| 马建萍,夏新舍,潘闻燕,何剑莉,叶红强,陈俊杰,王嘉琳,王勇,白雪红,折虹.膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响[J].中华放射医学与防护杂志,2019,39(9):652-657 |
| 膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响 |
| The impact of bladder filling status on the movement of uterus and the volume of organs at risk in intensity modulated radiotherapy of cervical cancer |
| 投稿时间：2019-03-01 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.09.003 |
| 中文关键词: 宫颈癌 调强放疗 膀胱充盈 移位 危及器官 |
| 英文关键词:Cervical cancer Intensity modulated radiotherapy Bladder filling Displacement Organs at risk |
| 基金项目:宁夏回族自治区重点研发计划项目（2016KJHM67） |
| 作者 | 单位 | E-mail | | 马建萍 | 宁夏医科大学总医院, 银川 750004 | | | 夏新舍 | 宁夏医科大学总医院, 银川 750004 | | | 潘闻燕 | 宁夏医科大学总医院, 银川 750004 | | | 何剑莉 | 宁夏医科大学总医院, 银川 750004 | | | 叶红强 | 宁夏医科大学总医院, 银川 750004 | | | 陈俊杰 | 宁夏医科大学总医院, 银川 750004 | | | 王嘉琳 | 宁夏医科大学总医院, 银川 750004 | | | 王勇 | 宁夏医科大学总医院, 银川 750004 | | | 白雪红 | 宁夏医科大学总医院, 银川 750004 | | | 折虹 | 宁夏医科大学总医院, 银川 750004 | 123zhehong@vip.sina.com |
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| 中文摘要: |
| 目的 通过研究膀胱充盈状态对子宫、宫颈的移位、靶区和危及器官（OAR）体积的影响，为宫颈癌调强放疗（IMRT）个体化内靶区（ITV）及临床靶区（CTV）到计划靶区（PTV）界定提供理论基础。方法 获取宁夏医科大学总医院27例局部进展期初治宫颈癌患者膀胱排空、膀胱充盈1.0 h、充盈1.5 h定位CT图像，分别勾画宫颈、宫体、OAR，以及膀胱充盈1.0 h的CTV、PTV，分析不同膀胱充盈间宫颈、宫体的移位，不同充盈状态下子宫、直肠、小肠、PTV内小肠、PTV内膀胱、PTV内直肠体积的差异；分析膀胱充盈与子宫移位及OAR体积的相关性。分析膀胱排空与充盈1.5 h靶区脱出PTV的体积。结果 膀胱充盈状态个体差异较大，子宫颈和子宫体随膀胱充盈状态变化引起的最大移动范围分别为0~3.04 cm、0~4.31 cm。不同充盈间子宫体在前方移位差异有统计学意义（F=7.818，P<0.05）；不同充盈状态下膀胱体积、PTV内膀胱及小肠体积差异有统计学意义（F=46.197、44.609、29.546，P<0.05）；膀胱的充盈状态与子宫体前缘的移位、小肠体积、PTV内膀胱体积、PTV内小肠体积间有相关性（r=-0.232、-0.298、0.915、-0.336，P<0.05）。在膀胱排空及充盈1.5 h时，宫颈、宫体脱出PTV的体积差异均具有统计学意义（t=-1.326、-1.559，P<0.05）。结论 膀胱充盈状态具有较大的个体差异，膀胱充盈状态对子宫前缘的影响较大，扩大CTV-PTV前方外放范围可能降低靶区的漏照，控制膀胱充盈状态的一致性对宫颈癌精确调强放疗是必要的。 |
| 英文摘要: |
| Objective To investigate the impact of bladder filling status on the movement of uterine and on the volume of organs at risk(OAR), so as to provide theoretical basis for individualized internal target volume (ITV) and planning target volume (PTV). Methods Simulation CT images for a total of 27 patients with locally advanced cervical cancer were acquired with empty bladder, 1.0 h after bladder filling, 1.5 h after bladder filling, respectively. The volumes of uterine corpus, cervix, OARs, CTV and PTV 1.0 h after bladder filling were delineated. The impact of bladder filling status on the displacements of cervix and corpus, volumetric changes of rectum, small intestine, and the volumes of small intestine, bladder and rectum within PTV were analyzed. The correlation between bladder filling status and uterine displacement and volume of OAR was also investigated, as well as the volume of cervix and corpus in the PTV with empty bladder and 1.5 h after bladder filling. Results Bladder filling status is different for individual cases. The maximum movement range of cervix and uterine body with bladder filling state was 0-3.04 cm and 0-4.31 cm respectively. The anterior displacements of corpus (F=7.818, P<0.05), the volumetric changes of blander, as well the volume of bladder and small intestine in the PTV (F=46.197, 44.609, 29.546, P<0.05) were significantly different between different bladder filling status. The bladder filling status was correlated with the displacements of the anterior of corpus, volumetric changes of small intestine, and the volumes of bladder and small intestine within the PTV (r=-0.232, -0.298, 0.915, -0.336, P<0.05). The volumes of cervix and corpus out of the PTV were significantly different between the empty bladder and 1.5 h after bladder filling (t=-1.326, -1.559, P<0.05). Conclusions Bladder filling status was different for individual patients. The displacements of the anterior of the corpus were significantly affected by the bladder filling status. Increasing the anterior margin of PTV was recommended. The consistency of bladder filling status was critical for the precise cervical cancer IMRT. |
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