不同因素对中下段食管癌患者摆位误差的影响分析

Analysis of the influence of different factors on set-up errors in patients with middle and lower esophageal carcinoma

目的探讨中下段食管癌患者在调强放疗(IMRT)中摆位误差的影响因素,为今后改善患者放疗体位重复性及提高疗效提供依据。方法收集2020年11月~2021年11月在我院放疗科接受IMRT的23例中下段食管癌患者的174组锥形束计算机断层扫描(CBCT)数据,并对其进行回顾性分析。采用独立样本t检验进行组间比较,运用多元逻辑回归分析不同因素对患者产生大误差值的影响。结果不同性别组及不同化疗方式组的患者在三维治疗轴上的摆位误差均无统计学意义(P>0.05)。不同年龄组比较显示在Y轴上低龄组患者的摆位误差小于中龄组(P=0.006);在同年龄分组下,不同性别的患者在三维治疗轴上的摆位误差无统计学意义(P>0.05)。在中龄组患者中,X轴上接受同步放化疗患者的摆位误差大于非同步放化疗患者(P=0.042);其余各治疗轴的摆位误差均无统计学意义(P>0.05);多元逻辑回归分析显示,性别(P=0.020)和化疗方式(P=0.034)对患者大误差值的产生有显著影响,其他因素对大误差值的产生暂无影响(P>0.05)。结论建议男性患者加强自身体表标记线保护意识,对接受同步放化疗的患者应多关注患者体位舒适度的调整,以提高患者治疗时的体位固定性,进而提高治疗时治疗体位的精准度。

Objective To investigate the influence factors of set-up errors in patients with middle and lower esophageal carcinoma during Intensity-Modulated Radiotherapy(IMRT),so as to provide a basis for improving the position reproducibility and efficacy of treatment in future.Methods The data of 174 cone-beam computed tomography(CBCT)for 23 patients with middle and lower esophageal carcinoma who accepted IMRT of our hospital from Nov 2020 to Nov 2021 was retrospectively analyzed.Independent-samples T test was used for comparison between different groups.Meanwhile,multiple logistic regression analysis was used to determine the influence of different factors on patients with large errors values.Results There was no statistical significance in the setup errors in the groups of different gender and chemotherapy on three-dimensional treatment axis(P>0.05).In the groups of different ages,the set-up errors in younger age on the Y-axis were smaller than middle aged one(P=0.006).Within same age group,set-up errors of different genders on the three-dimensional treatment axis was not statistically significant(P>0.05),while in middle aged group,the setup errors of chemotherapy patients on the X-axis was greater than that of non-chemotherapy ones(P=0.042).The set-up errors of other treatment axes were not statistically significant(P>0.05).In multiple logistic regression analysis,gender factor(P=0.020)and chemotherapy factor(P=0.034)had a great influence on the large errors value of patients,while other factors had no such kind of influence.Conclusion The body surface marking line should be protected for male patients.The positon should be adjusted to more comfortable for chemotherapy patients.So that the fixation of body position and the accuracy of treatment could be improved.