口含器在鼻咽癌放射治疗中的研究应用-现代医学

口含器在鼻咽癌放射治疗中的研究应用

单位：华南国家肿瘤实验室, 中山大学肿瘤防治中心放疗科, 广东广州 510060

分类号：R739.62

出版年·卷·期（页码）：2024·52·第一期（83-89）

摘要：

目的：探讨口含器在鼻咽癌放射治疗体位固定中的临床应用，为临床决策提供参考。方法：选取2022年11月至2023年5月在中山大学附属肿瘤医院放疗中心进行治疗的鼻咽癌患者35例，对照组为17例采用头颈肩热塑膜联合发泡胶固定；实验组为18例采用头颈肩热塑膜联合发泡胶+口含器固定，回顾性分析两组患者的治疗前CBCT图像在3个区域(Ⅰ区域：头颈联合框；Ⅱ区域：鼻咽部及上颈部椎体框；Ⅲ区域：下颈部椎体框)上的摆位误差。结果：通过对实验组和对照组在3个区域的6个方向上摆位误差进行独立样本t检验。在Ⅰ区域的Pitch和Yaw方向和Ⅱ区域的AP、Pitch、Roll、Yaw方向和Ⅲ区域的6个方向上的摆位误差的差异均具有统计学意义。对照组在Ⅱ区域与Ⅲ区域的摆位误差的SI、LR、A、Roll和Pitch方向上差异均具有统计学意义，同时，对照组在Ⅱ区域上的外扩边界(SI：0.39；LR：0.31；AP：0.46)在3个方向上均小于Ⅲ区域(SI：0.84；LR：0.73；AP：0.74)。实验组Ⅱ区域与Ⅲ区域的摆位误差的SI、LR、Roll、Pitch和Yaw方向上差异均不具有统计学意义，患者在应用口含器的情况下对下颈部的固定效果有明显的提升。结论：在本研究中，患者佩戴口含器联合发泡胶的体位固定方式的摆位误差较单发泡胶的有明显优势。颈肩热塑膜联合发泡胶＋口含器的固定方式更有利于提高鼻咽癌调强放疗的摆位精度和重复性，尤其是对于患者下颈部误差的改善有明显优势。

Objective: To explore the clinical application of mouthpiece in position fixation during radiotherapy for nasopharyngeal carcinoma, and provide reference for clinical decision-making. Method: A total of 35 nasopharyngeal carcinoma patients who underwent treatment at the Radiotherapy Center of Sun Yat sen University Affiliated Cancer Hospital from November 2022 to May 2023 were selected, while the control group consisted of 17 patients who were fixed with head, neck, and shoulder thermoplastic film combined with foam adhesive; The experimental group consisted of 18 patients who were fixed with head, neck, and shoulder thermoplastic film combined with foam adhesive and mouthpiece. A retrospective analysis was conducted on the positioning errors of CBCT images before treatment in three regions(region Ⅰ: head and neck joint frame; region Ⅱ: nasopharyngeal and upper cervical vertebral frame; and region Ⅲ: lower cervical vertebral frame). Result: Independent sample t-tests were conducted on the positioning errors of the experimental group and the control group in six directions in three regions. The difference in positioning errors between the Pitch and Yaw directions in Region Ⅰ and the AP, Pitch, Roll, and Yaw directions in Region Ⅱ, as well as the six directions in Region Ⅲ, is statistically significant. The differences in the SI, LR, A, Roll, and Pitch directions of the positioning errors between the control group in Region Ⅱ and Region Ⅲ were statistically significant. At the same time, the extended boundaries(SI: 0.39; LR: 0.31; AP: 0.46) of the control group in Region Ⅱwere smaller than those in Region Ⅲ in all three directions(SI: 0.84; LR: 0.73; AP: 0.74). The differences in positioning errors in SI, LR, Roll, Pitch, and Yaw directions between the experimental group Ⅱ and Ⅲ regions were not statistically significant. Patients showed a significant improvement in the fixation effect of the lower neck with the use of oral implants. Conclusion: In this study, the positioning error of the patient wearing a mouthpiece combined with foam adhesive is significantly better than that of a single foam adhesive. The fixation method of neck and shoulder thermoplastic film combined with foam adhesive and mouthpiece is more conducive to improving the positioning accuracy and repeatability of intensified modulated radiotherapy for nasopharyngeal carcinoma, especially for the improvement of lower neck error in patients.

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