背景:为了回顾性分析使用锥形束计算机断层扫描(CBCT)进行放射治疗的准确性,聚苯乙烯泡沫塑料固定,乳腺癌患者胸壁靶区和锁骨上淋巴引流区(锁骨上靶区)的乳腺支架固定。并比较设置效率和舒适度满意度。
方法:共65例乳腺癌术后淋巴结转移患者,其中聚苯乙烯泡沫塑料固定术36例,乳房支架固定术29例,于2021年3月至2022年8月招募并进行回顾性分析。所有患者每周进行CBCT扫描,比较并记录胸壁和锁骨上目标体积的设置误差。使用相关性MPTV=2.5Σ0.7σ计算两组的计划目标体积(PTV)裕度。记录并分析两组患者的设置时间和舒适度满意度评分。使用Pearson相关分析对各方向误差之间的相关性进行分析。
结果:聚苯乙烯泡沫塑料组和乳房托架组之间的胸壁目标区域的左右方向(X)轴存在显着差异(1.59±1.47mmvs.2.05±1.64mm,P=0.012)。锁骨上靶区腹背方向(Z)和床角有统计学差异,数据为(1.36±1.27mm与1.75±1.55mm,P=0.046;0.47±0.47°vs.0.66±0.59°,分别为P=0.006)。在X中,Y,和Z方向,两组在胸壁靶区的PTV边缘分别为5.01mm,5.99mm,聚苯乙烯泡沫塑料组5.47毫米,而乳房支架组为6.10毫米,6.34mm,和6.10毫米,分别。此外,三个方向锁骨上目标的PTV边缘为3.69mm,3.86mm,聚苯乙烯泡沫塑料组4.28毫米,而乳房支架组为3.99毫米,3.72mm,和5.45毫米,分别。两组的设置时间分别为3.4±1.1min和5.5±3.1min(P=0.007)。两组患者主观舒适度满意度评分分别为27.50±1.24和25.44±1.23(P<0.001)。
结论:在乳腺癌锁骨上淋巴结区放疗中应用聚苯乙烯泡沫塑料固定术较乳腺支架固定术有一定的优势。包括更高的定位精度,较小的外部膨胀边界,提高工作效率,和病人的安慰,为临床工作提供参考。
BACKGROUND: To retrospectively analyze the accuracy of radiotherapy using cone beam computed tomography (CBCT), Styrofoam fixation, and breast bracket fixation in the chest wall target area and supraclavicular lymphatic drainage area (supraclavicular target area) of patients with breast cancer.and compare the setting efficiency and comfort satisfaction.
METHODS: A total of 65 patients with postoperative lymphatic metastasis of breast cancer, including 36 cases of Styrofoam fixation and 29 cases of breast bracket fixation, were recruited from March 2021 to August 2022 and retrospectively analyzed. All the patients underwent CBCT scans weekly, and the setup errors of the chest wall and supraclavicular target volume were compared and recorded. The planning target volume (PTV) margins of the two groups were calculated using the correlation MPTV = 2.5Σ + 0.7σ. The setup time and comfort satisfaction scores of the two groups were recorded and analyzed. The correlations among errors in each direction were analyzed using the Pearson correlation analysis.
RESULTS: There was a significant difference in the left-right direction (X) axis of the chest wall target area between the Styrofoam and breast bracket groups (1.59 ± 1.47 mm vs. 2.05 ± 1.64 mm, P = 0.012). There were statistical differences in the ventrodorsal direction (Z) and bed angle of the supraclavicular target area, the data were (1.36 ± 1.27 mm vs. 1.75 ± 1.55 mm, P = 0.046; 0.47 ± 0.47° vs. 0.66 ± 0.59°, P = 0.006, respectively). In the X, Y, and Z directions, the respective PTV margins of the two groups in the chest wall target area were 5.01 mm, 5.99 mm, and 5.47 mm in the Styrofoam group, while those in the breast bracket group were 6.10 mm, 6.34 mm, and 6.10 mm, respectively. Moreover, the PTV margins of the supraclavicular target in the three directions were 3.69 mm, 3.86 mm, and 4.28 mm in the Styrofoam group, while those in the breast bracket group were 3.99 mm, 3.72 mm, and 5.45 mm, respectively. The setup time of the two groups was 3.4 ± 1.1 min and 5.5 ± 3.1 min (P = 0.007). The subjective comfort satisfaction scores of the two groups were 27.50 ± 1.24 and 25.44 ± 1.23 (P < 0.001).
CONCLUSIONS: The application of Styrofoam fixation in radiotherapy of breast cancer in the supraclavicular lymph node area has several advantages as compared to breast bracket fixation, including higher positioning accuracy, smaller external expansion boundary, improved work efficiency, and patients\' comfort, which might provide a reference for clinical work.