Pergolizzi S, Settineri N, Gaeta M, Scribano E, Santacaterina A, Ascenti G, Frosina P, de Renzis C
Department of Radiotherapy, University of Messina, Italy.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):119-22. doi: 10.1016/s0360-3016(99)00418-6.
To evaluate the best position of the arms in mantle field for Hodgkin's disease.
In 12 patients, with surgical clips placed at the time of an axillary dissection for breast cancer, the radiological projection of the clips according to three arm positions was prospectively evaluated: akimbo (A), extended (E), and up over the head (U). The surgical clips were arbitrarily separated into two groups: lower and upper. In each patient, the distance between the surgical clips and chest wall was measured, and the possibility of shielding the lungs and humeral heads was evaluated.
The mean displacement of the lower clips away from the chest wall when the patients were in A, E, and U positions was 2.5, 3.0, and 4.6 cm, respectively. The upper group clips showed a lower difference in distance from chest wall. In the U position, there was always a clip of the lower group that projected over the humeral head, making it impossible to block this structure.
In the A position, there is the possibility of blocking the humeral head, but it is necessary to irradiate more lung parenchyma. Type E treatment setup allows the shielding of both lung and humeral head, while maintaining adequate margins around the axillary nodes. In the U position, there is a greater possibility of shielding the lung parenchyma, but it is impossible to block the humeral heads.
评估霍奇金淋巴瘤患者斗篷野照射时双臂的最佳位置。
12例因乳腺癌腋窝清扫术时放置手术夹的患者，前瞻性评估手术夹在三种手臂位置时的放射学投影：双手叉腰（A）、伸直（E）和举过头顶（U）。手术夹被任意分为两组：下方和上方。测量每位患者手术夹与胸壁之间的距离，并评估肺部和肱骨头受屏蔽的可能性。
患者处于A、E和U位置时，下方手术夹远离胸壁的平均位移分别为2.5 cm、3.0 cm和4.6 cm。上方组手术夹与胸壁的距离差异较小。在U位置时，下方组总有一个手术夹投影在肱骨头上方，无法屏蔽该结构。
在A位置，有可能屏蔽肱骨头，但需要照射更多的肺实质。E型治疗体位可在保持腋窝淋巴结周围有足够边界的同时，屏蔽肺部和肱骨头。在U位置，屏蔽肺实质的可能性更大，但无法屏蔽肱骨头。
