CT引导徒手腔内联合插植自适应后装与传统A点后装治疗宫颈癌剂量比较

doi:10.3760/cma.j.cn113030-20190312-00083

摘要
图/表
参考文献(20)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探讨CT引导徒手腔内联合插植实现影像引导自适应后装(IGABT)相较于传统A点二维后装(CP)剂量学优势,明确其在宫颈癌治疗中的价值。方法选取在中山大学肿瘤医院行全量放疗的宫颈癌患者 26例,每例患者行4次后装治疗。治疗时先徒手置入宫腔管及2根插植针,后增加插植针数量并调整方向、深度,分别行CT扫描获得2套图像。勾画高危临床靶区(HRCTV),A点和危及器官(直肠、膀胱及乙状结肠)。在2套图像上分别行CP和IGABT计划设计,并配对t检验、Wilcoxon检验两者剂量参数差异。结果以CP计划的覆盖指数(CI)进行分组,A组(CI≥0.90)包含20个CP和对应IGABT计划,B组(CI<0.90)包含84个CP和对应IGABT计划。A组的HRCTV体积及肿瘤直径明显小于B组(46.7cm³∶62.1cm³,P<0.001及3.1cm∶4.4cm,P<0.0001)。IGABT显著提高所有及B组D90%及覆盖指数,降低膀胱剂量,减少A组乙状结肠剂量,并改善剂量适形度及均匀性。结论 IGABT能提高靶区覆盖、剂量适形度和均匀性,保护危及器官,且对肿瘤较大的患者仍有优势。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王燕红
	叶伟军
	詹时兆
	欧阳翼
	曹新平

关键词 ：宫颈肿瘤/CT引导徒手腔内联合组织插植后装疗法, 宫颈肿瘤/传统A点二维后装疗法, 剂量学

Abstract：Objective To analyze the dosimetric differences between CT-guided free-hand intracavity/interstitial brachytherapy[image-guided adaptive brachytherapy (IGABT)] and conventional point-A plan (CP) in the treatment of cervical cancer. Methods Twenty-six cervical cancer patients who received four cycles of IGABT in Sun Yat-sen University Cancer Center were enrolled in this study. Two sets of CT images were obtained before and after applicator adjustment to aid in the design of CP and IGABT plans. The high-risk clinical target volume (HRCTV), point A, and organs at risk (bladder, rectum, and sigmoid colon) were defined on CT images. CP and IGABT plans were designed on CT images. Parameter differences between CP and IGABT plans were analyzed with paired t-test and Wilcoxon test. Results According to the coverage index (CI) of CP, plans were divided into two groups:in group A (CI≥0.90), 20 CP and corresponding IGABT plans were included, and 84 CP and corresponding IGABT plans in group B (CI<0.90). The mean volume of HRCTV and mean tumor diameter in group A were significantly smaller than those in group B (46.7 cm³ vs. 62.1 cm³, P<0.001 and 3.1 cm vs. 4.4 cm, P<0.001). Compared with CP, IGABT significantly improved the value of D90% in all plans and group B, whereas lowered the bladder dose. IGABT also reduced the dose of sigmoid colon in group A. IGABT significantly improved conformal index and dose homogeneity index. Conclusions IGABT can significantly improve the target coverage, conformal index and dose homogeneity index, protect organs at risk. Compared with CP, IGABT has advantages in the treatment of patients with bulky tumor.

Key words： Cervical neoplasm/CT-guided free-hand intracavitary plus interstitial brachytherapy Cervical neoplasm/conventional point-A brachytherapy Dosimetry

收稿日期: 2019-03-12

通讯作者: 曹新平,Email:caoxp@sysucc.org.cn

引用本文:

王燕红,叶伟军,詹时兆等. CT引导徒手腔内联合插植自适应后装与传统A点后装治疗宫颈癌剂量比较[J]. 中华放射肿瘤学杂志, 2020, 29(10): 882-887.

