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目的 利用锥形束计算机断层扫描（cone-beam computed tomography, CBCT）探讨发泡胶固定和乳腺托架固定对包括锁骨上淋巴引流区（简称锁骨上靶区）的乳腺癌靶区放疗精度的影响。方法 回顾性选择2021年9月至2023年8月空军军医大学第一附属医院收治的74例术后行调强放射治疗的女性乳腺癌淋巴结转移患者，其中38例采用发泡胶固定（发泡胶组），36例采用乳腺托架固定（乳腺托架组）。所有患者每周接受1次CBCT扫描与定位CT计划图像进行匹配，并记录胸壁靶区和锁骨上靶区的摆位误差。比较2种固定方法的摆位误差。计算临床靶区扩至计划靶区（planning target volume, PTV）的外放边界(PTV margin, MPTV)。比较两组摆位时间和里克特五分制量表舒适满意度评分。采用Pearson相关系数分析2种固定方法摆位误差的相关性。结果 发泡胶组在胸壁靶区的左右方向（X轴）平移误差小于乳腺托架组[（1.6±1.5）mm vs（2.0±1.6）mm,P=0.012]，锁骨上靶区的腹背方向（Z轴）平移误差[（1.4±1.3）mm vs（1.8±1.5）mm,P=0.046]和矢状位旋转误差[（0.5±0.5）°vs（0.7±0.5）°，P=0.006]均小于乳腺托架组。发泡胶组在胸壁靶区的X、Y（头脚方向）和Z轴的MPTV分别为5.01、5.99和5.47 mm，乳腺托架组分别为6.10、6.34和6.10 mm；发泡胶组锁骨上靶区X、Y和Z轴MPTV分别为3.69、3.86和4.28 mm，乳腺托架组分别为3.99、3.72和5.45 mm。发泡胶组分次摆位时间比乳腺托架组短[（3.4±1.1）min vs（5.5±3.1）min,P=0.007]。发泡胶组患者对固定装置的主观舒适满意度评分高于乳腺托架组[（27.5±1.2）分vs（25.4±1.2）分，P<0.01]。结论 乳腺癌淋巴结转移患者术后放疗中应用发泡胶固定在锁骨上靶区照射中的摆位精度比乳腺托架固定更高，MPTV更小，可提高工作效率和患者的治疗舒适度。
Abstract：Objective To investigate the effects of foam cushion immobilization and breast board immobilization on positioning accuracy of breast cancer targets including the supraclavicular lymphatic drainage region（abbreviated as supraclavicular target volume） in radiotherapy by cone-beam computed tomography（CBCT）. Methods A total of 74 female postoperative patients with lymph node-positive breast cancer receiving intensity-modulated radiation therapy who were admitted to the First Affiliated Hospital of Air Force Military Medical University from September 2021 to August 2023 were retrospectively enrolled. Among them, 38 patients receiving foam cushion immobilization were selected as the foam group, and 36 patients adopting breast board immobilization as the breast board group. All patients underwent weekly CBCT scanning registered with planning CT images. The setup errors of the chest wall target volume and supraclavicular target volume were compared between the two groups. The planning target volume margin(MPTV), expanded from clinical target volume（CTV） to planning target volume（PTV）, was calculated. Single-fraction setup time and patient comfort and satisfaction scores based on the five-point Likert scale were compared between the two groups. Pearson correlation coefficient was applied to analyze the correlation of setup errors between the two immobilization methods. Results The translational setup error along the left-right（X-axis） direction of the chest wall target volume was significantly lower in the foam group than that in the breast board group [（1.6±1.5） mm vs（2.0±1.6） mm, P=0.012]. For the supraclavicular target volume, the anteroposterior（Z-axis） translational error [（1.4±1.3） mm vs（1.8±1.5） mm, P=0.046] and sagittal rotational error [（0.5±0.5）° vs（0.7±0.5）°, P=0.006] were significantly smaller in the foam group. The MPTV values on the X, Y（craniocaudal direction）, and Z axes for the chest wall target volume were 5.01, 5.99, and 5.47 mm in the foam group, and 6.10, 6.34, and 6.10 mm in the breast board group, respectively, and those for the supraclavicular target volume were 3.69, 3.86, and 4.28 mm in the foam group, and 3.99, 3.72, and 5.45 mm in the breast board group, respectively. The single-fraction setup time was shorter in the foam group [（3.4±1.1） min vs（5.5±3.1） min, P=0.007]. The foam group had higher subjective comfort and satisfaction score [（27.5±1.2） points vs（25.4±1.2） points, P<0.01]. Conclusions For breast cancer patients with lymph node metastasis undergoing postoperative radiotherapy, foam cushion immobilization delivers superior setup accuracy and smaller MPTV during supraclavicular target irradiation compared with breast board immobilization. This technique can elevate clinical workflow efficiency and improve treatment-related comfort for patients.
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基本信息:
DOI：10.3785/syzlzz.2026.049
引用信息:
[1]周艳,姚晓伟,张丽华,等.锥形束计算机断层扫描下研究不同固定装置对乳腺癌锁骨上淋巴引流区放疗摆位精度的影响[J],2026,41(4):352-358.DOI:10.3785/syzlzz.2026.049.