| 张永侠,袁香坤,史福敏,胡建伟,郜蕾,苗珺珺,左晓娜,谢昱伟.局部晚期宫颈癌腔内放疗联合组织间插植的剂量学研究[J].中华放射医学与防护杂志,2017,37(12):919-923 |
| 局部晚期宫颈癌腔内放疗联合组织间插植的剂量学研究 |
| A dosimetric analysis of combined intracavitary/interstitial brachytherapy for locally advanced cervical cancer |
| 投稿时间：2017-04-11 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.12.008 |
| 中文关键词: 宫颈癌 近距离放疗 腔内 组织间插植 剂量学 |
| 英文关键词:Cervical cancer Brachytherapy Intracavitary Interstitial interpolation Dosimetry |
| 基金项目: |
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| 摘要点击次数: 3314 |
| 全文下载次数: 2026 |
| 中文摘要: |
| 目的 比较局部晚期宫颈癌单纯腔内放疗与腔内联合组织间插植放疗的剂量学差异。方法 2016年5月—2017年3月局部晚期宫颈癌患者共35例，均行根治性放疗，治疗方法为外照射+腔内联合组织间插植放疗。调强放射治疗处方剂量为46.8~50.4 Gy/26~28次，1.8 Gy/次。腔内联合组织间插植放疗剂量为7 Gy/次，1次/周，共4次。同一患者首先置入三管式后装放疗施源器，采集CT图像制定治疗计划，取出三管式施源器后，置入宫腔管并植入插植针，再次采集图像制定放疗计划。分别评价比较两组计划中靶区及危及器官的受照剂量差别。结果 共制定212次后装放疗计划，其中单纯腔内治疗计划106例，腔内联合组织间插植治疗计划106例。腔内联合组织间插植放疗组计划较单纯腔内放疗组的靶区剂量明显升高，高危临床靶区（CTV）的D90、中危CTV的D90均显著增高（t=-6.01、-2.73，P<0.05），膀胱、直肠、乙状结肠的D2 cm3显著降低（t=3.07、4.52、2.91，P<0.05）。结论 局部晚期宫颈癌应用腔内联合插植放疗可以明显提高靶区剂量，并降低危及器官膀胱、直肠和乙状结肠的受照剂量。 |
| 英文摘要: |
| Objective To compare the dosimetric differences between intracavitary brachytherapy in combination with interstitial brachytherapy or not for locally advanced cervical cancer. Methods From May 2016 to March 2017, 35 patients with locally advanced cervical cancer treated with combined external beams and intracavitary/interstitial brachytherapy were selected in this study. The prescription of intensity-modulated radiation therapy was:46.8-50.4 Gy/26-28 fractions, 1.8 Gy/fraction. The prescription for combined intracavitary/interstitial brachytherapy was 7 Gy/fraction×4, once per week. Each patient was first implanted with a three tube applicator for brachytherapy, and the CT images were acquired for treatment planning. The three tube applicator was removed before a uterine tube and needles were implanted, thereafter planning images were acquired again. Dose to the targets and organs at risk were evaluated respectively for the two groups. Results A total of 212 brachytherapy plans were developed, including 106 intracavitary and 106 endoluminal combined interstitial plans. The target dose in endoluminal combined interstitial brachytherapy was significantly higher than that of intracavitary treatment alone, where D90 of the high-risk clinical target volume (CTV) and moderate CTV were both significantly increased (t=-6.01, -2.73, P<0.05). The D2 cm3 of the bladder, rectum and sigmoid colon were significantly reduced (t=3.07, 4.52, 2.91, P<0.05). Conclusions The application of the endoluminal combined interstitial brachytherapy for locally advanced cervical cancer can significantly increase the target dose, and reduce the dose to organs at risk such as the bladder, rectum and sigmoid colon. |
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