Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi'an, China.
Radiol Oncol. 2024 Jan 6;58(1):124-132. doi: 10.2478/raon-2024-0001. eCollection 2024 Mar 1.
To retrospectively analyze the accuracy of radiotherapy using cone beam computed tomography (CBCT), Styrofoam fixation, and breast bracket fixation in the chest wall target area and supraclavicular lymphatic drainage area (supraclavicular target area) of patients with breast cancer.and compare the setting efficiency and comfort satisfaction.
A total of 65 patients with postoperative lymphatic metastasis of breast cancer, including 36 cases of Styrofoam fixation and 29 cases of breast bracket fixation, were recruited from March 2021 to August 2022 and retrospectively analyzed. All the patients underwent CBCT scans weekly, and the setup errors of the chest wall and supraclavicular target volume were compared and recorded. The planning target volume (PTV) margins of the two groups were calculated using the correlation M = 2.5Σ + 0.7σ. The setup time and comfort satisfaction scores of the two groups were recorded and analyzed. The correlations among errors in each direction were analyzed using the Pearson correlation analysis.
There was a significant difference in the left-right direction (X) axis of the chest wall target area between the Styrofoam and breast bracket groups (1.59 ± 1.47 mm 2.05 ± 1.64 mm, P = 0.012). There were statistical differences in the ventrodorsal direction (Z) and bed angle of the supraclavicular target area, the data were (1.36 ± 1.27 mm 1.75 ± 1.55 mm, P = 0.046; 0.47 ± 0.47° 0.66 ± 0.59°, P = 0.006, respectively). In the X, Y, and Z directions, the respective PTV margins of the two groups in the chest wall target area were 5.01 mm, 5.99 mm, and 5.47 mm in the Styrofoam group, while those in the breast bracket group were 6.10 mm, 6.34 mm, and 6.10 mm, respectively. Moreover, the PTV margins of the supraclavicular target in the three directions were 3.69 mm, 3.86 mm, and 4.28 mm in the Styrofoam group, while those in the breast bracket group were 3.99 mm, 3.72 mm, and 5.45 mm, respectively. The setup time of the two groups was 3.4 ± 1.1 min and 5.5 ± 3.1 min (P = 0.007). The subjective comfort satisfaction scores of the two groups were 27.50 ± 1.24 and 25.44 ± 1.23 (P < 0.001).
The application of Styrofoam fixation in radiotherapy of breast cancer in the supraclavicular lymph node area has several advantages as compared to breast bracket fixation, including higher positioning accuracy, smaller external expansion boundary, improved work efficiency, and patients' comfort, which might provide a reference for clinical work.
本研究旨在回顾性分析锥形束 CT（CBCT）、泡沫固定和乳房托架固定在乳腺癌患者胸壁靶区和锁骨上淋巴引流区（锁骨上靶区）中的准确性，并比较其摆位效率和舒适度满意度。
2021 年 3 月至 2022 年 8 月期间，共纳入 65 例乳腺癌术后淋巴转移患者，其中 36 例采用泡沫固定，29 例采用乳房托架固定。所有患者每周进行一次 CBCT 扫描，比较并记录胸壁和锁骨上靶区的摆位误差。采用相关 M = 2.5Σ + 0.7σ 计算两组的计划靶区（PTV）边界。记录并分析两组的摆位时间和舒适度满意度评分。采用 Pearson 相关分析研究各方向误差之间的相关性。
在胸壁靶区的左右（X）轴方向，泡沫固定组与乳房托架固定组存在显著差异（1.59 ± 1.47 mm 比 2.05 ± 1.64 mm，P = 0.012）。锁骨上靶区的前后（Z）方向和床角也存在统计学差异，数据分别为（1.36 ± 1.27 mm 比 1.75 ± 1.55 mm，P = 0.046；0.47 ± 0.47° 比 0.66 ± 0.59°，P = 0.006）。在 X、Y 和 Z 方向，泡沫固定组胸壁靶区的各自 PTV 边界分别为 5.01 mm、5.99 mm 和 5.47 mm，而乳房托架固定组的相应边界分别为 6.10 mm、6.34 mm 和 6.10 mm。此外，在三个方向上，泡沫固定组锁骨上靶区的 PTV 边界分别为 3.69 mm、3.86 mm 和 4.28 mm，而乳房托架固定组的相应边界分别为 3.99 mm、3.72 mm 和 5.45 mm。两组的摆位时间分别为 3.4 ± 1.1 min 和 5.5 ± 3.1 min（P = 0.007）。两组的主观舒适度满意度评分分别为 27.50 ± 1.24 和 25.44 ± 1.23（P < 0.001）。
与乳房托架固定相比，泡沫固定在乳腺癌锁骨上淋巴结区域放疗中的应用具有更高的定位准确性、更小的外部扩展边界、提高工作效率和患者舒适度等优势，可为临床工作提供参考。
