赵志鹏,刘影,毛壮,程光惠.宫颈癌腔内联合插植近距离放疗中卵圆体的剂量学贡献研究[J].中华放射医学与防护杂志,2021,41(3):188-193
宫颈癌腔内联合插植近距离放疗中卵圆体的剂量学贡献研究
Dosimetric contribution of ovoid in the cervical cancer brachy radiotherapy through the intracavity combined with interstitial technique
投稿时间:2020-06-11  
DOI:10.3760/cma.j.issn.0254-5098.2021.03.006
中文关键词:  宫颈癌  近距离放疗  腔内/组织间插植  卵圆体  剂量学
英文关键词:Cervical cancer  Brachy radiotherapy  Intracavity/Interstitial  Ovoid  Dosimetry
基金项目:国家自然科学基金(81703034)
作者单位E-mail
赵志鹏 吉林大学中日联谊医院放疗科,长春 130033  
刘影 吉林大学中日联谊医院放疗科,长春 130033  
毛壮 吉林大学中日联谊医院放疗科,长春 130033  
程光惠 吉林大学中日联谊医院放疗科,长春 130033 chenggh@jlu.edu.cn 
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中文摘要:
      目的 探讨宫颈癌腔内联合组织间插植近距离放射治疗中卵圆体的剂量学贡献。方法 选取2015—2017年间在吉林大学中日联谊医院接受根治性放射治疗的局部晚期宫颈癌患者20例,患者病理分期依据国际妇产科协会(FIGO)2009年分期标准为ⅡA、ⅡB和ⅢB期。外照射治疗45 Gy/1.8 Gy×25次。近距离治疗为MRI引导下腔内联合插植近距离放疗,处方为28 Gy/7 Gy×4次。20位患者均制定两种计划,分为应用卵圆体组和未用卵圆体组。提取的患者近距离放疗治疗核磁模拟定位影像及原始治疗计划为应用卵圆体组,共80分次。未用卵圆体组在定位影像中,去掉卵圆体驻留模拟建立仅用宫腔管联合插植针的计划实验模型,由原计划物理师进行计划设计,使未用卵圆体组的高危CTV(HR-CTV)D90%与应用卵圆体组相近。比较两组计划的HR-CTV D90%D98%,中危CTV(IR-CTV)D90%D98%,及膀胱、直肠、乙状结肠和小肠的D2cm3剂量差异。结果 卵圆体组与未应用卵圆体组比较,HR-CTV D90%差异无统计学意义(P>0.05),HR-CTVD98%(6.99±0.60 vs. 6.78±0.76)、IR-CTVD90%(4.71±0.58 vs. 4.26±0.57)和D98%(3.77±0.58 vs. 3.26±0.59),差异均有统计学意义(t=3.906、9.860、8.636,P<0.05);乙状结肠的D2cm3差异无统计学意义(P>0.05);膀胱(5.29±0.67 vs. 4.92±0.74)、直肠(3.72±0.69 vs. 3.35±0.92)和小肠(3.05±1.37 vs. 2.98±1.34)的D2cm3,卵圆体组与未应用卵圆体组比较差异均有统计学意义(t=8.758、7.543、8.059,P<0.05)。结论 在宫颈癌腔内联合插植近距离放射治疗中合理的优化卵圆体和插植针的剂量权重比,可以带来更好的临床获益。
英文摘要:
      Objective To discuss the dosimetric contribution of the ovoid in the cervical cancer brachytherapy through the intracavity combined with interstitial(IC/IS)technique. Methods The data on 20 patients with FIGO(2009)stageⅡA, ⅡB or ⅢBcervical cancer treated with radical radiotherapy in China-Japan Union Hospital of Jilin University during 2015-2017 was collected. External irradiation treatment was 45 Gy/1.8 Gy×25 fractions. Brachytherapy was MRI-guided IC/IS brachytherapy with a prescription of 28 Gy/7 Gy×4 fractions. All of 20 patients developed two kinds of plans, the ovoid group and the non-ovoid group. The original MRI-guided brachytherapy treatment plan was set(80 fractions)to the ovoid group. As contrast model that removed the ovoid and consisted of tandem combined with needles set to the non-ovoid group was built, and the same physicist designed the plan to make the dose of D90% for high-risk clinical target volume(HR-CTV)similar to the ovoid group. The dosimetric differences of the D90% and D98% for HR-CTV, D90% and D98% for intermediate-risk clinical target volume(IR-CTV)and D2 cm3 for the bladder, rectum, sigmoid colon and small intestines between two groups of plans were analyze by paired t-test. Results Compared with the ovoid group, the non-ovoid group showed no significant difference on HR-CTV D90%(P>0.05), but the HR-CTV D98%(6.99±0.60 vs. 6.78±0.76), IR-CTV D90%(4.71±0.58 vs. 4.26±0.57) and D98%(3.77±0.58 vs. 3.26±0.59) of the non-ovoid group decreased significantly(t=3.906,9.860,8.636,P<0.05).The sigmoid colon showed no significant difference(P>0.05), while the bladder (5.29±0.67 vs. 4.92±0.74), rectum (3.72±0.69 vs. 3.35±0.92) and small intestines (3.05±1.37 vs. 2.98±1.34) D2 cm3of the non-ovoid group decreased significantly(t=8.758,7.543,8.059, P<0.05). Conclusions Ovoid is very important for IC/IS technique in cervical cancer brachytherapy. Reasonable optimization of the dose weight ratio of the ovoid and the needle can bring better clinical benefits.
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