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目的：比较热塑膜与真空垫体位固定技术在儿童全脑全脊髓(CSI)螺旋断层放疗(HT)中的摆位误差，为患儿体位固定方案优化提供依据。方法 ：回顾性纳入2024年1月至12月于北京世纪坛医院放疗科接受CSI治疗的12例2～17岁患儿，根据采用的固定装置不同将其分为热塑膜组和真空垫组，每组6例。通过兆伏级CT(MVCT)验证量化摆位误差，对比热塑膜组与真空垫组在左右(x)、头脚(y)、腹背(z)方向和横断面旋转(Roll)的摆位误差，同时计算两组计划靶区(PTV)外放边界。结果 ：热塑膜组与真空垫组在x、y、z方向和Roll的摆位误差分别为0.3 mm(-0.40, 0.98)、-2.85 mm(-3.68,-1.68)、(2.69±1.90)mm、0.1°(0, 0.28)和(-0.23±2.91)mm、(-2.90±3.36)mm、(-1.12±2.74)mm、0.1°(0, 1.30)，热塑膜组x方向摆位误差显著小于真空垫组(U=251.0,P<0.001)。在无每日MVCT验证的情况下，推荐热塑膜组和真空垫组PTV外放边界在x、y、z方向分别为3、5、5 mm及7、8和7 mm。结论 ：热塑膜和真空垫固定技术均能满足儿童CSI螺旋断层放疗体位固定要求，临床应综合评估患儿情况进行个体化选择。
Abstract：Objective: To compare the positioning errors between thermoplastic mask immobilization technique and vacuum-lock bag immobilization technique for posture in craniospinal irradiation(CSI) utilizing helical tomotherapy(HT) for children, so as to provide basis for optimizing immobilization plan of posture of pediatric patients. Methods: A retrospective analysis was conducted on pediatric patients who underwent CSI at Beijing Shijitan Hospital between January and December 2024. Patients were divided into two groups based on the different immobilization device, thermoplastic mask group(n=6) and vacuum-lock bag group(n=6). The positioning errors were quantified using megavoltage CT(MVCT) verification. The positioning error of the thermoplastic mask group was compared to that of the vacuum-lock bag group at left-right(x) direction, head-foot(y) direction, abdomen-back(z) direction and cross-section rotation(Roll) direction. At the same time, the external boundary of planning target volume(PTV) of two groups were respectively calculated. Results: The positioning errors of the thermoplastic mask group and the vacuum-lock bag group on x, y, z and Roll directions were respectively [0.3 mm(-0.40, 0.98),-2.85 mm(-3.68,-1.68),(2.69±1.90) mm and 0.1°(0, 0.28)] and [(-0.23±2.91) mm,(-2.90±3.36) mm,(-1.12±2.74) mm and 0.1°(0, 1.30)]. The positioning error of the thermoplastic mask group was significantly smaller than that of the vacuum-lock bag group on x direction(U=251.0, P<0.001). Under the condition without MVCT verification in each day, the PTV external boundary values of the thermoplastic mask group and the vacuum-lock bag group were recommended respectively as(3 mm, 5 mm and 5 mm) and(7 mm, 8 mm and 7 mm) on x, y and z directions. Conclusion: Both the thermoplastic mask technique and the vacuum-lock bag technique can meet the requirements of posture immobilization in CSI utilizing HT for children, and the conditions of children should be comprehensively assessed in clinical application so as to conduct individual selection for children.
[1]Ajithkumar T,Horan G,Padovani L,et al.SIOPE-Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy[J].Radiother Oncol,2018,128(2):192-197.DOI:10.1016/j.radonc.2018.04.016.
[2]Pinnix CC,Yahalom J,Specht L,et al.Radiation in central nervous system leukemia:guidelines from the international lymphoma radiation oncology group[J].Int J Radiat Oncol Biol Phys,2018,102(1):53-58.DOI:10.1016/j.ijrobp.2018.05.067.
[3]Martin AM,Raabe E,Eberhart C,et al.Management of pediatric and adult patients with medulloblastoma[J].Curr Treat Options Oncol,2014,15(4):581-594.DOI:10.1007/s11864-014-0306-4.
[4]Seravalli E,Bosman M,Lassen-Ramshad Y,et al.Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers:analysis on behalf of the SIOP-E-BTG(radiotherapy working group)[J].Acta Oncol,2018,57(9):1240-1249.DOI:10.1080/0284186x.2018.1465588.
[5]Schiopu SR,Habl G,H??fner M,et al.Craniospinal irradiation using helical tomotherapy for central nervous system tumors[J].J Radiat Res,2017,58(2):238-246.DOI:10.1093/jrr/rrw095.
[6]Welsh JS,Lock M,Harari P M,et al. Clinical implementation of adaptive helical tomotherapy:a unique approach to image-guided intensity modulated radiotherapy[J].Technol Cancer Res Treat,2006,5(5):465-479.DOI:10.1177/153303460600500503.
