实时图像引导系统对乳腺癌保乳术后放疗摆位误差的影响

梁广立; 李岩; 徐翠玲; 王静; 刘桂芝; 杜武; 蒋胜鹏; 袁智勇

doi:10.12354/j.issn.1000-8179.2023.20221040

实时图像引导系统对乳腺癌保乳术后放疗摆位误差的影响

doi: 10.12354/j.issn.1000-8179.2023.20221040

1.
天津医科大学肿瘤医院放疗科，国家恶性肿瘤临床医学研究中心，天津市"肿瘤防治"重点试验室，天津市恶性肿瘤临床医学研究中心，乳腺癌防治教育部重点试验室（天津市300060）
2.
山东省聊城市第二人民医院放疗科
3.
山东省莱阳市中医院放疗科

基金项目: 本文课题受中华国际医学交流基金会肿瘤精准放疗星火计划科研公益项目（编号：2019-N-11-05）资助

详细信息

作者简介:
梁广立：专业方向为肿瘤放射治疗技术研究

通讯作者:
王静　wj62182@126.com

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出版历程
- 收稿日期: 2022-07-13
- 录用日期: 2022-09-20
- 修回日期: 2022-09-19
- 网络出版日期: 2022-11-10

Impact of real-time image guidance system on setup errors in breast cancer radiotherapy after breast-conserving surgery

1.
Department of Radiotherapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Tianjin 300060, China
2.
Department of Radiotherapy, The Second People's Hospital of Liaocheng City, Liaocheng 252000, China
3.
Department of Radiotherapy, Shandong Laiyang Hospital of Traditional Chinese Medicine,Laiyang 266600, China

Funds: This work was supported by the China Foundation for International Medical Exchange Spark Program for Cancer Precise Radiotherapy (No. 2019-N-11-05)

More Information

Corresponding author: Jing Wang; E-mail: wj62182@126.com

摘要

摘要: 目的探讨基于图像引导系统的乳腺癌保乳术后行容积旋转调强放疗（volumetric modulated arc therapy, VMAT）患者在投照过程中摆位误差的实时校正及剂量学参数变化。方法选取 2020年10月至2021年12月天津医科大学肿瘤医院收治的20例保乳术后行VMAT患者，随机分为对照组10例和试验组10例，放疗时行图像引导，对误差数据进行统计学分析，将摆位误差引入治疗计划重新计算，比较两组剂量学差异。结果对照组和试验组在左右（LR）、腹背（AP）、头脚（SI）方向的摆位误差校正前分别为（3.58±2.35）mm和（3.51±2.08）mm、（4.44±3.62）mm 和（4.23±2.17）mm、（2.85±2.36）mm和（2.99±1.90）mm。对照组在治疗后摆位误差分别为（2.64±1.62）、（3.15±1.50）、（2.49±1.70）mm；试验组在治疗中与治疗后摆位误差分别为（2.07±1.65）mm与（1.85±1.22）mm、（2.29±1.93） mm与（1.78±1.26）mm、（1.98±1.49）mm与（1.67±1.27） mm。LR、AP、SI方向摆位误差≤3 mm时试验组占比多于对照组，两组比较差异均具有统计学意义（χ²=21.07、60.76、33.63，均P<0.01）；两组在治疗后摆位误差比较差异亦均具有统计学意义（t=6.36、10.35、5.60，均P<0.05）。试验组在肿瘤区和临床靶区处方剂量的覆盖体积、心脏平均剂量、肺受照剂量均有优势，两组比较差异均具有统计学意义（均P<0.05）。结论实时图像引导系统能校正患者投照过程中的摆位误差，治疗中增加一次校正可明显减小分次内摆位误差，并获得更好的剂量学结果。
- 乳腺癌保乳术 /
- 调强放疗 /
- 图像引导定位系统 /
- 摆位误差 /
- 剂量评估
Abstract: Objective To investigate the setup errors and their dosimetric impacts during volumetric modulated arc therapy (VMAT) for breast cancer after breast-conserving surgery in patients using an image guidance system. Methods Twenty patients who underwent VMAT after breast-conserving surgery at Tianjin Medical University Cancer Institute & Hospital between October 2020 and December 2021 were randomly assigned into the control (n=10) and experimental groups (n=10). The error data were statistically analyzed, and the dosimetric impacts of the positional errors were compared between the two groups by recalculating the treatment plans with the measured setup errors. Results In the control and experimental groups, the setup errors were (3.58±2.35) and (3.51±2.08) mm, (4.44±3.62) and (4.23±2.17) mm, and (2.85±2.36) and (2.99±1.90) mm along the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. In the control group, the displacement in the LR, AP, and SI directions after irradiation were (2.64±1.62) mm, (3.15±1.50) mm, and (2.49±1.70) mm, respectively. In the experimental group, the displacement in the LR, AP, and SI directions after the first and second arc deliveries were (2.07±1.65) mm and (1.85±1.22) mm, (2.29±1.93) mm and (1.78±1.26) mm, and (1.98±1.49) mm and (1.67±1.27) mm, respectively. The experimental group had more posttreatment positional errors ≤3 mm in the LR, AP and SI directions than the control group, and the difference was statistically significant (χ²=21.07, 60.76, 33.63; P<0.01). The posttreatment displacement exhibited a statistically significant difference between the two groups (t=6.36, 10.35, 5.60; P<0.05). The dosimetric parameters from the recalculated virtual treatment plans showed that the experimental group was significantly superior to the control group in terms of the proportion of gross tumor volume and clinical target volume receiving the prescription dose, the mean dose of the heart, and the dose of the lung (P<0.05). Conclusions The real-time image guidance system can correct setup errors during radiotherapy. Intrafractional correction significantly reduced patient setup errors and obtained better dosimetric results.
- breast-conserving surgery /
- intensity modulated radiotherapy /
- image guided positioning system (IGPS) /
- setup error /
- dose assessment

