- 期刊
回溯研究乳癌放射治療時的擺位誤差與皮膚反應
Retrospective Study of Setup Error and Skin Reaction in Breast Cancer Radiotherapy
摘要
由於乳癌的新增個案逐年增加，現已躍昇成為女性癌症發生率的第一位，根據美國癌症協會乳癌治療共識提及乳房保留手術合併放射治療能夠提升腫瘤的控制率。由於臨床分次放射治療中無法有效的將發泡劑鎖定在治療床的相同位置，導致病人身體歪斜或旋轉，因此本次研究以回溯分析的方式，區分保麗龍與人型底板等兩個群組，搭配使用指引定位桿（Lock bar）將發泡劑鎖定在治療床的相同位置，透過影像導引（IGRT）之體積弧形調控放射治療技術（Rapid arc）來評估乳癌治療的擺位誤差與皮膚反應；應用治療床參數來計算保麗龍（發泡劑）與人型底板（發泡劑）群組，在前後、頭腳、左右軸位的位移與治療床的角度修正平均數值分別為2.4±0.7 mm、-1.1±0.4 mm、-0.3±0.8 mm、0.1±0.2度與2.2±0.6 mm、-1.1±0.9 mm、1.1±0.9 mm、0.2±0.2度，其中負值代表方向性；而擺位誤差值為2.60 mm與2.65 mm（P＜0.235）。研究結果僅有一位在保麗龍（發泡劑）群組的病人出現輕度濕性脫屑的二級皮膚反應，佔比為3.1%，其餘病人皮膚皆只出現色素沉澱及乾性脫屑的一級反應，而且兩種群組都能將治療床的平均位移差異控制在3 mm的範圍以內。因此透過本次研究發現，臨床治療中發泡劑佐以使用指引定位桿，確實具有強化治療再現性與減少擺位誤差的優點。
並列摘要
As the number of new cases of breast cancer increased over the years, it has become the leading cancer among women. According to the American Cancer Society's Breast Cancer Treatment Consensus, breast preservation surgery combined with radiation therapy can improve tumor control rate. Alpha cradle can not effectively fix on the same position of the couch top in fractionated radiotherapy, causing the patient's body to be skewed or rotated. Therefore, this study used retrospective analysis the use of Styrofoam (alpha cradle) and Type S baseplate (alpha cradle) combined lock bar to fix on the same position of the couch top. Through image guidance of volumetric modulated arc therapy to assess the setup error and skin reaction. Application the readings of couch shift to calculate the Styrofoam(alpha cradle ) and Type S baseplate (alpha cradle ) displacement values of the AP, SI, RL, Rtn are respectively, 2.4±0.7 mm、-1.1±0.4 mm、-0.3±0.8 mm、0.1±0.2 degree and 2.2±0.6 mm、-1.1±0.9 mm、1.1±0.9 mm、 0.2±0.2 degree, where negative values represent directionality; and setup error are 2.60 mm & 2.65 mm. Only one patient of Styrofoam (alpha cradle) appear mild wet desquamation skin reaction (Gr2),the ratio is 3.1%, and the rest were only pigmentation and dry desquamation (Gr1). And both groups can control the difference in the average displacement of the couch within the range of 3 mm. Therefore, the clinical use of lock bar to fix alpha cradle has the advantages of enhancing treatment reproducibility and reducing setup error.
延伸閱讀
- 楊淑琴、洪佳伶、謝禮存、沙亞拿、劉淑芬、李昕薇、盧盈真、蘇啟文、李淞維、何聖佑（2020）。腹部壓迫器對乳癌放射治療的擺位誤差研究。中華放射線技術學雜誌，44(3)，147-154。https://www.airitilibrary.com/Article/Detail?DocID=16849418-202009-202105130009-202105130009-147-154
- Wang, N. T., Shaw, S. Z., Lui, L. T., Lee, H. Y., & Wu, C. J. (2015). 乳癌倂廣泛皮膚轉移之姑息放射性治療：案例報告與文獻回顧. 放射治療與腫瘤學, 22(3), 239-247. https://doi.org/10.6316/TRO/201522(3)239
- 陳怡任（2015）。評估乳癌病人使用強度調控或體積調控放射治療後引起皮膚炎併發症之劑量體積效應分析〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0011-1007201511470100
- 周佩君（2006）。乳癌病人放射治療期間的照射劑量、症狀困擾與細胞激素之相關性探討〔碩士論文，臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-1704200715031712
- 何迦聖、張智深、陳妙芬（2021）。Accuracy Evaluation of Left Breast Cancer Patients were Treated in Using of Surface Guided Radiotherapy。中華放射線技術學雜誌，45(1)，1-8。https://www.airitilibrary.com/Article/Detail?DocID=16849418-202103-202109090013-202109090013-1-8