塑形垫结合热塑膜在头颈部肿瘤放疗患者体位固定中的应用

Application of shaping pad combined with thermoplastic membrane in postural fixation for radiotherapy patients of head and neck neoplasms

目的 探讨塑形垫结合热塑膜在头颈部肿瘤放疗患者体位固定中的优势.方法 收集2021年2月至2021年12月于山西医科大学第一医院治疗的50例头颈部肿瘤放疗患者的临床资料,其中男性40例、女性10例,年龄(58.0±8.2)岁.按照不同固定方式将患者分为观察组(30例)和对照组(20例).观察组采用塑形垫结合头颈肩热塑膜个性化定位方式;对照组采用标准化头枕结合头颈肩热塑膜常规定位方式对头颈部肿瘤患者进行体位固定.患者在治疗过程中每周1次采用MV级电子射野影像系统(EPID)进行摆位验证,对2组头颈部肿瘤患者腹背、头脚、左右方向的摆位误差进行比较.组间比较采用独立样本t检验.结果 50例患者完成了258次EPID验证,其中观察组验证101次,对照组验证157次.以靶区为感兴趣区(ROI),观察组患者在腹背、头脚、左右方向的摆位误差分别为(0.057±1.805)、(0.569±1.611)、(0.020± 2.946)mm,小于对照组的(-0.599±2.531)、(0.637±2.239)、(0.780±1.957)mm,且 2 组在腹背和左右方向的差异有统计学意义(t=-2.435,P=0.016;t=2.289,P=0.023).以头部中心为ROI,观察组患者在腹背、头脚、左右方向的摆位误差分别为(-0.327±1.898)、(0.594±2.089)、(0.891± 1.944)mm,小于对照组的(0.975±1.950)、(0.917±2.245)、(1.070±1.912)mm,且 2 组在腹背方向的差异有统计学意义(t=5.320,P<0.001).以颈部中心为ROI,观察组在腹背、头脚、左右方向的摆位误差分别为(0.010±2.278)、(0.554±2.095)、(-0.574±2.321)mm,小于对照组的(1.217± 2.663)、(0.637±2.397)、(-0.764±2.600)mm,且2组在腹背和左右方向的差异有统计学意义(t=-3.947,P<0.00l;t=3.431,P=0.001).结论 塑形垫结合热塑膜应用于头颈部肿瘤放疗患者的体位固定,可明显提高摆位精确度和患者的舒适度,具有临床推广价值.

Objective To investigate the advantages of shaping pad combined with thermoplastic membrane in postural fixation for radiotherapy patients of head and neck neoplasms.Methods The clinical data of 50 patients with head and neck neoplasms treated by radiotherapy the First Hospital of Shanxi Medical University from February 2021 to December 2021 were collected,including 40 males and 10 females,aged(58.0±8.2)years.The selected patients were divided into the control group(20 cases)and the observation group(30 cases).The observation group was immobilized using individualized shaping pad with thermoplastic membrane,and the control group was fixed with standard plastics pillow with the thermoplastic membrane.The MV electronic portal imaging device(EPID)was carried out for postioning verification once a week,and the setup errors were compared in a vertical(abdominal and dorsal),longitudinal(head and foot),and lateral(left and right)direction.The setup errors were analyzed by independent sample t-test.Results A total of 50 patients completed 258 EPID validations,including 101 validations in the observation group and 157 validations in the control group.With the target area as ROI,the setup errors in a vertical,longitudinal,and lateral direction of the observation group were lower than those of the control group((0.057±1.805)mm vs.(0.599±2.531)mm,(0.569±1.611)mm vs.(0.637±2.239)mm;(0.020±2.946)mm vs.(0.780±1.957)mm,respectively),and the differences were statistically significant in a vertical and lateral direction(t=−2.435,P=0.016;t=2.289,P=0.023).With the head center as ROI,the setup errors in a vertical,longitudinal,and lateral direction of the observation group were lower than those of the control group((−0.327±1.898)mm vs.(0.975±1.950)mm,(0.594±2.089)mm vs.(0.917±2.245)mm,(0.891±1.944)mm vs.(1.070±1.912)mm,respectively),and the difference was statistically significant in a vertical direction(t=5.320,P<0.001).With the neck center as ROI,the setup errors in a vertical,longitudinal,and lateral direction of the observation group were lower than those of the control group((0.010±2.278)mm vs.(1.217±2.663)mm,(0.554±2.095)mm vs.(0.637±2.397)mm,(−0.574±2.321)vs.(−0.764±2.600)mm,respectively).Furthermore,and the differences were statistically significant in a vertical and lateral direction(t=−3.947,P<0.001;t=3.431,P=0.001).Conclusions The application of shaping pad and thermoplastic membrane in postural fixation of head and neck neoplasms during radiotherapy can improve positioning accuracy and patients'comfort,indicating their clinical promotion value.