中华放射医学与防护杂志

吴爱林,吴爱东,刘云琴,等.宫颈癌二维近距离后装治疗中危及器官参考点剂量与三维体积剂量的相关性研究[J].中华放射医学与防护杂志,2016,36(11):847-851.Wu Ailin,Wu Aidong,Liu Yunqin,et al.Study of association between OARs reference points doses and OARs 3D volume doses in 2D intracavitary brachytherapy for cervical cancer[J].Chin J Radiol Med Prot,2016,36(11):847-851

宫颈癌二维近距离后装治疗中危及器官参考点剂量与三维体积剂量的相关性研究

Study of association between OARs reference points doses and OARs 3D volume doses in 2D intracavitary brachytherapy for cervical cancer

投稿时间：2016-07-25

DOI：10.3760/cma.j.issn.0254-5098.2016.11.010

中文关键词: 宫颈癌二维近距离后装治疗膀胱/直肠参考点剂量三维体积剂量

英文关键词:Cervical cancer 2D intracavitary brachytherapy Bladder/rectum reference point 3D volume dose

基金项目:

作者	单位	E-mail
吴爱林	230031 合肥, 安徽医科大学附属省立医院(西区), 安徽省肿瘤医院放疗科
吴爱东	230031 合肥, 安徽医科大学附属省立医院(西区), 安徽省肿瘤医院放疗科	aidongwu@21cn.com
刘云琴	230031 合肥, 安徽医科大学附属省立医院(西区), 安徽省肿瘤医院放疗科
钱立庭	230031 合肥, 安徽医科大学附属省立医院(西区), 安徽省肿瘤医院放疗科

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中文摘要:

目的利用宫颈癌二维近距离后装治疗中危及器官（OARs）点剂量预测其三维体积剂量，评估在特定条件下，二维计划OARs体积剂量能否满足三维后装剂量限值要求。方法回顾性分析基于CT图像的10例宫颈癌患者近距离后装治疗计划，将处方参考点剂量定为600 cGy，膀胱和直肠参考点剂量<360 cGy，设计并优化得到二维后装治疗计划。采用Pearson相关分析法对膀胱、直肠参考点剂量及OARs体积受量做相关性分析，利用线性回归方法得出膀胱、直肠参考点与其体积剂量的线性方程。结果膀胱、直肠参考点剂量分别与其D_{1 cm³}、D_{2 cm³}、D_{5 cm³}和平均剂量显著正相关（r=0.559~0.668，P<0.05）；膀胱、直肠参考点剂量分别是其D_{2 cm³}的1.404和1.181倍；内外照射完成后膀胱、直肠D_{2 cm³}的相当于200 cGy分次等效生物剂量（EQD2）分别为8 410.0和6 827.0 cGy，均低于二者体积剂量限值。结论利用膀胱、直肠参考点剂量能在一定程度上预测其体积剂量，对于满足膀胱、直肠参考点剂量低于处方剂量60%二维近距离后装计划，可将膀胱、直肠体积受量控制在相对安全的剂量范围内。而由于缺乏对小肠、乙状结肠剂量检测，二维后装计划在临床使用上仍然具有很大局限性。

英文摘要:

Objective To investigate the relationship between organs at risk (OARs) reference point dose and three dimensional OARs volume dose of two dimensional (2D) brachytherapy for cervical cancer, and to study whether the OARs volume dose can meet the dose constraints of three dimensional (3D)brachytherapy under certain conditions. Methods A retrospective study was carried out on 10 patients with cervical cancer who were treated with CT image guided high dose rate (HDR) brachytherapy. The graphical optimized 2D plan was designed with the prescription dose was 600 cGy. Both the dose of bladder and rectum reference point were lower than 360 cGy. The relationship between the bladder or rectum reference point dose and OARs volume dose was analyzed by Pearson correlation analysis. Through regression analysis, the linear equations were given to describe the connection between the dose of bladder and rectum reference point and their volume dose. Results D_{1 cm³}, D_{2 cm³}, D_{5 cm³} and D_mean of bladder and rectum correlated positively with the dose of reference point (r=0.559-0.668, P<0.05). The dose of bladder and rectum reference point underestimated D_{2 cm³} with ratio of 1.404 and 1.181. Total equivalent dose at 200 cGy/fraction (EQD2) dose (external beam radiotherapy plus intracavitary brachytherapy) of bladder and rectum were 8 410.0 and 6 827.0 cGy, which were below the volume dose limit of them. Conclusions The bladder and rectum volume dose could be estimated to a certain extent by the dose of bladder and rectum reference point. If the bladder and rectum reference dose kept to less than 60% of prescription dose in 2D brachytherapy, the bladder and rectum volume dose could be controlled within relatively safe dose range. Due to the lack of dose detection of small intestine and sigmoid, the two dimensional brachytherapy has serious limitations in clinical application.

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