头颈部调强放射治疗中影响摆位误差的相关因素分析

Analysis of related factors affecting setup error in head and neck intensity-modulated radiotherapy

目的探究头颈部调强放射治疗(IMRT)中影响摆位误差的相关因素。方法回顾性选取2021年10月至2023年12月在池州市人民医院肿瘤放射治疗中心进行治疗的头颈部IMRT患者72例作为研究对象。患者在治疗时每周行1次扫描,记录在左右(X)方向、头脚(Y)方向、腹背(Z)方向及旋转方向的摆位误差。根据患者固定装置对患者进行分组:观察1组(头颈肩塑形垫联合头颈肩面罩固定,n=16)、观察2组(真空垫+头颈肩面罩固定,n=18)、观察3组(透明头枕+头颈肩面罩固定,n=19)和观察4组(单独头颈肩面罩固定,n=19)。比较不同固定装置组间X、Y、Z方向及旋转方向患者的摆位误差。分析患者的临床资料[性别、年龄、体重指数(BMI)、病灶位置、肩部下垂、脊柱侧弯],探究影响患者摆位误差的因素。并采用多元线性回归分析不同固定装置、病灶位置、脊柱侧弯、肩部下垂对患者摆位误差的影响。结果观察1组在X方向、Y方向及Z方向的摆位误差小于观察2、3、4组,观察2组X方向、Y方向及Z方向的摆位误差小于观察3、4组,观察1、2组在旋转方向的摆位误差小于观察3、4组,差异均有统计学意义(P<0.05);但观察1、2组组间旋转方向误差比较、观察3、4组组间各指标比较,差异均无统计学意义(P>0.05)。不同性别、年龄、不同病灶位置的患者在X方向、Y方向、Z方向及旋转方向摆位误差比较,差异均无统计学意义(P>0.05);BMI<23 kg/m^(2)、肩部下垂、脊柱侧弯的患者X方向、Y方向、Z方向及旋转方向摆位误差高于BMI≥23 kg/m^(2)、未发生肩部下垂及未发生脊柱侧弯患者,差异均有统计学意义(P<0.05)。经多元线性回归分析,固定装置、脊柱侧弯会对患者的X方向、Y方向、Z方向及旋转方向摆位误差产生影响(P<0.05),肩部下垂会影响患者X方向的摆位误差(P<0.05)。结论固定装置在头颈部IMRT中对患者的摆位误差具有一定的影响,且患者存在肩部下垂、脊柱侧弯可能导致摆位误差增大。

Objective To explore the related factors affecting the positioning error in head and neck intensity-modulated radiotherapy(IMRT).Methods A total of 72 patients with head and neck IMRT who were treated in the tumor radiotherapy center of Chizhou People's Hospital from October 2021 to December 2023 were retrospectively selected as the research objects.Patients underwent weekly scans during treatment to record setup errors in the left-right(X),head-feet(Y),anterior-posterior(Z),and rotational directions.The clinical data of patients[gender,age,body mass index(BMI),lesion location,shoulder droop,scoliosis]were analyzed to explore the factors affecting the positioning error of patients.The patients were grouped according to the fixation device:the observation group 1(head neck shoulder plastic pad combined with head neck shoulder mask fixation,n=16),the observation group 2(vacuum pad+head neck shoulder mask fixation,n=18),the observation group 3(transparent head pillow+head neck shoulder mask fixation,n=19)and the observation group 4(single head neck shoulder mask fixation,n=19).The setup errors of patients in X,Y,Z and rotation directions were compared between different fixation devices.The effects of different fixation devices,lesion location,scoliosis and shoulder droop on the positioning error of patients were analyzed by multiple linear regression analysis.Results The set-up errors in the X direction,Y direction and Z direction of the observation group 1 were less than those of the observation groups 2,3 and 4.The set-up errors in the X direction,Y direction and Z direction of the observation group 2 were less than those of the observation groups 3 and 4.The set-up errors in the rotation direction of the observation groups 1 and 2 were less than those of the observation groups 3 and 4,the differences were statistically significant(P<0.05).However,there was no statistically significant difference in the rotation direction error between the observation groups 1 and 2,and the indexes between the observation groups 3 and 4(P>0.05).There was no statistically significant difference in setup errors in X direction,Y direction,Z direction and rotation direction among patients with different genders,ages and lesion locations(P>0.05),The setup errors in X direction,Y direction,Z direction and rotation direction of patients with BMI<23 kg/m^(2),shoulder droop and scoliosis were higher than those of patients with BMI≥23 kg/m^(2),no shoulder droop and no scoliosis,and the differences were statistically significant(P<0.05).Multiple linear regression analysis showed that the fixation device and scoliosis would affect the positioning errors in the X direction,Y direction,Z direction and rotation direction of the patients(P<0.05),shoulder droop would affect the positioning error in the X direction of the patients(P<0.05).Conclusion The fixation device has a certain influence on the positioning error of the patient in the head and neck IMRT,and the patient's shoulder droop and scoliosis may lead to an increase in the positioning error.