个体化发泡胶联合颈胸膜固定在中下段食管癌放射治疗中的应用

Application of personalized foam adhesive combined with cervical pleura fixation in radiotherapy for middle and lower esophageal cancer

目的探讨个体化发泡胶联合颈胸膜固定在中下段食管癌放射治疗中的应用。方法选取在医院放疗科接受放射治疗的60例中下段食管癌患者,根据不同的体位固定方式分为个体化发泡胶联合颈胸膜固定组(A组)和应用发泡胶联合体部热塑膜固定组(B组),每组30例。采用Varian TrueBeam直线加速器的锥形束CT(Cone Beam CT,CBCT)对每例患者进行扫描采集,第1周前3次和后续每周1次,并与计划CT图像进行配准对比,通过软组织配准和人工校对得出左右、头脚、腹背三个方向的线性位移数据。比较两组摆位误差的不同以及根据靶区运动的大小,得出靶区外扩边界的距离。结果每组各30例,A组CBCT共210人次,B组CBCT共205人次,A、B两组在左右(X轴)、头脚(Y轴)、腹背(Z轴)方向的摆位误差分别为:(0.059±1.938)mm与(0.259±2.168)mm(P=0.227)、(0.950±1.883)mm与(0.315±2.806)mm(P<0.05)、(0.723±1.543)mm与(1.004±2.159)mm(P<0.05)。AB两组在X、Y、Z三个方向的外扩边界(MPTV)距离分别为4.21mm和4.72mm、4.27mm和6.12mm、3.32mm和4.50mm。结论对于需要放疗中下段的食管癌患者,使用个体化发泡胶联合颈胸膜固定方式在Y轴和Z轴方向上明显优于发泡胶联合体部热塑膜固定方式,摆位精度和重复性明显提升。同时得出中下段的食管癌靶区三个方向的外扩边界,对于临床治疗有一定的参考意义。

Objective Exploring the application of personalized foam adhesive combined with cervical pleural fixation in radiotherapy for middle and lower esophageal cancer.Methods Sixty patients with middle and lower segment esophageal cancer who received radiotherapy in the radiotherapy department of the hospital were selected and divided into individual styrofoam combined with cervical pleural fixation group(group A)and styrofoam combined with thermoplastic film fixation group(group B)according to different postural fixation methods,with 30 cases in each group.Cone Beam CT(CBCT)of Varian TrueBeam linear accelerator was used for scanning collection of each patient,three times before the first week and once a week thereafter,and the registration was compared with the planned CT images.The linear displacement data of left and right,head and foot,abdomen and back were obtained by soft tissue registration and manual calibration.By comparing the difference of the two sets of positioning errors and the size of the target area movement,the distance of the outer boundary of the target area is obtained.Results There are 30 cases in each group,with a total of 210 CBCTs in Group A and 205 CBCTs in Group B.The positioning errors in the left and right(X-axis),head and foot(Y-axis),and abdominal and dorsal(Z-axis)directions of Groups A and B are(0.059±1.938)mm and(0.259±2.168)mm(P=0.227),(0.950±1.883)mm and(0.315±2.806)mm(P<0.05),(0.723±1.543)mm and(1.004±2.159)mm(P<0.05),respectively.The MPTV distances of AB and AB groups in the X,Y,and Z directions are 4.21mm and 4.72mm,4.27mm and 6.12mm,3.32mm and 4.50mm,respectively.Conclusion For patients with esophageal cancer requiring radiotherapy in the middle and lower segments,the use of individualized foam adhesive combined with cervical pleural fixation is significantly superior to the use of thermoplastic film in the combination of foam adhesive in the Y and Z axis directions,and the positioning accuracy and repeatability are significantly improved.At the same time,the boundary of three directions of the target area of esophageal cancer in the middle and lower segment was obtained,which has certain reference significance for clinical treatment.