摘要
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/m2、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/m2、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.
Abstract
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 Hospi-tal 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[gen-der,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 fixa-tion,n=19).The setup errors of patients in X,Y,Z and rotation directions were compared between different fixation devices.The effects of dif-ferent 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 obser-vation 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 l and 2,and the indexes between the observation groups 3 and 4(P＞0.05).There was no statis-tically significant difference in setup errors in X direction,Y direction,Z direction and rotation direction among patients with different genders,a-ges 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/m2,shoulder droop and scoliosis were higher than those of patients with BMI≥23 kg/m2,no shoulder droop and no scoliosis,and the differ-ences 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.
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