胸腹平架和头颈肩架固定装置在胸中上段食管癌放射治疗中的摆位误差比较

Comparison of setup errors between thoracoabdominal flat immobilization device and head and neck thermoplastic mask in esophageal cancer treated with radiotherapy

目的:分析和比较在食管癌放射治疗中胸腹平架和头颈肩架固定装置对患者的体位固定效果。方法:回顾性筛选2020年11月至2021年4月在某院放疗科行放射治疗的41例病变位于胸中段或胸上段的食管癌患者,其中20例采用胸腹平架固定(作为胸腹平架组),21例采用头颈肩架固定(作为头颈肩架组)。比较X(左右)、Y(头脚)、Z(腹背)、RX(矢状面)、RY(横断面)、RZ(冠状面)方向上的整体摆位误差、胸锁关节摆位误差和肩锁关节摆位误差及靶区外放范围。采用SPSS 25.0软件进行统计学分析。结果:在整体摆位误差方面,胸腹平架组在X、RX和RZ方向上显著小于头颈肩架组(0.15 cm vs 0.21 cm,P=0.000;0.66°vs 0.80°,P=0.034;0.52°vs 0.80°,P=0.000),但在Y方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.002)。在胸锁关节摆位误差方面,胸腹平架组在X、RY、RZ方向上显著小于头颈肩架组(0.15 cm vs 0.24 cm,P=0.000;0.92°vs 1.19°,P=0.000;0.63°vs 1.00°,P=0.000)。在肩锁关节摆位误差方面,胸腹平架组在RX方向上显著小于头颈肩架组(0.90°vs 1.08°,P=0.019),在Y和RY方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.024;0.81°vs 0.62°,P=0.016)。在整体靶区外放方面,胸腹平架组和头颈肩架组在X、Y和Z方向上需要的外放范围分别为0.43、0.66、0.46 cm和0.60、0.58、0.43 cm。结论:对于需要放射治疗的胸中上段食管癌患者,胸腹平架和头颈肩架在不同方向上的固定效果各有优劣,临床上应该根据具体情况选择合适的固定装置。

Objective To analyze and compare the setup errors between thoracoabdominal flat immobilization device(TAFID)and head and neck thermoplastic mask(HANTOM)in esophageal cancer treated with radiotherapy.Methods Totally 41 esophageal cancer patients with lesions located in the mid-or upper thoracic segments who underwent radiation therapy in the radiotherapy department of some hospital from November 2020 to April 2021 were retrospectively selected,of whom 20 ones fixed with TAFID were enrolled into a TAFID group and the other 21 ones with HANTOM were divided into a HANTOM group.The TAFID and HANTOM groups were compared over the overall errors,the setup error of sternoclavicular joint and the setup error of acromioclavicular joint at X(left-right),Y(head-foot),Z(abdomen-back),RX(sagittal),RY(transverse)and RZ(coronal)directions and the margin of target area.SPSS 25.0 software was used for statistical analysis.Results TAFID group had the overall setup errors significantly lower than those in HANTOM group at X,RX and RZ directions(0.15 cm vs 0.21 cm,P=0.000;0.66°vs 0.80°,P=0.034;0.52°vs 0.80°,P=0.000),while higher at Y direction(0.26 cm vs 0.22 cm,P=0.002);the setup errors of sternoclavicular joint in TAFID group were significantly lower than those in HANTOM group at X,RY and RZ directions(0.15 cm vs 0.24 cm,P=0.000;0.92°vs 1.19°,P=0.000;0.63°vs 1.00°,P=0.000);the setup errors of acromioclavicular joint of TAFID group were significantly lower than those in HANTOM group at RX direction(0.90°vs 1.08°,P=0.019),while higher at Y and RY directions(0.26 cm vs 0.22 cm,P=0.024;0.81°vs 0.62°,P=0.016).The margins of target area at X,Y and Z directions were 0.43,0.66 and 0.46 cm respectively in TAFID group and 0.60,0.58 and 0.43 cm respectively in HANTOM group.Conclusion Both TAFID and HANTOM have their own advantages and disadvantages at different directions when used for the immobilization of esophageal cancer patients with lesions located in the mid-or upper thoracic segments,which have to be selected according to specific clinical conditions.