The Impact of Prone Position with Belly-Board Device on Three-Dimensional Conformal Radiotherapy of Prostate Cancer: Decreasing the Rectum Complication Probability

腹板及俯臥姿勢對於攝護腺癌直腸照射劑量之影響

劉裕明(Yu-Ming Liu) ； 趙良曉(Liang-Hsiao Chao) ； 王俊瑋(Chun-Wei Wang) ； 顏上惠(Sang-Hue Yen) ； 李美玲(Mei-Ling Lee) ； 謝春梅(Chuen-Mei Hsieh) ； 李玉麟(Yuh-Lin Lee) ； 黃品逸(Pin-I Huang) ； 王令瑋(Ling-Wei Wang) ； 蕭正英(Cheng-Ying Shiau)

《放射治療與腫瘤學》 20卷2期 (2013/06) Pp. 107-114

https://doi.org/10.6316/TRO/201320(2)107

摘要

背景和目的：比較使用Belly board（腹板）之俯臥位是否優於仰臥位式攝護腺癌放療，並計算直腸的直徑變化、直腸與攝護腺間距及評估治療劑量與體積直方圖（DVH）之關係。材料與方法：15例攝護腺癌患者分別進行兩組骨盆電腦斷層掃描，分別是使用Belly board之俯臥位及沒有固定的仰臥位。每個病人在兩種擺位下的治療計劃皆使用4-field box technique（方盒治療技術）三維適形放療（3DCRT）。使用Wilcoxon signed-rank test作統計分析，分析項目包括:直腸的幾何變化、直腸與攝護腺間距及重要器官的治療劑量與體積直方圖（DVH）分析。結果：患者於俯臥姿勢加腹板治療相對於患者在仰臥位置有較大的直腸前後徑和橫向徑為（p值=0.003和p=0.031），和較大的攝護腺和直腸的中心間的距離（p值= 0.002）。關於DVHs數據，患者於俯臥治療導致治療部位的直腸體積較大（P=0.015），意味著較低直腸劑量（p=0.002）和較小的直腸體積接受高輻射劑量（p=0.001）。結論：攝護腺癌病人治療時使用Belly board（腹板）之俯臥位之固定方式對直腸直徑（前後向及橫斷面）都有顯著的增大（相較於仰臥位的固定方式），在直腸與攝護腺中心點間的距離也是使用Belly board（腹板）之俯臥位之固定方式有較大的距離，在劑量與體積的直方圖也顯示使用Belly board（腹板）之俯臥位之固定方式有較低的直腸輻射劑量可以降低放療引起的併發症。

關鍵字

攝護腺癌 ； 三維適形放療 ； 治療姿勢 ； 腹板 ； 劑量與體積的直方圖

並列摘要

Backaround and Purpose: To investigate the impact of supine position versus prone position with belly-board on prostate radiotherapy by evaluation the geometric parameter change between internal organs and treatment dose-volume histograms (DVHs).Materials and Methods: Fifteen patients with prostate cancer underwent pelvic CT scan in position of both prone with belly-board device and supine without immobilization. Four-field box three-dimensional conformal radiotherapy (3DCRT) treatment planning was planned for each patient in both positions. Geometric change including diameter of rectum, distant between critical organs and treatment DVHs were investigated. Wilcoxon signed-rank test was used for statistical analysis.Results: Patients in prone treatment position had both larger anterio-posterior diameters and transverse diameter of rectum (p = 0.003 and p = 0.031), and larger distance between the centers of prostate and rectum (p=0.002) than those of patients in supine position. In regard to the DVHs data, prone treatment position resulted in larger rectal volume (p = 0.015), lower mean rectal dose (p = 0.002) and smaller rectal volume receiving high radiation dose (p = 0.001).Conclusions: Patients in prone treatment position with belly-board immobilization had both larger anterio-posterior diameters, transverse diameter of rectum, and larger distance between the centers of prostate and rectum than those of patients in supine position. Prone treatment position with belly-board device can reduce rectum dose, which may in turn decrease the risk of radiation-induced complications.

並列關鍵字

Prostate cancer ； Three-dimensional conformal radiotherapy ； Treatment position ； Belly-board ； Dose-Volume Histogram