| 亓昕,高献书,李飞宇,等.局限期前列腺癌放疗精囊临床靶区勾画范围的研究[J].中华放射医学与防护杂志,2014,34(7):518-522.Qi Xin,Gao Xianshu,Li Feiyu,et al.The optimal clinical target volume for the seminal vesicle in localized prostate cancer radiotherapy[J].Chin J Radiol Med Prot,2014,34(7):518-522 |
| 局限期前列腺癌放疗精囊临床靶区勾画范围的研究 |
| The optimal clinical target volume for the seminal vesicle in localized prostate cancer radiotherapy |
| 投稿时间：2014-03-10 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.07.010 |
| 中文关键词: 前列腺癌 放射治疗 精囊 靶区勾画 CT重建 |
| 英文关键词:Prostate cancer Radiotherapy Seminal vesicle Target delineation CT reconstruction |
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| 中文摘要: |
| 目的 探讨局限期前列腺癌精囊临床靶区（CTV）的勾画范围。方法 114例接受根治性放疗的局限期中、高危前列腺癌患者行定位CT扫描，对比欧美指南共同参考的精囊亚临床灶范围的病理结果，得到精囊长轴距起点1.0 cm和2.0 cm处的精囊截面，确定精囊近端1.0 cm和2.0 cm的解剖范围，然后测量两个截面距精囊起始平面的最大垂直距离（D10H、D20H）和最小垂直距离（D10L、D20L），并与欧美指南规定的勾画范围对比，进一步指导高剂量区精囊CTV的勾画范围。结果D10H、D10L、D20H、D20L平均值分别为（10.6 ± 1.8）、（2.1 ± 2.0）、（17.2 ± 2.9）和（8.8 ± 2.7）mm，包括95%病例的D10H和D20H分别为13.5和21.5 mm，多因素分析显示，D10H和D20H与精囊倾斜角度和横断面最大径相关（R2=0.64和0.77， P<0.01）。对比欧美指南规定的精囊靶区勾画方法，即自精囊起始平面开始沿人体长轴方向垂直向上勾画1.0 cm或2.0 cm作为CTV时，分别有65.8%（75/114）及17.5%（20/114）的病例无法完全包含根部1.0 cm或2.0 cm的精囊。结论 局限期中、高危前列腺癌勾画高剂量区精囊CTV时，按照现行欧美指南的画法存在部分亚临床病灶漏照风险。若要包含1.0 cm 近端精囊，推荐前内侧部垂直向上勾画1.4 cm、后外侧部垂直向上勾画0.5 cm可包含95%病例的亚临床病灶；若要包含2.0 cm 近端精囊，前内侧部垂直向上勾画2.2 cm即可，后外侧部可适当降低，但不低于1.4 cm。 |
| 英文摘要: |
| Objective To discuss the clinical target volume (CTV) for the seminal vesicle (SV) in localized prostate cancer radiotherapy.Methods Radiotherapy planning CT images from 114 patients with intermediate- or high-risk prostate cancer were collected and reconstructed at a thickness of 1 mm. Cross sections of the SV, 1.0 and 2.0 cm from the starting point, were located. Then, the maximum (D10H, D20H) and minimum (D10L, D20L) distance from these two cross sections to the initial plane of the SV were measured the proximal SV included in the high-dose CTV based on EORTC prostate cancer radiotherapy guideline and the current RTOG 0815 protocol guideline and the anatomic volume of proximal 1 and 2 cm SV were compared. Results The distance of D10H, D10L, D20H and D20L were (10.6 ± 1.8), (2.1 ± 2.0), (17.2 ± 2.9) and (8.8 ± 2.7)mm, D10H and D20H that can include 95% of the patients were 13.5 mm and 21.4 mm respectively. A smaller SV tilt angle (α and β) and a larger diameter of the cross section (R10/20) were associated with a longer D10H (R2=0.64, P<0.01) or D20H (R2=0.77, P<0.01). When it was defined 1.0 cm vertically upward from the initial plane as the upper limit of the CTV, the proximal 1.0 cm of the SV could not been entirely encompassed in 65.8%(75/114) of the enrolled cases. The proximal 2.0 cm of the SV could not been entirely encompassed in 17.5%(20/114) of our cases when 2.0 cm as the upper limit were used. Conclusions In order to contouring anatomic 1.0 cm/2.0 cm SV, the high-dose CTV need to extend 1.4 cm/2.2 cm upward for the anteromedial portion of the SV, and 0.5 cm/1.4 cm for the posterolateral SV. |
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