胸壁无刺青及局部淋巴结表面显像照射

Q1 Nursing
Boris Mueller , Yulin Song , Xingchen Zhai , Yubei Liang , Paul Tamas , Simon Powell , David M Guttmann , Diana Roth O’Brien , Beryl McCormick , Atif Khan , Laura Cervino-Arriba , Bo Zhao , Linda Hong , Lior Z. Braunstein
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引用次数: 0

摘要

目的/目的皮肤文身是乳腺癌放射治疗表面对准和设置的标准,但也会造成不良的美容效果和患者的不满。随着当代表面成像技术的出现,我们评估了传统的基于纹身的设置技术和“无纹身”方法对淋巴结阳性和高风险乳腺癌患者需要胸壁和区域淋巴结放射的设置准确性、时间和剂量参数。材料/方法接受胸壁放射治疗的乳腺癌患者接受传统的基于纹身的设置(TTB),每天交替使用AlignRT (ART)通过表面成像进行无纹身的设置,作为内部控制。在初始设置(使用纹身或AlignRT)后,通过每日kV成像验证目标位置,胸壁骨骼解剖结构匹配代表基本事实。确定平移(TS)和旋转位移(RS),以及设置时间和总室内时间。使用反向等中心移位技术计算递送剂量。统计分析采用Wilcoxon sign Rank检验和Pitman-Morgan方差检验。结果49例乳腺癌患者共接受1118次胸壁放射治疗,ART组560例,TTB组558例。对于通过ART进行的无纹身设置,中位绝对TS为垂直0.28 cm(范围:0.14—0.48),横向0.24 cm(0.10—0.40),纵向0.26 cm(0.13—0.44)。对于TTB设置,相应的中位TS分别为0.34 cm(0.15—0.52)、0.29 cm(0.13—0.46)和0.34 cm(0.14—0.59)。ART在TS方面的准确性明显高于TTB (p = 0.038, 0.007, <0.001)。方差检验还显示,ART在垂直方向(p <;0.001)和纵向(p <;0.001)轴。ART的中位绝对RS为0.80°旋转(范围:0.40-1.50),0.60°滚动(0.20-1.20)和0.50°俯仰(0.10-1.00)。TTB相应的中位RS为1.00°(0.40-1.70)、0.60°(0.20-1.20)和0.50°(0.10-1.00)。ART诊断RS的准确率明显高于TTB (p = 0.023)。ART设置与TTB在侧倾和俯仰方面无统计学差异(p分别= 0.558,0.929)。ART与TTB在RS、俯仰和横摇方面的精度无差异(p = 0.181, p = 0.544, p = 0.858)。ART治疗的总室内时间中位数为18.77分钟(范围:16.04-20.77),TTB治疗的总室内时间中位数为18.70分钟(17.58-20.67)(p = 0.38)。ART的中位设置时间为12.75 min (11.43 ~ 14.80), TTB的中位设置时间为13.78 min (12.42 ~ 15.09) (p = 0.054)。在设置和室内时间方面,AlignRT和基于纹身的方法之间没有显着差异。结论使用AlignRT的无纹身设置方法提供了足够的准确性和速度,潜在地取代了需要胸壁和区域淋巴结放射治疗的淋巴结阳性和高危乳腺癌患者表面纹身的使用。涉及更大患者群体的进一步研究将进一步告知表面成像是否可以完全取代基于纹身的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tattoo-less chest wall and regional nodal irradiation using surface imaging

Purpose/Objective

Skin tattoos represent the standard for surface alignment and setup of breast cancer radiotherapy yet contribute to adverse cosmesis and patient dissatisfaction. With the advent of contemporary surface imaging technology, we evaluated setup accuracy, time, and dosimetric parameters between traditional tattoo-based setup techniques and a “tattoo-less” approach for lymph node positive and high-risk breast cancer patients requiring chest wall and regional nodal radiation.
Material/Methods
Patients receiving chest wall radiation for breast cancer underwent a traditional tattoo-based setup (TTB), alternating daily with a tattoo-less setup via surface imaging using AlignRT (ART) to serve as an internal control. Following initial setup (using tattoos or AlignRT), target position was verified by daily kV imaging, with matching on the chest wall bony anatomy representing ground truth. Translational (TS) and rotational shifts (RS) were ascertained, as were setup time and total in-room time. Delivered dosimetry was calculated using the reverse isocenter shift technique. Statistical analyses used the Wilcoxon Signed Rank test and Pitman-Morgan variance test.

Results

A total of 49 breast cancer patients receiving a total of 1118 fractions (n = 560 for ART and 558 for TTB) of chest wall radiation were analyzed. For tattoo-less setup via ART, the median absolute TS was 0.28 cm vertical (range: 0.14–––0.48), 0.24 cm lateral (0.10–––0.40), and 0.26 cm longitudinal (0.13––0.44). For TTB setup, the corresponding median TS were 0.34 cm (0.15–––0.52), 0.29 (0.13–––0.46), and 0.34 cm (0.14–––0.59), respectively. ART was significantly more accurate than TTB with regard to TS (p = 0.038, 0.007, <0.001, respectively). Variance testing also showed increased precision with ART in the vertical (p < 0.001) and longitudinal (p < 0.001) axes.
The median absolute RS for ART was 0.80° rotational (range:0.40–1.50), 0.60° roll (0.20–1.20), and 0.50° pitch (0.10–1.00). The corresponding median RS for TTB was 1.00° (0.40–1.70), 0.60° (0.20–1.20), and 0.50° (0.10–1.00). ART was significantly more accurate for RS than TTB (p = 0.023). ART setup was otherwise not statistically different from TTB regarding roll and pitch (p = 0.558, 0.929, respectively). ART showed no difference in precision versus TTB regarding RS, pitch, and roll (p = 0.181, p = 0.544, p = 0.858).
The median total in-room time for ART was 18.77 min (range: 16.04–20.77) and 18.70 min (17.58–20.67) for TTB (p = 0.38). The median setup time was 12.75 min (11.43–14.80) for ART and 13.78 min (12.42–15.09) for TTB (p = 0.054). There was no significant difference between the AlignRT and the tattoo-based methods for both setup and in-room time.

Conclusion

These findings indicate that utilizing the tattoo-less setup method with AlignRT provides sufficient accuracy and speed to potentially supplant the use of surface tattoos in lymph node positive and high-risk breast cancer patients requiring chest wall and regional lymph node radiation. Further investigations involving larger patient cohorts will further inform whether surface imaging can wholly replace tattoo-based approaches.
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来源期刊
CiteScore
4.10
自引率
0.00%
发文量
48
审稿时长
67 days
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