脊柱转移瘤调强放射治疗发泡剂泡沫垫和热塑体膜固定技术临床应用比较

Analysis in intensity modulated radiotherapy for spinal metastases using two immobilization devices

目的目前精准放射治疗已成为治疗恶性肿瘤脊柱转移的重要手段。本研究采用调强放疗技术(intensity modulated radiotherapy,IMRT)治疗恶性肿瘤脊柱转移,比较发泡剂泡沫垫和热塑体膜2种体位固定技术的精确性和舒适度。方法回顾性分析2018-06-01-2018-12-31西南医科大学附属医院肿瘤科60例恶性肿瘤脊柱转移患者,分为发泡胶组30例和体膜组30例。2组患者均接受IMRT治疗,并在治疗过程中进行3次CT-sim校位,以照射中心点为原点,以患者的左右、上下、前后(x、y、z)为三维方向建立坐标系,分析定位坐标系原点在上述坐标系中的位移。采用问卷调查形式评估患者对固定装置及技师操作的主观治疗护理舒适满意度。数字疼痛评分法(numerical rating scale,NRS)量化患者治疗前后的癌痛程度并评价镇痛效果,并按照常见不良事件评价标准随访不良反应。SPSS 17.0对数据进行统计学处理。结果发泡胶组摆位误差分别为,x轴(2.06±1.21)mm、y轴(2.36±1.42)mm和z轴(1.67±0.86)mm;体膜组摆位误差分别为,x轴(2.70±0.87)mm、y轴(2.13±1.59)mm和z轴(2.16±1.01)mm,其中x轴(t=-2.364)和z轴(t=-2.013)方向的摆位误差组间比较差异有统计学意义,均P<0.05。发泡胶组患者的主观舒适满意度为86.6%(26/30),体膜组患者的主观舒适满意度为63.3%(19/30),发泡胶组明显高于体膜组,χ^2=7.368,P=0.025。发泡胶组患者治疗前后NRS得分为7.10±2.16和3.23±1.94,差异有统计学意义,t=8.761,P<0.001;体膜组患者治疗前后NRS得分为6.87±2.69和3.27±1.72,差异有统计学意义,t=8.693,P<0.001。治疗后2组间NRS疼痛评分差异无统计学意义,t=-0.070,P=0.477。所有患者未见严重不良反应。结论发泡剂泡沫垫和热塑体膜2种体位固定技术均可将摆位误差控制在可接受范围内,发泡剂泡沫垫个体化固定技术可以减少患者摆位误差并提高在放疗中的舒适满意感,具有一定的临床应用意义。

OBJECTIVE Precise radiationtherapy has become the main treatment for malignant spinal metastasis.This research was to evaluate two immobilization techniques(styrofoam and body membrane)in intensity modulated radiotherapy(IMRT)for the treatment of malignant spinal metastasis.METHODS Sixty patients with malignant bone metastasis who underwent IMRT were divided into styrofoam group(30cases)and body membrane(30cases).Independent ttest was used to evaluate the differences among the setup errors in left-right(x),superior-inferior(y)and anterior-posterior(z)directions.The level of patient satisfaction with the immobilization techniques was assessed at the time of completing of IMRT.Pain intensity was evaluated by numeric rating scale(NRS)and side effects were carefully observed and recorded.RESULTS The setup errors of the styrofoam group were:x(2.06±1.21)mm,y(2.36±1.42)mm,and z(1.67±0.86)mm.The setup errors of the body film group were:x(2.70±0.87)mm,y(2.13±1.59)mm,z(2.16±1.01)mm,among which the difference in x and z directions was statistically significant(t=-2.364,t=-2.013,both P<0.05).The satisfaction of immobilization technique in the styrofoam group was 86.6%(26/30),and 63.3%(19/30)in the body film group.The styrofoam group was significantly higher than the body film group(χ^2=7.368,P=0.025).The NRS scores of patients in the styrofoam group before and after treatment were 7.10±2.16and 3.23±1.94,and the difference was statistically significant(t=8.761,P<0.001).The NRS scores of the patients in the body membrane group before and after treatment were 6.87±2.69and 3.27±1.72,and the difference was also statistically significant(t=8.693,P<0.001).However,there was no significant difference in NRS pain scores between the two groups after treatment(t=-0.070,P=0.477).Patients had not experienced any serious side effects events.CONCLUSIONS Styrofoam can increase the precision for immobilization of body position on patients with malignant bone metastasis received IMRT and enhance the comfort level of patient in treatment.It has the application value in clinical practice.