李凤虎,梅烦,李杰慧,杜燕军,胡丽丽,田雪,洪卫,刘雯,卢冰.早期宫颈癌术后三维后装近距离治疗时膀胱不同充盈体积对靶区与危及器官影响研究[J].中华放射医学与防护杂志,2022,42(4):277-282
早期宫颈癌术后三维后装近距离治疗时膀胱不同充盈体积对靶区与危及器官影响研究
Effects of different bladder filling volumes on target area and organs at risk during three-dimensional brachytherapy of postoperative early cervical cancer
投稿时间:2022-01-09  
DOI:10.3760/cma.j.cn112271-20220109-00011
中文关键词:  宫颈癌|三维后装|膀胱体积|高危临床靶区|危及器官剂量
英文关键词:Cervical cancer|3D brachytherapy|Bladder volume|HR-CTV|Dose to organs at risk
基金项目:国家自然科学基金(82073333);北京市科学技术委员会(Z181100001718192)
作者单位E-mail
李凤虎 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
梅烦 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004 2420521561@qq.com 
李杰慧 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
杜燕军 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
胡丽丽 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
田雪 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
洪卫 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
刘雯 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
卢冰 贵州医科大学附属医院妇科肿瘤科 贵州医科大学附属肿瘤医院妇科肿瘤科, 贵阳 550004  
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中文摘要:
      目的 通过分析膀胱不同充盈体积对三维后装靶区及危及器官体积、剂量的影响,探讨宫颈癌术后三维后装近距离治疗时最佳膀胱充盈体积。方法 纳入术后病理明确的早期宫颈癌切缘阳性及安全边界不够的患者共111例,采用随机数表法给予膀胱灌注50、60、70、80、90、100 ml生理盐水共6组,每组依次为66、69、66、69、72、56人次分别行CT模拟定位,按照国际辐射单位和测量委员会(ICRU)89号报告勾画高危临床靶区及膀胱、直肠、小肠、乙状结肠等危及器官,采用Oncentra计划系统制定治疗计划,分别记录不同体积下的高危临床靶区(the high-risk clinical target volume,HR-CTV)体积、D90及危及器官(organ at risk,OAR)的1 cm3受照剂量(D1cm3)、2 cm3受照剂量(D2 cm3)。结果 60 ml组与50 ml组、70 ml组、80 ml组、90 ml组及100 ml组比较,HR-CTV体积、剂量差异无统计学意义(P>0.05),膀胱D2 cm3D1 cm3及直肠D2 cm3D1 cm3明显降低,差异具有统计学意义(t膀胱=3.21、5.83、2.89、12.95、7.96,P膀胱=0.031、0.010、0.041、0.000、0.001;t直肠=2.94、4.66、2.53、5.89、4.13,P直肠=0.037、0.024、0.049、0.005、0.028)。其他组两两比较,HR-CTV体积、剂量、膀胱D2 cm3D1 cm3及直肠D2 cm3D1 cm3差异无统计学意义(P>0.05)。乙状结肠及小肠D2 cm3D1 cm3各组间差异无统计学意义(P>0.05)。结论 在早期宫颈癌术后三维后装近距离治疗时,膀胱灌注60ml时较其他体积能够保证HR-CTV体积、剂量,又能够更好保护膀胱和直肠。
英文摘要:
      Objective To investigate the optimal bladder filling volume in the 3D brachytherapy of postoperative cervical cancer.Methods Totally 111 early cervical cancer patients with positive incisal margins or insufficient safety boundaries were included. The normal saline 50, 60, 70, 80, 90, and 100 ml were filled into their bladders, and accordingly six groups were determined, and 66, 69, 66, 69, 72, 56 person-times in each group, respectively. The CT-based simulation positioning was performed. According to the ICRU 89 report, high-risk clinical target volume and organs at risk such as bladder and rectum were delineated. The Oncentra planning system was used to prepare the treatment program. The high-risk clinical target volume (HR-CTV), D90, and the D2 cm3 and D1 cm3 of organs at risk under different volumes were recorded.Results Compared to the 60 ml group, the volume and dosage of HR-CTV in the groups of 50, 70, 80, 90, and 100 ml had no significant difference (P>0.05). The D2 cm3 and D1 cm3 of the bladder and rectum of patients in these groups significantly decreased, and the difference was statistically significant (tbladder=3.21, 5.83, 2.89, 12.95, 7.96, Pbladder =0.031, 0.010, 0.041, 0.000, 0.001; trectum=2.94, 4.66, 2.53, 5.89, 4.13, Prectum =0.037, 0.024, 0.049, 0.005, 0.028). The pairwise comparison among these groups except for the 60 ml group showed that the volume and dosage of HR-CTV and the D2 cm3 and D1 cm3 of bladder and rectum had no significant difference (P > 0.05). Moreover, the D2 cm3 and D1 cm3 of sigmoid colon and small intestine of these groups had no significant difference (P > 0.05).Conclusions In the 3D brachytherapy of postoperative early cervical cancer, a bladder filling volume of 60 ml can ensure the volume and dose of HR-CTV and can protect the bladder and rectum compared with other filling volumes.
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