|Table of Contents|

Application of vacuum pad combined with CIVCO prone brackets in rectal cancer radiotherapy positioning

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 02
Page:
316-322
Research Field:
Publishing date:

Info

Title:
Application of vacuum pad combined with CIVCO prone brackets in rectal cancer radiotherapy positioning
Author(s):
QIU Teng; YU Dahai; ZHAO Di; LU Hong; WANG Pei; QIN Liang; WANG Yijun; MA Jun
Department of Radiotherapy，Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Provincial Hospital of Traditional Chinese Medicine)，Jiangsu Nanjing 210029,China.
Keywords:
radiotherapy; position error; rectal neoplasms; vacuum cushion
PACS:
R735.3
DOI:
10.3969/j.issn.1672-4992.2024.02.021
Abstract:
Objective:To improve the application method of CIVCO prone brace in rectal cancer,to investigate the difference in positional error between the combined use of vacuum pad and CIVCO prone brace (improved fixation group A) and CIVCO prone brace alone (general fixation group B),and to develop the process and requirements for vacuum pad fixation of the lower extremity.Methods:Based on cone-beam CT (CBCT) acquisition of positional error data,patients undergoing prone rectal cancer radiation therapy from October 2021 to March 2023 were retrospectively selected.There were 32 cases in the modified fixation group and 32 cases in the general fixation group.In both groups,subgroups were classified using body mass index (BMI)=24 kg/m2 as the cut-off value (obese body A1,B1,normal body A2,B2).The differences in the mean values of pendulum errors in the X (lateral,LAT),Y (length,LNG),and Z (vertal,VRT) directions were compared between the two groups by the statistical method of two independent samples t-test.The differences in the mean values of pendulum errors in the X,Y and Z directions were compared between the subgroups.The rank sum test was used to compare the differences in three-dimensional space vector errors between the two groups and to analyze whether the differences were correlation tests related to the adoption of the new technology.The chi-square test was used to demonstrate the percentage of three-dimensional space vector errors>0.52 cm.One-way ANOVA was used to explore the relationship between the improved fixation group and the radiotherapy placement time,and the trend of the mean value of error change in each direction was analyzed by post hoc multiple comparisons.The clinical value of improved fixation in prone rectal cancer radiation therapy positioning was evaluated according to the PTV boundary formula.Results:The results of the t-test for the mean value of positional error in both groups:X (t=2.404,P=0.017),Y (t=4.864,P＜0.05),and Z (t=3.704,P＜0.05),with statistically significant differences in the mean value of error in the three directions.Three-dimensional space vector error rank sum test and chi-square test analysis results:Improved fixation group 0.35(0.25~0.42) cm,Δ＞0.52 cm accounted for 8.7%.General fixation group 0.42(0.29~0.61)cm,Δ＞0.52 cm accounted for 28.2%(Z=-5.783,-5.718,χ2=32.757,P＜0.05).The difference was statistically significant,and the patients in the improved fixed group had a smaller range of three-dimensional spatial vector error drift.The MPTV of the two groups in the X,Y and Z directions of the PTV margin values were A (0.51,0.49,0.58)cm,B (0.73,0.92,0.83)cm,respectively.based on the BMI index:The differences in the mean error values in group A were X (t=-2.053,P=0.042),Y (t=-4.621,P＜0.05),and Z (t=-3.676,P＜0.05) differences were statistically significant.In the two groups of obese patients A and B the difference in error means was only found to be statistically significant in Z (t=3.431,P=0.002) differences,X (t=1.170,P=0.244),Y (t=1.969,P=0.051) differences were not statistically significant.The differences were statistically significant in X (t=-2.39,P=0.017),Y (t=-5.734,P＜0.05) and Z (t=-2.722,P=0.007) in the comparison of patients with ordinary BMI in groups A and B.For the one-way ANOVA of the modified fixation group,the two-way comparison between groups of pendulum error means for each time period was statistically significant only in the Y (F=5.951,P＜0.05) and Z (F=3.155,P=0.015) directions with differences in error means across pendulum periods,and the difference in pendulum error means was greater in week 1 than in the other weeks (P＜0.05).X (F=0.625,P=0.645) direction there was no significant difference in the mean error values over the pendulum time.Conclusion:The combination of vacuum pads and CIVCO prone brackets was overall better than prone brackets alone in improving prone positioning errors in rectal cancer when evaluated in combination,but the improved fixation modality was still less satisfactory in obese patients.In the modified fixation group,the errors in the Y and Z directions were larger in the first week of the full course of radiation therapy.Compared with the first week of treatment,the overall error in the Y and Z directions became smaller over time,and there was no difference in the error in the other treatment periods except for the first week.Repeatability of the pendulum position was stable.

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