肺癌和食管癌两种不同放疗体位锁骨上区摆位误差比较

Comparison of setup errors in supraclavicular regions of lung and esophageal cancer treated with radiotherapy

目的探讨应用胸腹平架固定装置的体侧与上举两种体位方式放疗时,肺癌、食管癌锁骨上区摆位误差的差异。方法回顾性分析2020—2021年在本中心行三维放疗的Ⅰ-Ⅳ期肺癌和食管癌患者资料,比较两种体位方式(双臂置于身体两侧即体侧组和双臂交叉抱肘置于额前即上举组)的摆位误差。结果共纳入56例患者,其中体侧组31例(55%),上举组25例(45%)。全组共进行了424次CBCT验证,两组整体摆位误差在X、Y、Z方向上相近(均P>0.05)。体侧组胸锁关节摆位误差在X和RZ方向上显著小于上举组[(0.163±0.120)cm∶(0.209±0.152)cm,P=0.033和0.715°±0.628°∶0.910°±0.753°,P=0.011]。体侧组肩锁关节摆位误差在Y和Z及RZ方向上显著小于上举组[(0.233±0.135)cm∶(0.284±0.193)cm,P=0.033和(0.202±0.140)cm∶(0.252±0.173)cm,P=0.005及0.671°±0.639°∶0.885°±0.822°,P=0.023]。体侧组在胸锁关节的X(0.45 cm∶0.54 cm)、Y(0.54 cm∶0.65 cm)方向以及肩锁关节的Y(0.59 cm∶0.78 cm)、Z(0.53 cm∶0.72 cm)方向需要的靶区外放范围更小。结论对于需要行锁骨上区照射的肺癌和食管癌患者,体侧组较上举组的摆位误差和靶区外放范围更小。临床上需要综合考虑放疗精确性和肢体额外照射,选择合适的体位。

Objective To compare the setup errors in the supraclavicular regions of two different postures(arms placed on each side of the body,namely the body side group;arms crossed and elbows placed above forehead,namely the uplifted group)using the chest and abdomen flat frame fixation device in lung and esophageal cancer.Methods Clinical data of patients with stageⅠtoⅣlung or esophageal cancer who received three-dimensional radiotherapy with chest and abdomen flat frame fixation device in our institution from November 2020 to April 2021 were retrospectively analyzed.The setup errors of two postures were compared.Results A total of 56 patients were included,including 31 patients(55%)in the body side group and 25 patients(45%)in the uplifted group.A total of 424 CBCTs were performed in the whole group.The overall setup errors in the X,Y and Z directions were similar in both groups(P>0.05).The setup errors of sternoclavicular joint in the X and RZ directions in the body side group were significantly smaller than those in the uplifted group[(0.163±0.120)cm vs.(0.209±0.152)cm,P=0.033;0.715°±0.628°vs.0.910°±0.753°,P=0.011].The setup errors of acromioclavicular joint in the Y,Z and RZ directions in the body side group were significantly smaller than those in the uplifted group[(0.233±0.135)cm vs.(0.284±0.193)cm,P=0.033;(0.202±0.140)cm vs.(0.252±0.173)cm,P=0.005;0.671°±0.639°vs.0.885°±0.822°,P=0.023].The margins of target volume for setup errors were smaller in the X(0.45cm vs.0.54cm)and Y(0.54cm vs.0.65cm)directions of the sternoclavicular joint,as well as in the Y(0.59cm vs.0.78cm)and Z directions(0.53cm vs.0.72cm)of the acromioclavicular joint in the body side group.Conclusions For lung and esophageal cancer patients requiring supraclavicular irradiation,the body side group yields smaller setup errors and corresponding margins of target volume than the uplifted group.In clinical practice,it is necessary to take comprehensive consideration of the accuracy of radiotherapy and additional radiation of the limbs to select appropriate posture.