Hu Yong, Zhou Yong-Kang, Chen Yi-Xing, Shi Shi-Ming, Zeng Zhao-Chong
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Med Dosim. 2017;42(1):37-41. doi: 10.1016/j.meddos.2016.10.005. Epub 2017 Jan 23.
A comprehensive clinical evaluation was conducted, assessing the Body Pro-Lok immobilization and positioning system to facilitate hypofractionated radiotherapy of intrahepatic hepatocellular carcinoma (HCC), using helical tomotherapy to improve treatment precision.
Clinical applications of the Body Pro-Lok system were investigated (as above) in terms of interfractional and intrafractional setup errors and compressive abdominal breath control. To assess interfractional setup errors, a total of 42 patients who were given 5 to 20 fractions of helical tomotherapy for intrahepatic HCC were analyzed. Overall, 15 patients were immobilized using simple vacuum cushion (group A), and the Body Pro-Lok system was used in 27 patients (group B), performing megavoltage computed tomography (MVCT) scans 196 times and 435 times, respectively. Pretreatment MVCT scans were registered to the planning kilovoltage computed tomography (KVCT) for error determination, and group comparisons were made. To establish intrafractional setup errors, 17 patients with intrahepatic HCC were selected at random for immobilization by Body Pro-Lok system, undergoing MVCT scans after helical tomotherapy every week. A total of 46 MVCT re-scans were analyzed for this purpose. In researching breath control, 12 patients, randomly selected, were immobilized by Body Pro-Lok system and subjected to 2-phase 4-dimensional CT (4DCT) scans, with compressive abdominal control or in freely breathing states, respectively. Respiratory-induced liver motion was then compared.
Mean interfractional setup errors were as follows: (1) group A: X, 2.97 ± 2.47mm; Y, 4.85 ± 4.04mm; and Z, 3.77 ± 3.21mm; pitch, 0.66 ± 0.62°; roll, 1.09 ± 1.06°; and yaw, 0.85 ± 0.82°; and (2) group B: X, 2.23 ± 1.79mm; Y, 4.10 ± 3.36mm; and Z, 1.67 ± 1.91mm; pitch, 0.45 ± 0.38°; roll, 0.77 ± 0.63°; and yaw, 0.52 ± 0.49°. Between-group differences were statistically significant in 6 directions (p < 0.05). Mean intrafractional setup errors with use of the Body Pro-Lok system were as follows: X, 0.41 ± 0.46mm; Y, 0.86 ± 0.80mm; Z, 0.33 ± 0.44mm; and roll, 0.12 ± 0.19°. Mean liver-induced respiratory motion determinations were as follows: (1) abdominal compression: X, 2.33 ± 1.22mm; Y, 5.11 ± 2.05mm; Z, 2.13 ± 1.05mm; and 3D vector, 6.22 ± 1.94mm; and (2) free breathing: X, 3.48 ± 1.14mm; Y, 9.83 ± 3.00mm; Z, 3.38 ± 1.59mm; and 3D vector, 11.07 ± 3.16mm. Between-group differences were statistically different in 4 directions (p < 0.05).
The Body Pro-Lok system is capable of improving interfractional and intrafractional setup accuracy and minimizing tumor movement owing to respirations in patients with intrahepatic HCC during hypofractionated helical tomotherapy.
进行全面的临床评估，评估Body Pro-Lok固定和定位系统，以促进肝内肝细胞癌（HCC）的大分割放疗，采用螺旋断层放疗提高治疗精度。
研究了Body Pro-Lok系统（如上所述）在分次间和分次内设置误差以及腹部压迫呼吸控制方面的临床应用。为评估分次间设置误差，共分析了42例接受5至20次肝内HCC螺旋断层放疗的患者。总体而言，15例患者使用简单真空垫固定（A组），27例患者使用Body Pro-Lok系统（B组），分别进行了196次和435次兆伏级计算机断层扫描（MVCT）。将治疗前MVCT扫描与计划千伏计算机断层扫描（KVCT）进行配准以确定误差，并进行组间比较。为确定分次内设置误差，随机选择17例肝内HCC患者使用Body Pro-Lok系统固定，每周在螺旋断层放疗后进行MVCT扫描。为此共分析了46次MVCT重新扫描。在研究呼吸控制方面，随机选择12例患者使用Body Pro-Lok系统固定，并分别在腹部压迫控制或自由呼吸状态下进行两期四维CT（4DCT）扫描。然后比较呼吸引起的肝脏运动。
平均分次间设置误差如下：（1）A组：X，2.97±2.47mm；Y，4.85±4.04mm；Z，3.77±3.21mm；俯仰，0.66±0.62°；滚动，1.09±1.06°；偏航，0.85±0.82°；（2）B组：X，2.23±1.79mm；Y，4.10±3.36mm；Z，1.67±1.91mm；俯仰，0.45±0.38°；滚动，0.77±0.63°；偏航，0.52±0.49°。组间在6个方向上差异有统计学意义（p<0.05）。使用Body Pro-Lok系统时的平均分次内设置误差如下：X，0.41±0.
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