and horizontal directions were measured. Results: The setup errors of arm support group in horizontal and vertical directions were 0 and 0 in >5 mm, 6.6% and 4.9% in 3-5 mm, 93.4% and 95.1% in <3 mm, respectively. The setup errors of breast bracket group were 6.7% and 3.3% in >5 mm, 45.0% and 23.3% in 3-5 mm, 48.3% and 73.3% in <3 mm, respectively. The differences of interfraction variation between two groups before fractionated radiation in both horizontal and vertical directions were statistically significant(P=0.000, P=0.006). The differences of interfraction variation between two groups in horizontal direction were statistically significant(P=0.003, P=0.008). And the difference of interfraction variation between two groups in horizontal direction was statistically significant(P=0.000). Conclusion: Breast brackets and arm support are both useful immobilization devices to ensure accuracy and reproducibility for radiation after breastconserving surgery. Arm support is superior to breast bracket and is recommended for position immobilization in whole breast radiation.

引文

[1]王健仰,王淑莲,黄鹏,等.乳腺托架固定下全乳调强放疗摆位误差兆伏X线验证平片测定分析[J].中华放射肿瘤学杂志,2013,22(3):239-242.
    [2]CLARKE M,COLLINS R,DARBY S,et al.Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J].Lancet,2005,366(9503):2087-2106.
    [3]FISHER B,ANDERSON S,BRYANT J,et al.Twenty-year follow-up of a randomized trial comparing total mastectomy,lumpectomy,and lumpectomy plus irradiation for the treatment of invasive breast cancer[J].N Engl J Med,2002,347(16):1233-1241.
    [4]SALM A V,STRIJBOS J,DIJCKS C,et al.Use of skin markers and electronic portal imaging to improve verification of tangential breast irradiation[J].Radiother Oncol,2009,90(1):106-109.
    [5]TRUONG P T,BERTHELET E,PATENAUDE V,et al.Setup variations in locoregional radiotherapy for breast cancer:an electronic portal imaging study[J].Br J Radiol,2005,78(932):742-745.
    [6]刘莉莉,徐威威,陈林.改进后的乳腺托架对提高放疗质量的作用[J].实用肿瘤学杂志,2008,22(5):454-455.
    [7]龚建舟,张萍,俞晓立,等.影响乳腺癌术后精确放疗的因素分析[J].中国癌症杂志,2009,19(6):439-442.
    [8]陈林,胡洪涛,云惟康,等.乳腺癌放疗体位固定技术的改进[J].中华放射肿瘤学杂志,2007,16(6):490-491.
    [9]TOPOLNJAK R,SONKE J J,NIJKAMP J,et al.Breast patient setup error assessment:comparison of electronic portal image devices and cone-beam computed tomography matching results[J].Int J Radiat Oncol Biol Phys,2010,78(4):1235-1243.
    [10]SIJTSEMA N M,VAN DIJK-PETERS F B,LANGENDIJK J A,et al.Electronic portal images(EPIs)based position verification for the breast simultaneous integrated boost(SIB)technique[J].Radiother Oncol,2012,102(1):108-114.
    [11]FENG C H,GERRY E,CHMURA S J,et al.An image-guided study of setup reproducibility of postmastectomy breast cancer patients treated with inverse-planned intensity modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2015,91(1):58-64.
    [12]CAI G,HU W G,CHEN J Y,et al.Impact of residual and intrafractional errors on strategy of correction for imageguided accelerated partial breast irradiation[J].Radiat Oncol,2010,5:96.