图像引导下前列腺癌放疗固定装置的摆位误差与临床因素相关性分析

doi:10.12122/j.issn.1673-4254.2025.12.19

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (12): 2718-2725.doi: 10.12122/j.issn.1673-4254.2025.12.19

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图像引导下前列腺癌放疗固定装置的摆位误差与临床因素相关性分析

郭旋¹^,²(), 刘洋¹, 熊燕¹, 刘镖水¹, 宋婷², 李云飞¹()

^1.中山大学肿瘤防治中心//华南肿瘤学国家重点实验室//肿瘤医学协同创新中心，广东广州 510060
^2.南方医科大学生物医学工程学院，广东广州 510515

收稿日期:2025-05-13 出版日期:2025-12-20 发布日期:2025-12-22
通讯作者: 李云飞 E-mail:guoxuan@sysucc.org.cn;liyf1@syusucc.org.cn
作者简介:郭旋，硕士，技师，E-mail: guoxuan@sysucc.org.cn
基金资助:
国家自然科学基金(82472117);国家自然科学基金青年项目(82303954)

Analysis of setup errors and their correlation with clinical factors in image-guided radiotherapy for prostate cancer using different immobilization devices

Xuan GUO¹^,²(), Yang LIU¹, Yan XIONG¹, Biaoshui LIU¹, Ting SONG², Yunfei LI¹()

^1.Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
^2.School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China

Received:2025-05-13 Online:2025-12-20 Published:2025-12-22
Contact: Yunfei LI E-mail:guoxuan@sysucc.org.cn;liyf1@syusucc.org.cn
Supported by:
Supported by National Natural Science Foundation of China(82472117);Youth Program of National Natural Science Foundation of China(82303954)

摘要/Abstract

摘要：

目的通过量化分析4种固定装置在前列腺癌放疗中的摆位误差，评估其精度差异并探讨影响因素，为临床选择最优固定方案提供依据。方法回顾性分析中山大学肿瘤防治中心2016年5月~2024年5月240例进行图像引导放疗的前列腺癌患者，按固定装置分为4组：1.2 m真空袋组、1.8 m真空袋组、Orfit架组和个体化俯卧板组，60例/组。所有患者每次治疗前行锥形束CT（CBCT）扫描，采用X射线容积成像仪（XVI）系统灰度配准获取RL、SI、AP三维方向的摆位误差。对所有患者进一步按有无淋巴结照射（各120例）、年龄（<65岁，n=80；≥65，n=160）以及BMI分层（BMI<24 kg/m²，n=120；BMI≥24 kg/m²，n=120）进行亚组分析。结果 4组在三维方向的摆位误差差异有统计学意义（P<0.05）。个体化俯卧板组RL（0.02±0.25）cm、SI（0.01±0.32）cm方向误差最小，但AP方向误差最大（-0.28±0.36）cm。淋巴结照射组在AP方向的误差（-0.22±0.36cm）高于无淋巴结组（-0.01±0.43 cm）（P<0.001）。BMI与SI方向误差呈负相关（R=-0.45，P<0.001），与年龄相关性无统计学意义（P>0.05）。结论个体化俯卧板在RL/SI方向的精度优势具有显著临床意义，但AP方向的系统误差问题亟待解决。对于接受淋巴结照射或BMI较低的患者群体，应当特别关注SI方向的摆位精度控制。本研究为前列腺癌精准放疗的固定装置选择和个体化治疗方案优化提供了更高级别的循证依据。

关键词: 前列腺癌, 固定装置, 摆位误差, BMI

Abstract:

