个体化塑形垫在鼻咽癌放射治疗体位固定中的临床应用研究

The clinical application of individualized plastic cushion in position fixation of radiotherapy for nasopharyngeal carcinoma

目的探讨个体化塑形垫在鼻咽癌放射治疗体位固定中的临床应用价值。方法收集2015年1月至2015年10月香港大学深圳医院收治的鼻咽癌患者40例,根据放疗定位方式的不同将入选患者分为塑形垫组和真空负压袋组,每组各20例。塑形垫组患者采用个体化塑形垫进行体位固定,真空负压袋组患者采用传统的头颈肩真空负压袋联合头颈肩热塑膜进行体位固定。两组患者在放疗前使用机载影像系统拍摄1次头颈部的正侧位片,将获得的图像与治疗计划系统生成的数字重建图像进行比较,记录其在三维方向和旋转角度上的摆位误差,并对两组患者放疗期间出现的不良反应进行比较。结果塑形垫组患者在左右方向(lateral,Lat)、头脚方向(longitudinal,Lng)、前后方向(vertica,Vrt)的摆位误差分别为(0.78±0.79)mm、(1.04±0.97)mm、(0.63±0.70)mm,旋转误差为0.34˚±0.39˚;真空负压袋组患者在Lat、Lng、Vrt方向的摆位误差分别为(1.05±1.15)mm、(1.60±1.55)mm、(0.91±1.12)mm,旋转误差为0.38˚±0.51˚。塑形垫组患者在Lat、Lng、Vrt方向的摆位误差均显著小于真空负压袋组(均P<0.05),两组患者旋转误差比较无统计学意义(P>0.05)。塑形垫组患者出现皮肤反应、口腔黏膜反应、吞咽困难、声音嘶哑的时间均晚于真空负压袋组(均P<0.05)。结论使用个体化塑形垫进行鼻咽癌放疗体位固定精确度高,能延缓放疗不良反应的发生,具有较好的临床应用价值。

Objective To explore the clinical application value of individualized plastic cushion in postural fixation for nasopharyngeal carcinoma.Method 40 cases of nasopharyngeal carcinoma patients admitted to the University of Hong Kong-Shenzhen Hospital from January 2015 to October 2015 were collected.According to the different radiotherapy positioning methods,the selected patients were divided into individualized plastic cushion group and vacuum negative pressure bag group,with 20 cases in each group.Patients of individualized plastic cushion group were immobilized using individualized plastic cushion,and patients of vacuum negative pressure bag group were immobilized using head-and-neck vacuum bag with head-and-neck thermoplastic masks.Before radiotherapy,the two groups of patients used the airborne imaging system to take a frontal and lateral image of the head and neck once,and the obtained images were compared with the digital reconstruction images generated by the treatment planning system.The alignment errors in the three-dimensional direction and rotation angle were recorded and the adverse reactions during radiotherapy were compared between the two groups.Result The lateral(Lat),longitudinal(Lng)and vertica(Vrt)of individualized plastic cushion group were(0.78±0.79)mm,(1.04±0.97)mm and(0.63±0.70)mm,respectively,and the rotation errors were(0.34˚±0.39˚).In the vacuum negative pressure bag group,the positioning errors in Lat,Lng and Vrt directions were(1.05±1.15)mm,(1.60±1.55)mm and(0.91±1.12)mm,respectively,and the rotation errors were 0.38˚±0.51˚.The positioning errors of the plastic pad group in Lat,Lng and Vrt directions were significantly lower than those in vacuum negative pressure bag group(all P<0.05).There was no significant difference in rotation error between the two groups(P>0.05).The time of skin reaction,oral mucosa reaction,dysphagia and hoarseness in individualized plastic cushion group was later than that in vacuum negative pressure bag group(all P<0.05).Conclusion The use of individualized plastic cushion for nasopharyngeal carcinoma radiotherapy has high accuracy in body fixation,which can delay the occurrence of adverse reactions of radiotherapy and has a good clinical application value.