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| 題 名 | 乳癌放射治療局部加強照射階段之影像導引誤差校正值與驗證頻次=Recommendations for Image-Guided Correction Threshold and Verification Frequency during the Boost Phase of Breast Cancer Radiotherapy |
|---|---|
| 作 者 | 王雅儀; 余思璇; 杜昭遠; 曾達超; 林煒柔; | 書刊名 | 臺灣應用輻射與同位素雜誌 |
| 卷 期 | 20:2 2024.12[民113.12] |
| 頁 次 | 頁2323-2331 |
| 分類號 | 418.95 |
| 關鍵詞 | 乳癌; 放射治療; 影像導引; 錐狀射束電腦斷層掃描; Breast cancer; Radiotherapy; Image-guided radiation therapy; Cone-beam computed tomography; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 乳癌是台灣女性中最常見的癌症,放射治療是乳癌的主要治療方法之一,尤其是早期乳癌,常用全乳房照射及局部加強照射。放射治療中嚴格控制位置誤差對於提高治療準確度及減少副作用至關重要。目前,少有研究探討在強度調控放射治療(IMRT)中使用影像導引放射治療(IGRT)進行局部加強照射的校正建議值及臨床驗證頻次。本研究使用CBCT進行影像驗證,分析治療期間三軸平移誤差數據。設定校正建議值:Δ(影像驗證誤差)≤0.2 cm可不校正,0.2 cm<Δ≤0.4 cm須校正,Δ>0.4 cm由醫師決定。研究蒐集2018年1月至2020年12月期間237名乳癌患者資料,顯示三軸平均誤差值均介於0.2-0.4 cm之間,檢視不同輔具、不同部位統計出12個軸向各平均誤差,其中9個軸向(超過50%)需要校正(大於0.2 cm)。本研究建議在治療初期可先執行連續三天的CBCT影像驗證,各別計算出X、Y、Z三個軸向平均誤差值,如任一軸平均值皆≤0.2 cm,則日後驗證與否乃依每日實際擺位情況各別評估。若有任一軸向平均值之大於0.2 cm,則建議其後每日治療前皆執行CBCT影像驗證,有助於提高靶區劑量覆蓋率及降低危急器官劑量。本研究提出以IMRT進行乳癌放射治療局部加強照射時使用CBCT進行IGRT的建議校正容許值及影像驗證建議頻次,能提高治療準確度、降低副作用,並提供臨床實踐參考。 |
| 英文摘要 | Breast cancer is the most common cancer among women in Taiwan, and radiotherapy is a primary treatment modality, particularly for early-stage breast cancer, often utilizing whole-breast and tumor bed boost irradiation. Precise control of positional errors during radiotherapy is crucial for enhancing treatment accuracy and minimizing side effects. Currently, there is limited research on the correction thresholds and clinical verification frequencies when using Image-Guided Radiation Therapy (IGRT) with Intensity Modulated Radiation Therapy (IMRT) for tumor bed boost. In this study, Cone-beam computed tomography (CBCT) was used for image verification, and translational error data across three axes during the treatment period were analyzed. The correction thresholds were set as follows: Δ (image verification error) ≤ 0.2 cm required no correction, 0.2 cm < Δ ≤ 0.4 cm required correction, and Δ > 0.4 cm required physician intervention. Data from 237 breast cancer patients treated between January 2018 and December 2020 were collected, showing that the mean errors across the three axes ranged from 0.2 to 0.4 cm. Further analysis of different auxiliary devices and anatomical locations yielded twelve average errors across the axes, with nine axes (exceeding 50%) requiring correction (greater than 0.2 cm). This study recommends performing CBCT image verification for the first three consecutive days of treatment to calculate the average error for the X, Y, and Z axes. If the average error for any axis is ≤ 0.2 cm, subsequent verification can be evaluated based on daily positional accuracy. If the average error for any axis exceeds 0.2 cm, daily CBCT image verification before each treatment session is advised. This approach helps improve target dose coverage and reduce doses to critical organs. The study proposes correction thresholds and verification frequencies for the use of CBCT in IGRT for localized boost irradiation in breast cancer treatment with IMRT. Implementing these recommendations can enhance treatment accuracy, reduce side effects, and provide valuable guidelines for clinical practice. |
本系統中英文摘要資訊取自各篇刊載內容。