[1]郑仁超,郑祖安,刘 琪,等.自粘性组织等效膜在乳腺癌调强放疗中的应用[J].医学信息,2021,34(04):110-114.[doi:10.3969/j.issn.1006-1959.2021.04.029]
　ZHENG Ren-chao,ZHENG Zu-an,LIU Qi,et al.Application of Self-adhesive Tissue Equivalent Membrane in Intensity-modulated Radiotherapy of Breast Cancer[J].Medical Information,2021,34(04):110-114.[doi:10.3969/j.issn.1006-1959.2021.04.029]
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自粘性组织等效膜在乳腺癌调强放疗中的应用()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年04期
页码:
110-114
栏目:
论著
出版日期:
2021-02-15

文章信息/Info

Title:
Application of Self-adhesive Tissue Equivalent Membrane in Intensity-modulated Radiotherapy of Breast Cancer
文章编号:
1006-1959（2021）04-0110-05
作者:
郑仁超; 郑祖安; 刘 琪; 等
（华中科技大学同济医学院附属同济医院肿瘤科，湖北 武汉 430030）
Author(s):
ZHENG Ren-chao; ZHENG Zu-an; LIU Qi; et al.
(Department of Oncology,Tongji Hospital,Tongji Medical College of HUST,Wuhan 430030,Hubei,China)
关键词:
乳腺癌; 调强放疗; 自粘性组织等效膜; 间隙
Keywords:
Breast cancer; Intensity-modulated radiotherapy; Self-adhesive tissue equivalent membrane; Gap
分类号:
R737.9
DOI:
10.3969/j.issn.1006-1959.2021.04.029
文献标志码:
A
摘要:
目的 探讨自粘性组织等效膜在乳腺癌放射治疗中的临床应用价值。方法 选择2019年4月1日~9月31日华中科技大学同济医学院附属同济医院经病理证实为乳腺癌的11例根治术后放疗患者，行个体化发泡胶体位固定垫固定，胸壁粘贴自粘性组织等效膜，再辅以颈肩胸一体化热塑网膜固定，采集CT定位影像，进行放射治疗计划设计，在图像中测量靶区范围内自粘性组织等效物与皮肤之间的间隙和相应点的皮肤剂量，测量肺组织剂量体积V20和V5；利用直线加速器机载CBCT（锥形束CT）行靶区位置验证，前3验证结果与后续每周1次的验证结果进行比较，并在XVI（X线容积影像）系统中测量靶区范围内自粘性组织等效物与皮肤之间的间隙，与定位计划影像中的相应点的皮肤与补偿物之间的间隙比较，实施调强放射治疗。结果 在靶区范围内, 76.77%自粘性组织等效膜与皮肤间的间隙为0，其余部分间隙在0.2 cm以内，皮肤剂量在中内点（4970.00±213.92）cGy最小，下中点（4988.18±74.41）cGy最大；肺组织V20为（27.34±1.80）%, V5为（56.46±3.16）%。CBCT验证后靶区范围内自粘性组织等效膜与皮肤之间的间隙与定位计划影像中的相应点的皮肤与补偿物之间的间隙比较，差异无统计学意义（P＞0.05）；治疗前3次CBCT位置验证线性误差最小在X轴（0.02±0.27）cm，最大在Y轴（0.08±0.24）cm，旋转误差最小在Y轴（0.09±0.84）°，最大在X轴（0.36±0.93）°，前3次CBCT验证与后续的CBCT验证相应维度比较，差异无统计学意义（P＞0.05）。结论 乳腺癌根治术后调强放疗使用自粘性组织等效膜，组织等效膜与皮肤之间的间隙小且重复性良好，靶区剂量分布均匀、肺组织剂量体积较低，治疗前CBCT位置验证误差较小且稳定。
Abstract:
Objective To explore the clinical application value of self-adhesive tissue equivalent membrane in breast cancer radiotherapy.Methods From April 1st to September 31st, 2019, 11 patients with breast cancer confirmed by pathology from Tongji Hospital of Tongji Medical College of HUST were selected for postoperative radiotherapy with individualized styrofoam positioning pads and chest wall sticking. Self-adhesive tissue equivalent membrane, supplemented by the integration of neck, shoulder and thoracic thermoplastic omentum for fixation,acquire CT positioning images, carry out radiotherapy plan design, measure the gap between the self-adhesive tissue equivalent and the skin in the target area and the skin dose at the corresponding point in the image, and measure the lung tissue dose volume V20 and V5;Use linear accelerator airborne CBCT (cone beam CT) to verify the target location. The first 3 verification results were compared with the subsequent verification results once a week.In the XVI (X-ray volume imaging) system, the gap between the self-adhesive tissue equivalent and the skin in the target area was measured, and the gap between the skin and the compensation at the corresponding point in the positioning plan image was compared, and the adjustment was implemented. Intensive radiation therapy.Results Within the target area, the gap between the 76.77% self-adhesive tissue equivalent membrane and the skin was 0, and the remaining gap was within 0.2 cm.The skin dose was the smallest at the midpoint (4970.00±213.92) cGy, and the lower midpoint (4988.18±74.41) cGy was the largest; lung tissue V20 was (27.34±1.80)%, V5 was (56.46±3.16)%.After CBCT verification, the gap between the self-adhesive tissue equivalent membrane and the skin in the target area was compared with the gap between the skin and the compensation at the corresponding point in the positioning plan image,the difference was not statistically significant(P＞0.05);The linear error of 3 CBCT position verification before treatment is the smallest on the X axis (0.02±0.27) cm, the largest on the Y axis (0.08±0.24) cm, and the smallest rotation error is on the Y axis (0.09±0.84)°,the maximum was on the X axis (0.36±0.93)°. There was no statistically significant difference between the corresponding dimensions of the first 3 CBCT verification and subsequent CBCT verification (P＞0.05).Conclusion After radical mastectomy for breast cancer, IMRT uses self-adhesive tissue equivalent membrane. The gap between the tissue equivalent membrane and the skin is small and reproducible. The dose distribution in the target area is uniform, and the lung tissue dose volume is low. The position of CBCT before treatment The verification error is small and stable.