[7]Pe??agarícano J,Moros E,Corry P,et al.Pediatric craniospinal axis irradiation with helical tomotherapy:patient outcome and lack of acute pulmonary toxicity[J].Int J Radiat Oncol Biol Phys,2009,75(4):1155-1161.DOI:10.1016/j.ijrobp.2008.12.083.
[8]Yoon M,Shin DH,Kim J,et al.Craniospinal irradiation techniques:a dosimetric comparison of proton beams with standard and advanced photon radiotherapy[J].Int J Radiat Oncol Biol Phys,2011,81(3):637-646.DOI:10.1016/j.ijrobp.2010.06.039.
[9]Al-Wassia R,Bahig H,Poon E,et al.Daily setup uncertainty analysis for craniospinal irradiation using helical tomotherapy[J].Pract Radiat Oncol,2013,3(4):349-355.DOI:10.1016/j.prro.2012.07.005.
[10]Zhou Y,Ai Y,Han C,et al.Impact of setup errors on multi-isocenter volumetric modulated arc therapy for craniospinal irradiation[J].J Appl Clin Med Phys,2020,21(11):115-123.DOI:10.1002/acm2.13044.
[11]Novak J,Du D,Shinde A,et al.Setup accuracy in craniospinal irradiation:implications for planning treatment volume margins[J].Adv Radiat Oncol,2021,6(5):100747.DOI:10.1016/j.adro.2021.100747.
[12]程晓龙,陈祥,刘吉平,等.全脑全脊髓螺旋断层放疗体位固定技术的优化及应用研究[J].实用肿瘤杂志.2019,34(4):348-352.DOI:10.1016/j.adro.2021.100747.
[13]van Herk M.Errors and margins in radiotherapy[J].Semin Radiat Oncol,2004,14(1):52-64.DOI:10.1053/j.semradonc.2003.10.003.
[14]van Herk M,Remeijer P,Rasch C,et al.The probability of correct target dosage:dose-population histograms for deriving treatment margins in radiotherapy[J].Int J Radiat Oncol Biol Phys,2000,47(4):1121-1135.DOI:10.1016/s0360-3016(00)00518-6.
[15]Mavroidis P,Ferreira BC,Shi C,et al.Comparison of the helical tomotherapy and MLC-based IMRT radiation modalities in treating brain and cranio-spinal tumors[J].Technol Cancer Res Treat,2009,8(1):3-14.DOI:10.1177/153303460900800102.
[16]??ztunali A,Elsayad K,Scobioala S,et al.Toxicity reduction after craniospinal irradiation via helical tomotherapy in patients with medulloblastoma:a unicentric retrospective analysis[J].Cancers,2021,13(3):501.DOI:10.3390/cancers13030501.
[17]Piotrowski T,Skórska M,Jodda A,et al.Tomotherapy-a different way of dose delivery in radiotherapy[J].Contemp Oncol(Pozn),2012,16(1):16-25.DOI:10.5114/wo.2012.27332.
[18]Biston MC,Jarril J,Dupuis P,et al.Comparison among four immobilization devices for whole breast irradiation with helical tomotherapy[J].Phys Med,2020,69:205-211.DOI:10.1016/j.ejmp.2019.12.023.
[19]Song Y,Peng J,Chen Q,et al.Compare of interfractional setup reproducibility between vacuum-lock bag and thermoplastic mask in radiotherapy for breast cancer[J].Technol Cancer Res Treat,2021,20:15330338211043037.DOI:10.1177/15330338211043037.
[20]Lee J,Kim E,Kim N,et al.Practical aspects of the application of helical tomotherapy for craniospinal irradiation[J].Sci Rep,2021,11(1):6120.DOI:10.1038/s41598-021-85574-y.
[21]Stroom JC,Heijmen BJ.Geometrical uncertainties,radiotherapy planning margins,and the ICRU-62report[J].Radiother Oncol,2002,64(1):75-83.DOI:10.1016/s0167-8140(02)00140-8.
[22]Meeks SL,Harmon JF,Langen KM,et al.Performance characterization of megavoltage computed tomography imaging on a helical tomotherapy unit[J].Med Phys,2005,32(8):2673-2681.DOI:10.1118/1.1990289.
[23]Gupta T,Upasani M,Master Z,et al.Assessment of three-dimensional set-up errors using megavoltage computed tomography(MVCT)during image-guided intensity-modulated radiation therapy(IMRT)for craniospinal irradiation(CSI)on helical tomotherapy(HT)[J].Technol Cancer Res Treat,2015,14(1):29-36.DOI:10.7785/tcrt.2012.500391.
基本信息:
中图分类号:R730.55
引用信息:
[1]骆飞,赵磊,葛永青,等.儿童全脑全脊髓螺旋断层放疗中体位固定技术的对比研究[J].中国医学装备,2026,23(02):18-22.
2026-02-25
2026-02-25