The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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Evaluating the usefulness of BinkieRTTM (oral positioning stent) for Head and Neck Radiotherapy

두경부암 환자 방사선 치료 시 BinkieRTTM(구강용 고정장치)에 대한 유용성 평가

  • GyeongJin Lee (Department of Radiation Oncology, Seoul National University Hospital) ;
  • SangJun Son (Department of Radiation Oncology, Seoul National University Hospital) ;
  • GyeongDal Lim (Department of Radiation Oncology, Seoul National University Hospital) ;
  • ChanYong Kim (Department of Radiation Oncology, Seoul National University Hospital) ;
  • JeHee Lee (Department of Radiation Oncology, Seoul National University Hospital)
  • 이경진 (서울대학교병원 방사선종양학과) ;
  • 손상준 (서울대학교병원 방사선종양학과) ;
  • 임경달 (서울대학교병원 방사선종양학과) ;
  • 김찬용 (서울대학교병원 방사선종양학과) ;
  • 이제희 (서울대학교병원 방사선종양학과)
  • Published : 2022.12.31
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Abstract

Purpose: The purpose of this study is to evaluate the effectiveness of oral positioning stent, the BinkieRTTM in radiation treatment for head and neck cancer patients in terms of tongue positions reproducibility, tongue doses and material properties. Materials and Methods: 24 cases using BinkieRTTM during radiation treatments were enrolled. The tongue was contoured on planning CT and CBCT images taken every 3 days during treatment, and then the DSC and center of tongue shift values were analyzed to evaluate the reproducibility of the tongue. The tongue dose was compared in terms of dose distribution when using BinkieRTTM and different type of oral stents (mouthpiece, paraffin wax). Randomly selected respective 10 patients were measured tongue doses of initial treatment plan for nasal cavity and unilateral parotid cancer. Finally, In terms of material evaluation, HU and relative electron density were identified in RTPS. Results: As a result of DSC analysis, it was 0.8 ± 0.07, skewness -0.8, kurtosis 0.61, and 95% CI was 0.79~0.82. To analyze the deviation of the central tongue shift during the treatment period, a 95% confidence interval for shift in the LR, SI, and AP directions were indicated, and a one-sample t-test for 0, which is an ideal value in the deviation(n=144). As a result of the t-test, the mean and SD in the LR and SI directions were 0.01 ± 0.14 cm (p→.05), 0.03 ± 0.25 cm (p→.05), and -0.08 ± 0.25 cm (p ←.05) in the AP direction. In the case of unilateral parotid cancer patients, the Dmean to the tongue of patients using BinkieRTTM was 16.92% ± 3.58% compared to the prescribed dose, and 23.99% ± 10.86% of patients with Paraffin Wax, indicating that the tongue dose was relatively lower when using BinkieRTTM (p←.05). On the other hand, among nasal cavity cancer patients, the Dmean of tongue dose for patients who used BinkieRTTM was 4.4% ± 5.6%, and for those who used mouthpiece, 5.9% ± 6.8%, but it was not statistically significant (p→.05). The relative electron density of Paraffin Wax, BinkieRTTM and Putty is 0.94, 0.99, 1.26 and the mass density is 0.95, 0.99 and 1.32 (g/cc), Transmission Factor is 0.99, 0.98, 0.96 respectively. Conclusion: The result of the tongue DSC analysis over the treatment period was about 0.8 and Deviation of the center of tongue shifts were within 0.2 cm, the reproducibility was more likely excellent. In the case of unilateral head and neck cancer patients, it was found that the use of BinkieRTTM rather than Paraffin Wax or Putty can reduce the unnecessary dose irradiated to the tongue. This study might be useful to understand of BinkieRTTM's properties and advantages. And also it could be another considered option as oral stent to keep the reproducibility of tongue and reducing dose during head and neck radiation treatments.