Objective To quantitatively analyze setup errors of 4 immobilization devices in precision radiotherapy for prostate cancer, their accuracy differences, and the factors affecting their setup precisions. Methods We conducted a retrospective analysis of 240 prostate cancer patients undergoing image-guided radiotherapy at Sun Yat-sen University Cancer Center from May, 2016 to May, 2024. According to the immobilization devices used, the patients were divided into 1.2 m vacuum bag group (n=60), 1.8 m vacuum bag group (n=60), Orfit frame group (n=60), and customized prone board group (n=60). All the patients received pre-treatment cone-beam CT (CBCT) scans, and setup errors in the right-left (RL), superior-inferior (SI), and anterior-posterior (AP) directions were obtained through XVI system grayscale registration. Further subgroup analyses were performed based on patient stratifications by lymph node irradiation status (n=120 each), age (<65 years, n=80; ≥65 years, n=160), and BMI (BMI<24 kg/m², n=120; BMI≥24 kg/m², n=120). Results The setup errors differed significantly among the 4 groups in three-dimensional directions (P<0.05). The customized prone board group showed minimal errors in the RL (0.02±0.25 cm) and SI (0.01±0.32 cm) directions, but demonstrated the largest error in the AP direction (-0.28±0.36 cm). The patients with lymph node irradiation had significantly greater AP directional errors (-0.22±0.36 cm) than those without (-0.01±0.43 cm; P<0.001). BMI showed a negative correlation with SI directional errors (R=-0.45, P<0.001), while age was not significantly correlated with the setup errors (P>0.05). Conclusion The customized prone board demonstrates clinically significant advantages for its high setup accuracies in RL and SI directions in spite of its systematic AP directional errors. The setup accuracy in the SI direction is especially important for patients with lymph node irradiation or low BMI. Our findings provide quantitative evidence for immobilization device selection and individualized optimization of precision radiotherapy for prostate cancer.

Key words: prostate cancer, immobilization devices, setup errors, body mass index

郭旋, 刘洋, 熊燕, 刘镖水, 宋婷, 李云飞. 图像引导下前列腺癌放疗固定装置的摆位误差与临床因素相关性分析[J]. 南方医科大学学报, 2025, 45(12): 2718-2725.

Xuan GUO, Yang LIU, Yan XIONG, Biaoshui LIU, Ting SONG, Yunfei LI. Analysis of setup errors and their correlation with clinical factors in image-guided radiotherapy for prostate cancer using different immobilization devices[J]. Journal of Southern Medical University, 2025, 45(12): 2718-2725.

图/表 6

参考文献 36

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Metric	1.2 m vacuum bag	1.8 m vacuum bag	Orfit board	Individualized prone	χ²/F	P
Age (year, Mean±SD)	64.2±7.8	65.1±8.2	63.8±6.9	65.5±7.5	0.78	0.505
BMI (kg/m², Mean±SD)	24.1±2.8	23.8±3.1	24.3±2.9	23.9±3.0	0.38	0.769
Clinical stage [n (%)]					2.15	0.542
T3	36 (60.0)	33 (55.0)	35 (58.3)	35 (58.3)
T4	24 (40.0)	27 (45.0)	25 (41.7)	25 (41.7)
Risk stratification [n (%)]					1.08	0.782
Intermediate risk	22 (36.7)	20 (33.3)	19 (31.7)	23 (38.3)
High risk	38 (63.3)	40 (66.7)	41 (68.3)	37 (61.7)
Lymph node irradiation [n (%)]	32 (53.3)	30 (50.0)	28 (46.7)	30 (50.0)	0.74	0.864

Metric	1.2 m vacuum bag	1.8 m vacuum bag	Orfit board	Individualized prone	χ²/F	P
Age (year, Mean±SD)	64.2±7.8	65.1±8.2	63.8±6.9	65.5±7.5	0.78	0.505
BMI (kg/m², Mean±SD)	24.1±2.8	23.8±3.1	24.3±2.9	23.9±3.0	0.38	0.769
Clinical stage [n (%)]					2.15	0.542
T3	36 (60.0)	33 (55.0)	35 (58.3)	35 (58.3)
T4	24 (40.0)	27 (45.0)	25 (41.7)	25 (41.7)
Risk stratification [n (%)]					1.08	0.782
Intermediate risk	22 (36.7)	20 (33.3)	19 (31.7)	23 (38.3)
High risk	38 (63.3)	40 (66.7)	41 (68.3)	37 (61.7)
Lymph node irradiation [n (%)]	32 (53.3)	30 (50.0)	28 (46.7)	30 (50.0)	0.74	0.864

