【摘要】 目的：分析乳腺癌放射治疗不同轴线摆位误差风险因素及对肺受量的影响。方法：选取接受放射治疗的103例乳腺癌病人，分别根据年龄、手术方式、肿瘤部位、体位固定方式、体质量指数（BMI）对病人进行分组。比较年龄、手术方式、肿瘤部位、体位固定方式、BMI在左右方向（X轴）、头脚方向（Y轴）、腹背方向（Z轴）上对摆位误差的影响。通过LASSO回归模型分析病人摆位误差的影响因素。结果：不同年龄组在Y、Z轴方向摆位误差的差异有统计学意义（P<0.05），在其他方向上的摆位误差差异无统计学意义（P > 0.05）。在相同年龄不同手术方式对比中，老年保乳术组在Y轴方向上的摆位误差大于老年改良根治术组（P<0.05）；在相同年龄不同肿瘤部位对比中，中年左侧组在Y轴方向上的摆位误差大于中年右侧组（P<0.05）；在相同年龄不同体位固定方式对比中，老年乳腺托架联合热塑膜组在X轴方向上的摆位误差均大于真空垫组（P<0.05）；在相同年龄不同BMI对比中，老年肥胖组在Y轴和Z轴方向上的摆位误差大于正常组（P<0.05）。年龄、手术方式、肿瘤部位、体位固定方式、BMI可以解释X轴、Y轴、Z轴误差的10%、15%、15%变化原因（P<0.05～P<0.01）。当病人Y轴或Z轴方向摆位误差> 5 mm时，病人产生放射性肺损伤风险较大。结论：年龄、手术方式、肿瘤部位、体位固定方式、BMI均为影响病人放射治疗摆位误差的独立危险因素。更多还原

【Abstract】 Objective: To analyze the risk factors for positioning errors along different axes in breast cancer radiotherapy and their impact on lung dose. Methods: A total of 103 breast cancer patients undergoing radiotherapy were selected and grouped based on age, surgical approach, tumor location, immobilization method, and body mass index(BMI). The effects of age, surgical approach,tumor location, immobilization method, and BMI on positioning errors in the left-right(X-axis), head-foot(Y-axis), and anterior-posterior(Z-axis) directions were compared. A LASSO regression model was used to analyze the influencing factors of patient positioning errors. Results: Significant differences in positioning errors along the Y and Z axes were observed among different age groups(P < 0.05), while no statistically significant differences were found in other directions(P > 0.05). Among patients of the same age, the positioning error along the Y-axis was greater in the elderly breast-conserving surgery group than in the elderly modified radical mastectomy group(P < 0.05). Among patients of the same age, the positioning error along the Y-axis was greater in the middle-aged left-side group than in the middle-aged right-side group(P < 0.05). Among patients of the same age, the positioning error along the X-axis was greater in the elderly breast support frame combined with thermoplastic mask group than in the vacuum cushion group(P < 0.05). Among patients of the same age, the positioning errors along the Y and Z axes were greater in the elderly obese group than in the normal-weight group(P < 0.05). Age, surgical approach, tumor location, immobilization method, and BMI could explain 10%, 15%, and 15% of the variations in X-axis, Y-axis, and Z-axis errors, respectively(P < 0.05 to P < 0.01). When the positioning error in the Y-axis or Z-axis direction exceeded 5 mm, patients were at a higher risk of developing radiation-induced lung injury. Conclusions: Age, surgical approach, tumor location, immobilization method, and BMI are all independent risk factors affecting patient positioning errors in radiotherapy.更多还原