分次内CBCT影像引导技术引入DIBH在左侧乳腺癌放疗中的意义

doi:10.19401/j.cnki.1007-3639.2025.06.007

摘要/Abstract

摘要：

背景与目的： 近年来基于光学体表引导放疗（surface-guided radiation therapy，SGRT）的深吸气屏气技术（deep inspiration breath hold，DIBH）是乳腺癌放疗中炙手可热的技术之一。一般在治疗前需采用锥形束CT（cone-beam CT，CBCT）验证患者体位偏差并纠正治疗，但患者治疗期间体位易发生变化，分次前CBCT不能充分反映患者在治疗时的实时体位偏差，因此本研究将分次内CBCT引入DIBH以监测并纠正实时偏差，同时求证患者在治疗时是否达到理想体位，探讨其在左侧乳腺放疗中的应用价值。方法： 收集2023年6月—2024年1月在复旦大学附属肿瘤医院接受放疗的左侧乳腺癌术后患者的临床资料。确认其心肺功能良好以及深吸气屏气状态能够符合医师治疗的需求，在治疗前先进行分次前CBCT扫描并记录数据；治疗时先将机架转到-180°触发kV级的分次内CBCT扫描，转至外切野起始角后再行出束治疗（10³kV级），外切野治疗期间采集分次内CBCT体位配准偏差并与分次前的结果进行对比。结果： 最终共选取30例符合本研究的患者，对每例患者分次前及分次内各150套对应的CBCT图像进行分析。分次内CBCT的平均配准偏差比分次前CBCT在X轴、Y轴和Z轴方向上分别减少26%、52%和51%，分次内偏差明显小于分次前（P<0.05），且分次内配准偏差<6 mm的概率分别为100.0%、100.0%、99.3%。在相关性方面，分次内与分次前配准偏差在X轴方面呈弱相关（P<0.05），在Y轴与Z轴方向不具备相关性（P > 0.05）。结论： 分次内CBCT可以监测乳腺DIBH患者治疗中的实时体位信息并做出纠正，可以作为以往分次前扫描的一个很好的补充。同时在临床上对治疗效率影响小，对于左侧乳腺癌放疗具有十分积极的意义和实用价值。

关键词: 分次内CBCT, 体表引导放射治疗, 深吸气屏气技术, 乳腺癌

Abstract:

Background and purpose: In recent years, deep inspiration breath hold (DIBH) based on surface-guided radiation therapy (SGRT) has emerged as one of the most promising techniques in breast cancer radiotherapy. Conventionally, cone-beam CT (CBCT) is used before treatment to verify and correct patient positioning deviations. However, patient position may change during treatment, and pre-fraction CBCT cannot fully reflect real-time positional deviations. Therefore, this study aimed to introduce intra-fraction CBCT into left-sided breast DIBH radiotherapy to monitor and correct real-time deviations, verify whether patients achieve the desired position during treatment, and evaluate the clinical value of intra-fraction CBCT in left-breast radiotherapy. Methods: Clinical data from postoperative left-sided breast cancer patients treated at Fudan University Shanghai Cancer Center between June 2023 and January 2024 were collected. Patients with satisfactory cardiopulmonary function and stable DIBH compliance were included. Pre-fraction CBCT scans were performed before treatment, and data were recorded. During treatment, the gantry was rotated to -180° to trigger kV-level intra-fraction CBCT scanning. After gantry repositioning to the starting angle of the tangential field, MV beam delivery commenced. Intra-fraction CBCT scans were acquired for positional registration, and deviations were compared with pre-fraction CBCT results. Results: A total of 30 eligible patients were included, with 150 pairs of pre-fraction and intra-fraction CBCT images analyzed per patient. The mean registration deviations for intra-fraction CBCT were 26%, 52%, and 51% lower than pre-fraction CBCT in the X, Y, and Z axes, respectively (P<0.05), demonstrating significantly reduced real-time deviations. The probability of intra-fraction deviations being <6 mm was 100.0%, 100.0%, and 99.3% for the X, Y, and Z axes, respectively. Correlation analysis revealed a weak correlation between intra-fraction and pre-fraction deviations in the X-axis (P <0.05), while no significant correlation was observed for the Y and Z axes (P>0.05). Conclusion: Intra-fraction CBCT effectively monitors and corrects real-time positional deviations in left-sided breast DIBH radiotherapy, serving as a valuable supplement to conventional pre-fraction CBCT. It minimally impacts treatment efficiency while significantly improving positional accuracy, offering clinical and practical benefits for left-breast cancer radiotherapy.

Key words: Intra-fraction CBCT, Surface-guided radiation therapy, Deep inspiration breath hold, Breast cancer

中图分类号:

R737.9

鲍正敏, 李乾永, 鲁晓腾, 杨彦举. 分次内CBCT影像引导技术引入DIBH在左侧乳腺癌放疗中的意义[J]. 中国癌症杂志, 2025, 35(6): 578-584.

BAO Zhengmin, LI Qianyong, LU Xiaoteng, YANG Yanju. Clinical implications of intra-fraction CBCT image guidance in DIBH radiotherapy for left-sided breast cancer[J]. China Oncology, 2025, 35(6): 578-584.

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参考文献 13

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Item	X-axis deviation D/mm				Y-axis deviation D/mm				Z-axis deviation D/mm
Item	<2	2≤D<4	4≤D<6	≥6	<2	2≤D<4	4≤D<6	≥6	<2	2≤D<4	4≤D<6	≥6
Pre-fraction	85(56.7)	46(30.6)	14(9.3)	5(3.3)	61(40.7)	47(31.3)	15(10.0)	27(18.0)	61(40.7)	34(22.7)	27(18.0)	28(18.7)
Intra-fraction	100(66.7)	40(26.7)	10(6.7)	0(0.0)	99(66.0)	45(30.0)	6(4.0)	0(0.0)	95(63.3)	47(31.3)	7(4.7)	1(0.7)

Item	X-axis	Y-axis	Z-axis
Pre-fraction (f=150)	2.09±1.62	3.37±2.77	3.34±2.69
Intra-fraction (f=150)	1.55±1.25	1.63±1.21	1.79±1.53
P value	0.001	<0.001	<0.001

Axial	r value	P value
X-axis	0.165	0.043
Y-axis	0.139	0.089
Z-axis	-0.043	0.599

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