목 적: 본원에서 방사선치료를 받는 두경부암 환자들에게 적용하기 위하여 도입한 구강용 고정장치 BinkieRTTM의 구강 내 재현성을 평가하고 기존 고정장치와의 재질과 선량 비교를 통해 그 유용성을 평가하고자 한다. 대상 및 방법: BinkieRTTM를 사용하여 치료한 두경부암 환자 24명을 대상으로 혀 재현성 평가를 위해 치료계획용 CT와 치료 중 3일 간격으로 촬영된 CBCT영상에 혀를 그린 후 DSC와 중심축 이동값을 분석하였다. 또한 BinkieRTTM를 사용하는 경우와 다른 종류의 구강 고정장치(mouth piece, paraffin wax)를 사용했을 때 선량 분포측면에서 혀에 조사되는 선량을 비교하였다. 이를 위해 상악에 위치한 종양 치료를 받는 환자들과 편측 두 경부암 환자들을 각 10명씩 선정하고 전산화 치료 계획 시 혀에 조사되는 선량을 확인하였다. 마지막으로 재질 평가 측면에서는 임상에서 혀를 치료부위 반대 방향으로 보내 고정하는 목적으로 많이 사용하는 Paraffin Wax나 Putty와의 비교를 통하여 BinkieRTTM의 단순 물질 특성을 알아보기 위해 전산화 치료 장비로 Mass density 및 상대전자밀도 등을 확인하고, 팬텀과 이온챔버를 이용하여 Transmission Factor를 측정하였다. 결 과: BinkieRTTM를 사용 시 DCS (n=144) 의 평균은 0.8 ± 0.07, 95% 신뢰구간은 0.79~0.82 로 나타났고, 빈도분포 분석 결과는 왜도 -0.8, 첨도 0.61 로 나타났다. 치료 기간 중 혀 중심축 이동에 대한 편차를 분석하기 위해 LR, SI, AP 방향 이동에 대한 95% 신뢰구간과 편차의 이상값인 0에 대한 일표본 t검정을 실시하였다.(n=144) t검정 결과 LR, SI 방향의 평균은 각각 0.01 ± 0.14 cm(p>.05), 0.03 ± 0.25 cm(p>.05), AP 방향은 -0.08 ± 0.25 cm(p<.05) 로 나타났다. 혀를 치료부위의 반대 방향으로 고정한 경우인 편측 귀밑샘 종양 환자들의 경우 BinkieRTTM를 사용한 환자들의 혀 평균선량은 처방선량 대비 평균 16.92% ± 3.58%, Paraffin Wax 환자 23.99% ± 10.86% 로 BinkieRTTM 사용 시 혀 선량이 비교적 더 낮은 것으로 나타났다(p<.05). 반면, 혀를 아래로 누르는 목적으로 BinkieRTTM를 사용한 환자들 중 비강암 환자의 혀 평균선량은 평균 4.4% ± 5.6%, mouth piece를 사용한 환자들은 5.9% ± 6.8% 로 나타났으나, 통계적으로 유의하지 않았다(p>.05). Paraffin Wax와 BinkieRTTM, Putty의 상대전자밀도 측정 결과 각각 0.94, 0.99, 1.26, Transmission Factor는 각각 0.99, 0.98, 0.96로 나타났다. 결 론: BinkieRTTM의 치료기간에 걸쳐 나타난 혀 DSC분석 결과는 약 0.8, 고정력은 LR, SI 방향으로의 편차가 0에 가까울 정도로 매우 우수하였으며, AP방향의 고정력 또한 평균 0.08 cm 로 우수한 편이었다. 또한 혀를 옆으로 밀어 치료부위 반대 방향으로 고정하는 편측 두경부암 환자의 경우 Paraffin wax나 Putty를 사용하는 것보다 BinkieRTTM를 사용하는 것이 혀에 조사되는 불필요한 선량을 줄일 수 있는 것으로 나타났다. 그러므로 본 실험 결과와 BinkieRTTM의 특성을 적절히 고려하여 두경부암 치료에 적용한다면 혀의 재현성 유지 및 선량 감소에 도움이 되리라 사료된다.

Keywords

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