呼吸調控裝置在乳癌病人的放射治療應用

Respiratory Control Devices for Radiation Therapy in Breast Cancer Patients

王慧雲(HUI-YUN WANG)

指導教授 ： 張振榮

中臺科技大學/健康科學院/醫學影像暨放射科學系暨研究所/碩士(2017年)

摘要

放射線治療中呼吸的運動會使治療計畫的傳遞增加了許多不確定的因素。為了改善這些臨床的不確定因素和治療上的誤差，可以利用呼吸調控技術來調整病人的呼吸律動。本研究收集12位乳癌病患，使用瓦里安(Varian)的TrueBeam-STx直線加速器分別使用即時位置管理系統(Real-time Position Management™ System,RPM)搭配深吸氣閉住氣(deep inspiration breath-hold, DIBH)和自由呼吸(free breathing, FB)兩種模式來監測病人的呼吸起伏，和完全沒有使用呼吸調控裝置的病患其之間的差異性做比較。結果顯示：心臟部分使用DIBH的呼吸模式，其心臟接受的體積較完全沒有使用呼吸調控裝置的病患在統計上有明顯的減少2.27%-4.13%(P值<0.05)。研究發現使用呼吸調控技術可以減少因呼吸所產生的治療誤差，對於正常組織也可以減少其照射體積。在放射線治療中，因為可搭配病患的呼吸振幅進而去調整射束的發射和停止，可以提升放射線治療的準確性；也可以減少其危急器官的劑量。

關鍵字

呼吸調控 ； 深吸氣後閉住氣 ； 自由呼吸 ； 乳癌

並列摘要

The respiratory motions of patient increase uncertainties in treatment plans of radiation therapy. In order to improve the uncertainty and clinical error during radiation therapy treatment, respiratory control devices can be utilized to adjust the patient's breathing rhythm.Inthis study, 12 breast cancer patients were evaluated by Real-time Position Management ™ System(RPM) of Varian TrueBeam-STx linear accelerator, in breathingdeep inspiration breath-hold(DIBH) and free breathing (FB) modes, respectively.The results displayed that the accepted volume of the patient’s heart of DIBH under breathing patterns received lower dosage of radiation 2.27%-4.13%(P <0.05),as compared with the patients without the respiratory control devices.Therespiratory control devices can also adjust the beam on and off of linear accelerator through the patient’s breathing amplitude. The accuracy of radiation therapy may enhance, by reduce the radiation volume of normal tissue.

並列關鍵字

Respiratory regulation ； deep inspiration breath-hold ； free breathing ； breast cancer

參考文獻

1. Edlund TGD: A single isocenter technique using CT-based planning in the treatment of breast cancer. Med Dosim 1999；24：239–245.

2. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005；366：2087-106.

3. Lee MS, Finch W, Mahmud E. Cardiovascular complications of radiotherapy. Am J Cardiol 2013；112：1688–96.

4. Duma MN, Molls M, Trott KR. From heart to heart for breast cancer patients cardiovascular toxicities in breast cancer radiotherapy. StrahlentherOnkol 2014；190：5–7.

5. Ong DS, Aertker RA, Clark AN, et al. Radiation-associated valvular heart disease. J Heart Valve Dis 2013；22：883–92.