“幼儿园效应”在3~5岁儿童肿瘤放疗中的应用研究

Application of "kindergarten effect" in radiotherapy for children with tumor aged 3-5 years

摘要:

目的 根据3~5岁学龄前儿童心理，将“幼儿园效应”引入到儿童肿瘤放射治疗（简称放疗）中，并评价临床应用效果。 方法 前瞻性将2020年1月至2021年8月在天津医科大学肿瘤医院放疗科收治的3~5岁患儿30例，随机分为对照组和试验组，每组15例。试验组患儿在治疗时采用“幼儿园模式”，即患儿们按规定时间一起来治疗，并待所有患儿治疗结束后一起离开。对照组患儿按放疗固定装置类型预约治疗时间，与成年患者穿插治疗。评估两组患儿的配合度，并比较两组患儿在头脚方向（superior-inferior，SI）、左右方向（left-right，LR）和前后方向（anterior-posterior，AP）上的摆位误差。 结果 试验组患儿平均治疗时间较对照组明显缩短（P<0.05）；发生中断情况的比例显著低于对照组（P<0.05）。试验组患儿行图像引导放疗后在SI、LR、AP 3个方向上的平均误差均小于对照组，其中在SI、LR 2个方向上差异有统计学意义（P<0.05）。 结论 利用这种“幼儿园效应”，放疗中大部分儿童可以积极配合，同时可以提高摆位的准确性和重复性，达到预期疗效。

Abstract:

Objective To study the clinical application effect of "kindergarten effect" in radiotherapy for children with tumor based on the psychology of preschool children aged 3-5 years. Methods A total of 30 children, aged 3-5 years, who were admitted to the Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, from January 2020 to August 2021 were enrolled in this prospective study. The children were randomly divided into a control group and a test group, with 15 children in each group. The children in the test group were treated in "kindergarten mode", i.e., all children were treated together at a specified time and left together after all children completed treatment. Those in the control group were treated alternately with adult patients according to the treatment time based on the type of radiotherapy fixation device. The treatment compliance was evaluated for both groups, and the two groups were compared in terms of the setup errors in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions. Results Compared with the control group, the test group showed a significantly shorter time for finishing the treatment (P<0.05) and a significantly lower proportion of children with treatment interruption (P<0.05). Compared with the control group, the test group showed smaller mean errors in the SI, LR and AP directions after image-guided radiotherapy, with significant differences in the mean errors in the SI and LR directions (P<0.05). Conclusions With the application of the "kindergarten effect", most children can actively cooperate in radiotherapy, and it can also improve the accuracy and repeatability of positioning and help to achieve the desired treatment outcome.