Improvement of Setup Accuracy by Neck-Shoulder Bag during Radiotherapy in Head and Neck Cancer Patients

以肩頭固定墊改善頭頭癌病患於放射治療中擺位之準確性

范佩華(Pei-Hua Fan) ； 陳臣苑(Chen-Yuan Chen) ； 劉義誠(Yi-Chen Liu) ； 陳學勳(Shiue-Shiun Chen) ； 陳彥超(Yen-Chao Chen) ； 蔡介生(Chieh-Sheng Tsai) ； 洪志宏(Jih-Hong Hong) ； 梁為民(Wai-Man Leung)

《放射治療與腫瘤學》 19卷2期 (2012/06) Pp. 143-151

https://doi.org/10.6316/TRO/201219(2)143

摘要

目的：藉由分析頸椎夾角於治療過程中之變化，評估肩頸固定墊對治療擺位正確性之改善。材料與方法：自2008年3月至2009年3月，將66名接受強度調控放射治療之頭頸癌病患，依肩頸和治療床間距離分為兩組：距離小於三公分未使用肩頸固定墊為A組（37名）、距離大於三公分且使用肩頸固定墊為B組（29名）；此外，回顧分析2007年3月至9月，31名病患為對照組，距離小於三公分為A'組（15名）、距離大於三公分為B組（16名），皆未使用肩頸固定墊用於評估單獨使用熱塑性面軍其頸椎角度之變異。分析頸椎角度為頸椎第二節投影與頸椎第五節後緣投影之夾角。利用Offline Review軟體，收集97位病患582張影像，量測第一次治療前之千伏影像與每週拍攝之常規照野驗證影像和參考影像間之頸椎角度差異，並記錄病患體重變化、治療前是否手術切除、肩頸和治療床間距離、是否使用肩頸固定墊；資料使用皮爾森相關係數及SPSS17進行單變數獨立樣本T檢定。結果：本實驗共分析582張影像；其中肩頸和治療床間距離小於3公分之A組頸椎夾角變異為0.67±2.58度和A'組為1.03±3.48度（p=0.4840）；而距離大於3公分且使用肩頸部固定墊之8組夾角變異為0.41±0.66度而未使用之B'組為1.52±3.63度（p=0.0462）。統計結果顯示病患放射治療前接受手術會使頸椎夾角變異增加（p = 0.0436），而病患體重變化和頸椎夾角變異間不具相關性（r : 0.01 to -0.21）。結論：本研究結果顯示對於肩頸和治療床間距離大於3公分之病患，使用肩頸固定墊可降低頸椎夾角變異，提升治療擺位正確性。

關鍵字

頭頸癌 ； 擺位正確性 ； 肩頸固定墊 ； 頸椎角度

並列摘要

Purpose: To study how neck-shoulder bag (NSB) improve the setup accuracy among head and neck cancer patients during radiation therapy (RT) by analyzing the cervical spine curvature difference.Meterials and Method: Between March 2008 and March 2009, sixty-six consecutive head and neck cancer patients received RT with immobilization by thermoplastic mask and hollow-pillow. These 66 patients were divided into two groups. Group A (n = 37) were those with a neck to couch perpendicular distance (NCD) ＜ 3 cm, measuring at the point just caudal to the hollow-pillow, and the γ did not use the NSS for neck support Group S (n = 29) were those with NCD equal to or larger than 3 cm, and all of them used NSB during RT. Another cohort of 31 cases treated in the year 2007, not using the NSB was used as the retrospective control group. Among these 31 cases, fifteen have NCD ＜ 3 cm (Group A') and sixteen cases were 3 cm (Group B'). Patient's cervical spine curvature was quantified by his/her second and fifth cervical vertebrae intersecting angle (cervical spine angle, CSA). It was measured weekly from patient's portal images and simulation films. A small difference between the weekly CSA indicated good setup accuracy. Body weight change, surgery prior to RT, NCD, and whether using a NSB or not were investigated correlating to CSA. Analyses were performed using the Pearson correlation coefficient and SPSS17 for independent univariate t test.Results: A total of 582 portal images were obtained. Patients with NCD ＜ 3 cm and not using the NSB have a CSA weekly difference of 0.67±2.58° for Group A, and 1.03±3.48° for Group A' (p = 0.484). Those with NCD ≥3 cm, CSA weekly variation for Group B was 0.41±0.66°, and was 1.52±3.63° for Group B', (p = 0.046). Surgery prior to RT significantly increased the CSA range of difference (p = 0.0436). Body weight change had little to no correlation with CSA variation (r range: 0.01 to -0.21).Conclusions: Our results indicated using NSS in patients with NCD ≥3 cm significantly reduced CSA variation among RT fractionations, thus improved setup accuracy. Patients with NCD ＜ 3 cm had acceptable setup accuracy in the absence of NSB.

並列關鍵字

Head and neck cancer ； Setup accuracy ； Neck-shoulder bag ； Cervical spine angle