Fionda Bruno, Placidi Elisa, Rosa Enrico, Lancellotta Valentina, Vaccaro Maria, Cornacchione Patrizia, Angeli Martina De, Scalise Sara, Ciasca Gabriele, Pastore Francesco, González-Pérez Víctor, Miccichè Francesco, Massaccesi Mariangela, Gambacorta Maria Antonietta, Galli Jacopo, Bussu Francesco, Spirito Marco De, Tagliaferri Luca
UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
UOC Fisica per le Scienze della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
J Contemp Brachytherapy. 2025 Apr;17(2):127-132. doi: 10.5114/jcb.2025.150065. Epub 2025 Apr 28.
This study aimed to investigate quality control (QC) strategies to enhance treatment delivery in interventional radiotherapy (IRT) for head and neck (H&N) cancers, focusing on ensuring the accuracy of therapy while addressing specific challenges, such as catheter displacement and tube misconnection.
A retrospective analysis was conducted among 30 patients treated with IRT for nasal vestibule or eyelid cancers at our institutional center from January 2022 to December 2023. All treatments involved 14 fractions over nine days. QC measures were implemented to monitor catheter placement and prevent misconnection, with daily visual checks and mid-course CT evaluations. Distance measurements between catheter markers were compared across scans, and variations exceeding 2 mm prompted re-planning. Statistical analyses included one-way tests to assess marker displacement significance.
A total of 420 fractions were delivered, and 360 marker distance measurements were analyzed. No significant differences were observed between initial and mid-course CT scans (mean distances, 35.2 ±10.5 mm and 35.9 ±10.5 mm, respectively). However, in 16.6% of cases, re-planning was required due to catheter displacement or marker variation exceeding 2 mm. Notably, patients with nasal vestibule cancers demonstrated higher number of catheters and increased risk of displacement. Dosimetric evaluation confirmed significant dose distribution changes in a sub-set of cases, highlighting the clinical importance of QC.
Quality control strategies are essential to ensure precise treatment delivery in H&N IRT, especially in complex anatomical sites and risk of catheter displacement. Implementation of systematic checks and re-planning criteria enhances patient safety and treatment efficacy. Further research is warranted to refine QC measures and evaluate their impact on clinical outcomes.
本研究旨在探讨质量控制（QC）策略，以提高头颈部（H&N）癌介入放疗（IRT）的治疗效果，重点是确保治疗的准确性，同时应对导管移位和管路误连等特定挑战。
对2022年1月至2023年12月在我院机构中心接受IRT治疗的30例鼻前庭或眼睑癌患者进行回顾性分析。所有治疗均在九天内分14次进行。实施了质量控制措施，以监测导管放置情况并防止误连，包括每日目视检查和疗程中期CT评估。比较各扫描间导管标记物之间的距离测量值，超过2 mm的变化提示重新规划。统计分析包括单向检验，以评估标记物移位的显著性。
共进行了420次分次治疗，并分析了360次标记物距离测量值。初始和疗程中期CT扫描之间未观察到显著差异（平均距离分别为35.2±10.5 mm和35.9±10.5 mm））。然而，在16.6%的病例中，由于导管移位或标记物变化超过2 mm，需要重新规划。值得注意的是，鼻前庭癌患者的导管数量较多，移位风险增加。剂量学评估证实了部分病例中剂量分布的显著变化，突出了质量控制的临床重要性。
质量控制策略对于确保H&N IRT的精确治疗至关重要，尤其是在复杂的解剖部位和导管移位风险方面。实施系统检查和重新规划标准可提高患者安全性和治疗效果。有必要进一步研究以完善质量控制措施并评估其对临床结果的影响。
