术前术后宫颈癌膀胱充盈度一致性在调强放疗中对靶区及危及器官重要性研究

doi:10.3760/cma.j.issn.1004-4221.2019.06.009

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摘要目的在宫颈癌调强放疗中使用膀胱容积测量仪(BVI 9400)控制术前及术后宫颈癌患者的膀胱充盈度,比较靶区位移误差及其引起的照射剂量变化、膀胱充盈形态变化,研究膀胱充盈度的一致性在宫颈癌调强放疗中的重要性。方法选取本院2018年内放疗的45例宫颈癌患者,分成A、B、C组,每组15 例。A组为未手术患者,B组为根治术后患者(两组疗前均使用BVI 9400监测膀胱尿量),C组随机选取患者采取自主憋尿未监测治疗前膀胱尿量。3个组患者疗前均行KV-CBCT扫描进行在线配准分析,计算在左右、头脚,腹背方向的靶区位移误差、处方剂量PTV覆盖体积百分比(V100)及百分比差值(ΔV100)。结果左右、头脚,腹背方向平均位移误差A组分别为1.67、1.55、1.67 mm,B组分别为1.43、1.58、1.84 mm,C组分别为2.27、2.30、2.08 mm。V100、ΔV100 A组分别为96.96%、1.17%,B组分别为95.9%、1.29%,C组分别为94.02%、2.17%。结论控制膀胱充盈度的一致性均能在一定程度上减小膀胱充盈程度不一致对误差产生的影响,保证了靶区位置的精度和靶区的照射剂量,对膀胱、小肠、直肠起到一定的保护作用,减轻宫颈癌患者放疗反应。

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	张蔚
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关键词 ：膀胱充盈度, 计划靶体积, 宫颈肿瘤/调强放射疗法

Abstract：Objective Bladder filling in patients with cervical cancer before and after operation during intensity-modulated radiotherapy (IMRT) was controlled by using bladder volume measurement instrument (BVI 9400). The displacement errors of the target area and the changes of the irradiation dose and the morphology of the filling bladder were compared. The significance of consistency of preoperative and postoperative bladder filling in IMRT for cervical cancer was investigated.Methods Forty-five patients with cervical cancer treated with radiotherapy in our hospital in 2018 were recruited and divided into A,B and C groups (n=15). In group A, patients did not undergo surgery, patients in group B received radical resection of cervical cancer (bladder volume measurement (BVI 9400) was utilized to monitor the bladder urine volume in both A and B groups before treatment). In group C, patients who self-controlled urination without monitoring bladder urine volume before treatment were randomly selected. All patients in three groups underwent KV-CBCT scan before treatment for online registration analysis. The displacement errors in the x-(left and right),y-(head and foot),z-axis directions (ventral and dorsal), PTV coverage volume percentage(V100) and percentage difference (ΔV100) of the prescription dose were calculated.Results The average displacement errors in the x-, y-, z-axis directions were as follows:1.67 mm,1.55 mm and 1.67 mm in group A, 1.43 mm,1.58 mm and 1.84 mm in group B, and 2.27 mm,2.30 mm and 2.08 mm in group C, respectively. In group A, the V100 was calculated as 96.96% and ΔV100 was 1.17%. In group B, V100 was95.9% and ΔV100 was 1.29%. In group C, V100 was 94.02% and ΔV100 was 2.17%.Conclusions Controlling the consistency of bladder filling can reduce the effect of inconsistency of bladder filling upon the displacement errors to certain extent, which can guarantee the accuracy of the target location and the irradiation dose of the target, protect the bladder, small intestine and rectum, and alleviate the radiation-induced response of cervical cancer patients.

Key words： Bladder filling status Planning target volume Cervical neoplasm/intensity-modulated radiotherapy

收稿日期: 2018-11-14

通讯作者: 许青,Email:396617183@qq.com

引用本文:

张蔚,许青,柯桂好等. 术前术后宫颈癌膀胱充盈度一致性在调强放疗中对靶区及危及器官重要性研究[J]. 中华放射肿瘤学杂志, 2019, 28(6): 438-441.

Zhang Wei,Xu Qing,Ke Guihao et al. Study on the significance of consistency of preoperative and postoperative bladder filling in patients with cervical cancer for target area and organ at risk in IMRT[J]. Chinese Journal of Radiation Oncology, 2019, 28(6): 438-441.

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