Raphael Jomon C, Varghese Mathew K, Gopu Paul G, Venkatesan K, Jimson A D, Febin Antony
Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
Indian J Cancer. 2018 Jul-Sep;55(3):226-229. doi: 10.4103/ijc.IJC_95_18.
: To assess the effectiveness of abdominal compression in reducing internal target motion during conformal radiotherapy for stomach cancer.
A pilot study was conducted on five patients who received adjuvant radiotherapy for stomach cancer. All the patients had surgical clips and were offered radiotherapy and concurrent chemotherapy as per the institutional protocol. An abdominal compression device was developed consisting of a triangular Styrofoam's plate and an inflatable air bladder that was positioned over the patients' abdomen. The pneumatic pressure was set according to the patients' comfort. On the simulation day, patients had two computed tomography (CT)-scanning sessions, with and without abdominal compression. Target volumes and organs at risk (OAR) were delineated on the CT images without compression. On the treatment day, fluoroscopy was acquired with onboard imager (OBI) and movements of surgical clips with and without compression analyzed with the help of a tracker software. Observed values with and without abdominal compression were compared.
Abdominal compression usage has reduced the mean breathing excursion (MBE) in medio lateral(ML) direction from 5.92mm to 4.15 mm and in cranio caudal direction (CC) from 11.3mm to 7.2mm. The range of reduction by 29.85% in the ML and 36.86% in CC direction. The average residual breathing excursion was 1.766 mm (SD = 1.33 mm) in the ML and 4.02 mm (SD = 2.18 mm) in the CC direction, respectively.
Abdominal compression was useful in reducing internal target motion during stomach cancer conformal radiotherapy. The device we developed is patient friendly and cost-effective.
评估腹部压迫在降低胃癌适形放疗期间内部靶区运动方面的有效性。
对5例接受胃癌辅助放疗的患者进行了一项初步研究。所有患者均有手术夹，并按照机构方案接受放疗和同步化疗。开发了一种腹部压迫装置，该装置由一个三角形聚苯乙烯泡沫板和一个可充气气囊组成，放置在患者腹部上方。根据患者的舒适度设置气压。在模拟日，患者进行了两次计算机断层扫描（CT），一次有腹部压迫，一次没有。在未进行压迫的CT图像上勾画靶区体积和危及器官（OAR）。在治疗日，使用机载成像仪（OBI）进行透视，并借助跟踪软件分析有无压迫时手术夹的运动。比较有无腹部压迫时的观察值。
腹部压迫的使用使平均呼吸偏移（MBE）在内外侧（ML）方向从5.92mm降至4.15mm，在头脚方向（CC）从11.3mm降至7.2mm。在ML方向减少范围为29.85%，在CC方向减少范围为36.86%。平均残余呼吸偏移在ML方向分别为1.766mm（标准差=1.33mm），在CC方向为4.02mm（标准差=2.18mm）。
腹部压迫在降低胃癌适形放疗期间的内部靶区运动方面是有效的。我们开发的装置对患者友好且具有成本效益。