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图 1 CT扫描正位片中A至D参考铅点

下载: 全尺寸图片幻灯片

图 2 IGPS图像引导投影图

A，B：参考DRR图像；C，D：实时图像；黑色箭头为 4个参考铅点位置

下载: 全尺寸图片幻灯片

图 3 两组患者LR、AP、SI方向摆位误差的比较

下载: 全尺寸图片幻灯片

表 1 两组患者治疗后摆位误差比较

方向	对照组*		试验组*		χ²	P
方向	≤3 mm	>3 mm	≤3 mm	>3 mm	χ²	P
LR	142（71）	58（29）	180（90）	20（10）	21.07	<0.01
AP	110（55）	90（45）	184（92）	16（8）	60.76	<0.01
SI	130（65）	70（35）	182（91）	18（9）	33.63	<0.01
（）内单位为%；*：均为10例×20次

下载: 导出CSV

表 2 两组患者靶区及重要危及器官剂量学的比较

剂量学指标	对照组	试验组	t	P
GTV处方剂量体积（%）	88.30±3.80	93.30±3.30	−2.43	0.04
CTV处方剂量体积（%）	85.70±4.00	90.70±2.90	−2.47	0.03
心脏平均剂量（Gy）	5.84±1.85	3.79±1.19	2.29	0.04
患侧肺
平均剂量（Gy）	10.50±2.13	7.78±1.95	2.35	0.04
V_{5 Gy}（%）	46.83±11.12	30.67±13.76	2.24	0.04
V_{20 Gy}（%）	19.29±5.69	13.11±4.92	12.32	<0.01
健侧肺
平均剂量（Gy）	2.90±1.95	2.53±1.86	3.86	0.01
V_{5 Gy}（%）	23.67±10.61	16.32±11.88	1.25	0.24
全肺
平均剂量（Gy）	7.26±1.67	4.97±1.75	2.32	0.04
V_{5 Gy}（%）	35.00±15.35	28.85±19.63	1.14	0.29
V_{20 Gy}（%）	9.83±2.64	6.33±2.25	2.47	0.03

下载: 导出CSV

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