改良颈肩体热塑膜固定下颈胸段食管癌放射治疗中的摆位误差分析

来源期刊：广州医药 | 52-57 发布时间：2023-10-12 收稿时间：2025/11/13 18:30:57 阅读量：159

作者：: 万丽娟,

许晓燕,

王亭亭,

王沛沛,

黄普胜,

李金凯,

关键词：: 食管癌体位固定摆位误差分析放射治疗; esophageal cancer body position fixation set-up error analysis radiotherapy

DOI：: 10.3969/j.issn.1000-8535.2023.09.009

收稿时间：: 2023-02-12
修订日期：
接收日期：
引用总数：: 2

目的应用锥形束CT比较改良颈肩体热塑膜和传统颈肩体热塑膜体位固定装置在颈胸段食管癌患者放射治疗中的摆位差异,分析两种固定方式对锁骨上下区摆位误差的影响。方法分析2021年6月—2022年10月在南京医科大学第一附属医院行放射治疗的29例食管癌患者的临床资料。将患者分为改良颈肩体热塑膜组（改良组）和光板颈肩体热塑膜组（对照组）,对比分析2组病例不同配准区域的摆位误差。结果改良组在X（左右）方向的平移误差及Rz（冠状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组锁骨上下区在X（左右）方向的平移误差以及Rx（矢状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组的整体靶区外放范围在X、Y方向上均小于颈肩体组,改良组在锁骨上下区的X方向靶区外放范围也更小。结论对于颈胸段食管癌需行锁骨上下区放疗的患者,应用改良颈肩体热塑膜可减少平移误差,控制旋转角度,减少靶区外放范围。

Objective To compare the set-up errors between the modified neck-shoulder body thermoplastic film and the traditional neck-shoulder body thermoplastic film fixation device in the radiotherapy of patients with cervical and thoracic esophageal cancer by cone beam CT,and to analyze the influence of the two fixation methods on the positioning error of the upper and lower clavicular region．Methods The clinical data of 29 patients with esophageal cancer who underwent radiotherapy in the First Affiliated Hospital of Nanjing Medical University from June 2021 to October 2022 were analyzed．The patients were divided into two groups：the modified neck-shoulder body thermoplastic film group（the modified group）and the smooth neck-shoulder body thermoplastic film group（the control group）,the positioning errors in different regions of the two groups were compared and analyzed．Results The translation error in the X（left and right）direction and the rotation error in the Rz（coronal plane）direction of the modified group were smaller than those of the control group,and the differences were statistically significant（P<0.05）．The translation error in the X（left and right）direction and the rotation error in the Rx（sagittal plane）direction of the superior and inferior clavicular region in the modified group were smaller than those in the control group,and the differencs were statistically significant（P<0.05）．The overall target area of the modified group was smaller in X and Y directions than that of the neck-shoulder body group,and the target area of the improved group in X direction was also smaller in the upper and lower clavicle area．Conclusions For patients with cervical and thoracic esophageal cancer who need radiotherapy in the upper and lower clavicular region,the application of modified neck shoulder body thermoplastic film can reduce the translation error,control the rotation angle and reduce the external radiation range of the target region．

1、白胜江,刘玉涛,李敏,等.正向射野在颈及胸上段食管癌IMRT的运用[J].中国CT和MRI杂志,2022,20(3):64-66.

2、陆康才,董秀娟,涂燕玲,等.多种体罩在胸上段食管癌IMRT中的固定性比较[J].中国医疗器械信息,2019,25(19):44-45.

3、 XI M,LIN S H.Recent advances in intensity modulated radiotherapy and proton therapy for esophageal cancer[J].Expert Rev Anticancer Ther,2017,17(7):635-646.

4、万宝,杨旭,郇福奎,等.肺癌和食管癌两种不同放疗体位锁骨上区摆位误差比较[J].中华放射肿瘤学杂志,2022,31(3):272-276.

5、谢自宏,王鹏.胸中段食管癌调强放疗计划设计剂量对比研究[J].安徽医药,2022,26(8):1593-1597.

6、王丹,沙翔燕,林海磊.中上段食管癌图像引导放疗中摆位误差及靶区外放边界的确定[J].中华放射医学与防护杂志,2014,34(8):610-612.

7、王振立,朱健,郑安平,等.胸中段食管癌图像引导治疗精确性评估[J].中华肿瘤防治杂志,2022,29(17):1271-1276.

8、 CHEN H,HUANG Y,WANG H,et al.Dosimetric comparison and biological evaluation of fixed-jaw intensity-modulated radiation therapy for T-shaped esophageal cancer[J].Radiat Oncol,2021,16(1):158.

9、 van HERK M.Errors and margins in radiotherapy[J].Semin Radiat Oncol,2004,14(1):52-64.

10、惠周光,王群,韩伟,等.食管癌放疗两种不同固定体位对摆位误差的影响[J].中华放射肿瘤学杂志,2014,23(4):336-339.

11、 SYLLAIOS A,VAILAS M,TOLIA M,et al.Radiation-induced esophageal cancer:investigating the pathogenesis,management,and prognosis[J].Medicina(Kaunas),2022,58(7):949.

12、万宝,李娇,于诺,等.不同放疗体位固定方式在胸中段食管癌中摆位误差的比较研究[J].国际放射医学核医学杂志,2022,46(6):347-353.

13、 WU A J,BOSCH W R,CHANG D T,et al.Expert consensus contouring guidelines for intensity modulated radiation therapy in esophageal and gastroesophageal junction cancer[J].Int J Radiat Oncol Biol Phys,2015,92(4):911-920.

14、 SEYEDIN S N,PAREKH K R,GINADER T,et al.The role of definitive radiation and surgery in metastatic esophageal cancer:an NCDB investigation[J].Ann Thorac Surg,2021,112(2):459-466.

15、 WANG X,HOBBS B,GANDHI S J,et al.Current status and application of proton therapy for esophageal cancer[J].Radiother Oncol,2021(164):27-36.

1、郑鹏旭.热塑膜联合真空垫在胸腹部肿瘤放射治疗中摆位误差的影响分析[J].中国医疗器械信息,2025,31(18):34-36.DOI:10.15971/j.cnki.cmdi.2025.18.004.

2、张喆,贾志强,肖克亚·亚森,等.乳腺癌根治术后放疗患者的两种固定方式比较[J].新疆医学,2025,55(09):1104-1106.