医学临床研究
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医学临床研究  2022, Vol. 39 Issue (12): 1823-1826    DOI: 10.3969/j.issn.1671-7171.2022.12.018
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鼻咽癌调强放射治疗的两种不同体表标记方式对患者颈椎摆位误差和危及器官剂量影响的三维分析
钟庆初, 林楚燕, 黄颖萍, 黄家升, 林承光*
中山大学肿瘤防治中心/华南肿瘤学国家重点实验室/广东省鼻咽癌诊治研究重点实验室,广东 广州 510060
Three Dimensional Analysis of the Effects of Two Different Body Surface Labeling Methods on Cervical Vertebra Positioning Errors and Organ Dose at Risk in Patients with Nasopharyngeal Carcinoma Undergoing Intensity-modulated Radiotherapy
ZHONG Qing-chu, LIN Chu-yan, HUANG Ying-ping, et al
Cancer Center of Sun Yat-sen University/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine/Guangdong Provincial Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangzhou Guangdong 510060
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摘要 【目的】鼻咽癌调强放射治疗的两种不同体表标记方式对患者颈椎摆位误差和危及器官剂量影响的三维分析。【方法】选取2019年1月至2020年6月在中山大学肿瘤防治中心经病理确诊为鼻咽癌的32例患者,按患者就诊时间先后分为A组和B组,每组16例, B组患者固定面膜采用常规3点标记方式,A组在B组的基础上于患者左右锁骨头中间增加1个定位点,用于引导患者的颈部摆位。每个患者每周进行一次锥形束CT(CBCT)扫描,共获取6套CBCT图像,通过CBCT图像与定位CT图像的配准,分析患者的6个颈椎(C1~C6)在三维方向的摆位误差。在ECLIPSE 15.5计划系统中,根据摆位误差的大小,调整靶区中心的移床参数来模拟摆位误差,重新计算剂量分布,得出危及器官颈髓的受量。【结果】两组患者的C1、C2、C3在左右、头脚和前后方向上的摆位误差比较,差异无统计学意义(P>0.05),但C4、C5、C6在左右、头脚和前后方向上的摆位误差比较,差异有统计学意义(P<0.05)。与B组相比,A组在左右、头脚和前后方向可减少1.4~3.3 mm、0.7~3.3 mm和1.5~3.1 mm,颈髓受量的增加明显减少。【结论】4点标记方式提高了鼻咽癌患者的颈椎摆位精度,减少了颈髓的照射。
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关键词 鼻咽肿瘤/放射疗法放射疗法,调强适形颈椎/辐射效应    
Abstract:【Objective】To undertake three dimensional analysis of the effect of two different body surface labeling methods on cervical vertebra positioning error and organ endangering dose in patients with nasopharyngeal carcinoma undergoing intensity modulated radiotherapy.【Methods】From January 2019 to June 2020, 32 patients who were pathologically diagnosed as nasopharyngeal carcinoma in the Cancer Prevention and Treatment Center of Sun Yat-sen University were selected and divided into two groups according to the time of treatment, with 16 cases in each group. Group B patients fixed the facial mask with a conventional three-point marking method. The Group A added a positioning point between the left and right clavicular heads of patients on the basis of the Group B to guide the positioning of the neck of patients. Each patient underwent cone beam CT (CBCT) scanning once a week, and a total of 6 sets of CBCT images were obtained. Through the registration of CBCT images and positioning CT images, the positioning errors of 6 cervical vertebrae (C1~C6) of the patient in the three-dimensional direction were analyzed.In the ECLIPSE 15.5 planning system, according to the size of positioning error, the bed transfer parameters in the center of the target area were adjusted to simulate the positioning error, the dose distribution was recalculated, and the dose to the cervical spinal cord of the organ at risk was obtained.【Results】There was no significant difference between the two groups in the positioning errors of C1, C2, C3 in the left and right, head foot and front and rear directions (P>0.05), but there was a significant difference between C4, C5, C6 in the left and right, head foot and front and rear directions (P<0.05). Compared with the group B, the group A can reduce 1.4~3.3 mm, 0.7~3.3 mm and 1.5~3.1 mm in the left and right, head and foot, front and rear directions, and the increase of cervical spinal cord uptake is significantly reduced. 【Conclusion】The 4-point marking method can improve the positioning accuracy of cervical vertebra in patients with nasopharyngeal carcinoma and reduce the irradiation of cervical spinal cord.
Key wordsNasopharyngeal Neoplasms/RT    Radiotherapy,Intensity-Modulated    Cervical Vertebrae/RE
收稿日期: 2022-05-05     
中图分类号:  R739.63  
通讯作者: * E-mail:linchg@sysucc.org.cn   
引用本文:   
钟庆初, 林楚燕, 黄颖萍, 黄家升, 林承光. 鼻咽癌调强放射治疗的两种不同体表标记方式对患者颈椎摆位误差和危及器官剂量影响的三维分析[J]. 医学临床研究, 2022, 39(12): 1823-1826.
ZHONG Qing-chu, LIN Chu-yan, HUANG Ying-ping, et al. Three Dimensional Analysis of the Effects of Two Different Body Surface Labeling Methods on Cervical Vertebra Positioning Errors and Organ Dose at Risk in Patients with Nasopharyngeal Carcinoma Undergoing Intensity-modulated Radiotherapy. JOURNAL OF CLINICAL RESEARCH, 2022, 39(12): 1823-1826.
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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.12.018     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I12/1823
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