参考文献/References:

[1]林承光,翟福山.放射治疗技术学[M].北京:人民卫生出版社,2016. [2]邓小武,傅剑华,陈立新,等.金属食管支架对放射治疗剂量分布的影响[J].中华放射肿瘤学杂志,2003,12(3):192-195. [3]Kang H,Lovelock DM,Yorke ED,et al.Accurate positioning for head and neck cancer patients using 2D and 3D image guidance[J].J Appl Clin Med Phys,2010,12(1):3270-3275. [4]李宏伟.胸腹膜真空袋体位固定术联合热塑膜体位对胸腹部肿瘤放疗患者零位源皮距误差的影响[J].河南医究,2019,28(10):1795-1796. [5]付秀根,袁响林,郑祖安,等.锥形束CT分析发泡胶个体化头枕在头颈部肿瘤调强放射治疗中的应用[J].放射学实践,2017,32(5):522-525. [6]郑祖安,付秀根,钟伟伟,等.面颈部肿瘤影像引导精确放射治疗摆位误差的研究[J].中华肿瘤防治杂志,2012,19(20):1554-1556. [7]吴晓圆.胸部肿瘤三维适形放疗致放射性肺炎的相关因素分析[J].中国继续医学教育,2016(1):97-98. [8]李小凯,张伶,任民.放疗途径对肺V5、V20、V30及放射性食管炎发生率的影响[J].中国煤炭工业医学杂志,2014,17(3):351-353. [9]朱彤.乳腺癌根治术后不同放疗技术的应用与剂量分析[J].上海医药,2018,39(4):19-20,32. [10] 王松林,潘金华,童武松.乳腺癌改良根治术后胸壁加锁骨野常规放疗与三维适形放疗的疗效及安全性分析[J].海南医学院学报,2017,23(4):539-541,545. [11]张文,施林心,刘亚洲,等.三维适形调强放疗在乳腺癌根治术中的应用[J].中国辐射卫生,2019(2):190-193. [12]Reshma J,Jean M,Robin M,et al.Evaluation of Four Techniques Using Intensity-Modulated Radiation Therapy for Comprehensive Locoregional Irradiation of Breast Cancer[J].International Journal of Radiation Oncology,Biology,Physics,2011,78(5):1594-1603. [13]蔡育欣,陈轶杰.螺旋断层固定野调强放疗技术在乳腺癌改良根治术后胸壁放疗中的应用效果[J].中国现代医生,2019,57(27):122-124,134. [14]陈亚正,黎杰,廖雄飞,等.VMAT和IMRT技术在乳腺癌根治术后放疗中的剂量学比较[J].肿瘤预防与治疗,2014(5):226-230. [15]Haertl PM,Pohl F,Weidner K,et al.Treatment of left sided breast cancer for a patient with funnel chest:Volumetric-modulated arc therapy vs.3D-CRT and intensity-modulated radiotherapy[J].Medical Dosimetry,2013,38(1):1-4. [16]周瑛瑛,邱小平,狄晓云,等."Pretend"Bolus在乳腺癌根治术后调强放疗应用中的剂量学研究[J].中国医学物理学杂志,2013(1):3848-3850. [17]蒋清,竺铭,许赪,等.头部热塑膜固定于乳腺托架联合标记线提高乳腺癌调强放疗摆位的准确性[J].外科理论与实践,2019,24(5):446-451. [18]徐慧,梁献伟,张遵浩,等.乳腺癌术后调强放疗热塑膜固定技术的改进方法研究[J].河北医药,2018(11):1714-1717.

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