Contesini Massimiliano, Guberti Monica, Saccani Roberta, Braglia Luca, Iotti Cinzia, Botti Andrea, Abbati Emilio, Iemmi Marina
Human Resource Development - Training, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy.
Nursing Directorate, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Radiat Oncol. 2017 Apr 27;12(1):72. doi: 10.1186/s13014-017-0807-y.
In patients with head-neck cancer treated with IMRT, immobility of the upper part of the body during radiation is maintained by means of customised immobilisation devices. The main purpose of this study was to determine how the procedures for preparation of customised immobilisation systems and the patients characteristics influence the extent of setup errors.
A longitudinal, prospective study involving 29 patients treated with IMRT. Data were collected before CT simulation and during all the treatment sessions (528 setup errors analysed overall); the correlation with possible risk factors for setup errors was explored using a linear mixed model.
Setup errors were not influenced by the patient's anxiety and pain. Temporary removal of the thermoplastic mask before carrying out the CT simulation shows statistically borderline, clinically relevant, increase of setup errors (+24.7%, 95% CI: -0.5% - 55.8%). Moreover, a unit increase of radiation therapists who model the customised thermoplastic mask is associated to a -18% (-29.2% - -4.9%) reduction of the errors. The setup error is influenced by the patient's physical features; in particular, it increases both in patients in whom the treatment position is obtained with 'Shoulder down' (+27.9%, 2.2% - 59.7%) and in patients with 'Scoliosis/kyphosis' problems (+65.4%, 2.3% - 164.2%). Using a 'Small size standard plus customized neck support device' is associated to a -52.3% (-73.7% - -11.2%) reduction. The increase in number of radiation therapists encountered during the entire treatment cycle does not show associations. Increase in the body mass index is associated with a slight reduction in setup error by (-2.8%, -5% - -0.7%).
The position of the patient obtained by forcing the shoulders downwards, clinically significant scoliosis or kyphosis and the reduction of the number of radiation therapists who model the thermoplastic mask are found to be statistically significant risk factors that can cause an increase in setup errors, while the use of 'Small size' neck support device and patient BMI can diminish them.
在接受调强放射治疗（IMRT）的头颈癌患者中，通过定制的固定装置在放疗期间保持身体上部的固定。本研究的主要目的是确定定制固定系统的准备程序和患者特征如何影响摆位误差的程度。
一项纵向前瞻性研究，纳入29例接受IMRT治疗的患者。在CT模拟前以及所有治疗疗程期间收集数据（共分析528次摆位误差）；使用线性混合模型探讨与摆位误差可能的风险因素之间的相关性。
摆位误差不受患者焦虑和疼痛的影响。在进行CT模拟前临时取下热塑性面罩显示，摆位误差在统计学上处于临界值，但具有临床相关性的增加（+24.7%，95%可信区间：-0.5% - 55.8%）。此外，制作定制热塑性面罩的放射治疗师人数每增加一个单位，误差减少-18%（-29.2% - -4.9%）。摆位误差受患者身体特征的影响；特别是，采用“肩部下垂”方式获得治疗体位的患者（+27.9%，2.2% - 59.7%）以及有“脊柱侧弯/驼背”问题的患者（+65.4%，2.3% - 164.2%），摆位误差均增加。使用“小号标准加定制颈部支撑装置”可使误差减少-52.3%（-73.7% - -11.2%）。在整个治疗周期中遇到的放射治疗师人数增加未显示出相关性。体重指数增加与摆位误差略有减少相关（-2.8%，-5% - -0.7%）。
强迫肩部向下获得的患者体位、具有临床意义的脊柱侧弯或驼背以及制作热塑性面罩的放射治疗师人数减少，是导致摆位误差增加的统计学显著风险因素，而使用“小号”颈部支撑装置和患者体重指数可减少摆位误差。