Direction/devices	1.2 m vacuum bag	1.8 m vacuum bag	Orfit board	Individualized prone panel	P
R-Ldirection	0.05±0.28	0.05±0.23	-0.05±0.28^＊ΔΟ	0.02±0.25	<0.001
S-Idirection	-0.06±0.36^＊▲	0.03±0.30	-0.13±0.45^＊▲	0.01±0.32	<0.001
A-Pdirection	0.03±0.24∆^＊	-0.10±0.42^▲	-0.02±0.21^＊▲	-0.28±0.36^Ο	<0.001
≥0.5 cm (%)	15.0%	11.67%	13.33%	18.33%	-

Direction/devices	1.2 m vacuum bag	1.8 m vacuum bag	Orfit board	Individualized prone panel	P
R-Ldirection	0.05±0.28	0.05±0.23	-0.05±0.28^＊ΔΟ	0.02±0.25	<0.001
S-Idirection	-0.06±0.36^＊▲	0.03±0.30	-0.13±0.45^＊▲	0.01±0.32	<0.001
A-Pdirection	0.03±0.24∆^＊	-0.10±0.42^▲	-0.02±0.21^＊▲	-0.28±0.36^Ο	<0.001
≥0.5 cm (%)	15.0%	11.67%	13.33%	18.33%	-

Direction	R-L	S-I	A-P
Have lymph nodes	-0.04±0.30	0.003±0.35	-0.22±0.36
No lymph nodes	0.002±0.29	-0.075±0.47	-0.01±0.43
t	2.14	3.46	4.27
P	0.033	0.001	<0.001

图像引导下前列腺癌放疗固定装置的摆位误差与临床因素相关性分析

Analysis of setup errors and their correlation with clinical factors in image-guided radiotherapy for prostate cancer using different immobilization devices

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参考文献 36

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Direction/devices		R-L	S-I	A-P
1.2 m vacuum bag	∑	0.20	0.29	0.18
	σ	0.21	0.25	0.17
	M_PTV	0.64	0.9	0.57
1.8 mvacuum bag	∑	0.13	0.19	0.35
	σ	0.08	0.91	0.14
	M_PTV	0.81	1.11	0.97
Orfit board	∑	0.23	0.35	0.19
	σ	0.20	0.28	0.27
	M_PTV	0.71	1.07	0.66
Individualized prone panel	∑	0.15	0.20	0.26
	σ	0.06	0.12	0.05
	M_PTV	0.41	0.58	0.69
Individualized prone panel
With lymph nodes	∑	0.22	0.20	0.28
	σ	0.07	0.07	0.09
	M_PTV	0.59	0.55	0.77
Withoutlymph nodes	∑	0.18	0.37	0.32
	σ	0.07	0.07	0.13
	M_PTV	0.51	0.97	0.88

Variable	Group	n	RLError	SIError	APError	Statistical method	Statistic	P
Age (year)	<65	80	0.02±0.23	-0.01±0.30	-0.14±0.32	Independent t-test	t=1.02	0.310
	≥65	160	0.01±0.25	0.03±0.33	-0.17±0.35
BMI (kg/m²)	<24	120	-0.01±0.21	-0.13±0.31	-0.09±0.32	Independent t-test	t=4.18	<0.001*
	≥24	120	-0.03±0.22	0.02±0.27	-0.20±0.29
Correlation analysis	Age		r=0.03	r=0.02	r=-0.04	Pearson correlation		>0.05
	BMI		R=-0.12	r=-0.45	r=-0.10	Pearson correlation		<0.001*

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