| 朱丽红,苏星,吴昊,韩树奎,王俊杰,徐博.宫颈癌限定盆骨的全盆调强放疗骨髓受照的剂量学研究[J].中华放射医学与防护杂志,2008,28(1):57-60 |
| 宫颈癌限定盆骨的全盆调强放疗骨髓受照的剂量学研究 |
| Dosimetry of bone marrow irradiated by intensity modulated whole pelvis radiotherapy for cervical cancer |
| 投稿时间：2007-05-26 |
| DOI： |
| 中文关键词: 调强放射疗法 盆骨骨髓 宫颈癌 血液学毒性 |
| 英文关键词:IMRT Pelvic bone marrow Cervical cancer Hematologic toxicity |
| 基金项目: |
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| 中文摘要: |
| 目的 评价应用限定盆骨骨髓的全盆调强放疗(intensity modulated whole pelvis radiotherapy,IM-WPRT)减少骨髓受照体积和剂量的可能性。方法 15例局部进展期宫颈癌患者,增强CT模拟定位,勾画CTV、PTV及危险器官直肠、膀胱、小肠、股骨头和包括第5腰椎和骶椎的全盆骨。CTV包括宫颈癌原发灶、子宫、宫旁组织以及区域淋巴结。CTV外扩1.0 cm为PTV。设计对限定和不限定盆骨骨髓的IM-WPRT,95% PTV＝50 Gy/25 f,比较两种IM-WPRT计划的PTV、盆骨骨髓及其他危险器官的DVH及剂量分布。结果 加骨髓限值的IM-WPRT比不加限值的IM-WPRT在不同剂量水平均明显减少骨髓的受照体积,尤其在20～50Gy差异有显著统计学意义(P≤0.008);在80%和100%的处方剂量时,前者较后者分别减少6.5%和8.8%的骨髓体积。在低剂量水平10～30Gy(P≤0.025)和10～20Gy(P≤0.008)分别对左、右股骨头有明显的保护作用。同时,限定骨髓的IM-WPRT未影响PTV的剂量覆盖率和剂量均匀性。结论 限定骨髓的IM-WPRT可以明显减少骨髓的受照剂量和体积,并减少股骨头的受照体积。证实限定盆骨骨髓的IM-WPRT计划是可行的,为降低同步放化疗治疗进展期宫颈癌血液毒性提供了剂量学依据。 |
| 英文摘要: |
| Objective To assess the effect of applying intensity modulated whole pelvis radiotherapy(IM-WPRT) on reducing the irradiated volume of pelvic bone marrow (BM).Methods 15 consecutive patients with cervical cancer underwent IM-WPRT. The clinical target volume(CTV) and the planning target volume (PTV＝CTV＋1.0 cm) and pelvic BM were contoured. Two plans were created for each patient: an IM-WPRT treatment plan (excluding pelvic BM), and a pelvic BM-sparing (BMS) IM-WPRT plan. Dose-volume histograms for the PTV and critical organs were evaluated.Results BMS IM-WPRT treatment plans demonstrated a significant reduction of the volume of pelvic BM at various dose levels, especially at 20-50Gy(P≤0.008).Compared with the conventional IM-WPRT, BMS IM-WPRT decreased the BM volume by 6.5% and 8.8% at 80% and 100% of the prescription dose,respectively. Furthermore, the BMS IM-WPRT plans,with adequate coverage and the same dose homogeneity of PTV, resulted in significant sparing of other critical organs.Conclusions BMS IM-WPRT is superior to pelvic BM. It provides dosimetric evidence of reducing hematologic toxicity of concurrent radiochemotherapy in locally advanced cervical cancer. |
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