Wang Yanhong,Ye Weijun,Zhan Shizhao et al. Dosimetric comparison between CT-guided free-hand intracavity/interstitial adaptive brachytherapy and conventional point-A brachytherapy in the treatment of cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(10): 882-887.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20190312-00083 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2020/V29/I10/882

[1] Toita T, Moromizato H, Ogawa K, et al. Concurrent chemoradiotherapy using high-dose-rate intracavitary brachytherapy for uterine cervical cancer[J]. Gynecol Oncol, 2005, 96(3):665-670. DOI:10.1016/j.ygyno.2004.11.046.
[2] Murakami N, Kasamatsu T, Wakita A, et al. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer[J]. BMC Cancer, 2014, 14:447. DOI:10.1186/1471-2407-14-447.
[3] WanderåsAD, Sundset M, Langdal I, et al. Adaptive brachytherapy of cervical cancer, comparison of conventional point A and CT based individual treatment planning[J]. Acta Oncol, 2012, 51(3):345-354. DOI:10.3109/0284186x.2011.626446.
[4] Onal C, Arslan G, Topkan E, et al. Comparison of conventional and CT-based planning for intracavitary brachytherapy for cervical cancer:target volume coverage and organs at risk doses[J]. J Exp Clin Cancer Res, 2009, 28(1):95. DOI:10.1186/1756-9966-28-95.
[5] Shin KH, Kim TH, Cho JK, et al. CT-guided intracavitary radiotherapy for cervical cancer:Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters[J]. Int J Radiat Oncol Biol Phys, 2006, 64(1):197-204. DOI:10.1016/j.ijrobp.2005.06.015.
[6] Tanderup K, Nielsen SK, Nyvang GB, et al. From point A to the sculpted pear:MR image guidance significantly improves tumour dose and sparing of organs at risk in brachytherapy of cervical cancer[J]. Radiother Oncol, 2010, 94(2):173-180. DOI:10.1016/j.radonc.2010.01.001.
[7] Malyapa RS, Mutic S, Low DA, et al. Physiologic FDG-PET three-dimensional brachytherapy treatment planning for cervical cancer[J]. Int J Radiat Oncol Biol Phys,2002, 54(4):1140-1146. DOI:10.1016/s0360-3016(02)03043-2.
[8] Nomden CN, de Leeuw AA, Moerland MA, et al. Clinical use of the Utrecht applicator for combined intracavitary/interstitial brachytherapy treatment in locally advanced cervical cancer[J]. Int J Radiat Oncol Biol Phys, 2012, 82(4):1424-1430. DOI:10.1016/j.ijrobp.2011.04.044.
[9] Dimopoulos JC, Kirisits C, Petric P, et al. The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer:clinical feasibility and preliminary results[J]. Int J Radiat Oncol Biol Phys, 2006, 66(1):83-90. DOI:10.1016/j.ijrobp.2006.04.041.
[10] Wang Y, Ye WJ, Du LH, et al. Dose-volume parameters and clinical outcome of CT-guided free-hand high-dose-rate interstitial brachytherapy for cervical cancer[J]. Chin J Cancer, 2012, 31(12):598-604. DOI:10.5732/cjc.011.10452.
[11] Nag S, Cardenes H, Chang S, et al. Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma:report from Image-Guided Brachytherapy Working Group[J]. Int J Radiat Oncol Biol Phys, 2004, 60(4):1160-1172. DOI:10.1016/j.ijrobp.2004.04.032.
[12] Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC-ESTRO Working Group (I):concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV[J]. Radiother Oncol, 2005, 74(3):235-245. DOI:10.1016/j.radonc.2004.12.015.
[13] Pötter R, Haie-Meder C, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (Ⅱ):concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology[J]. Radiother Oncol, 2006, 78(1):67-77. DOI:10.1016/j.radonc.2005.11.014.
[14] Jacob D, Raben A, Sarkar A, et al. Anatomy-based inverse planning simulated annealing optimization in high-dose-rate prostate brachytherapy:significant dosimetric advantage over other optimization techniques[J]. Int J Radiat Oncol Biol Phys, 2008, 72(3):820-827. DOI:10.1016/j.ijrobp.2008.02.009.
[15] Huckle A, Al-Qaisieh B, Bownes P. Methods of verifying the output of the treatment planning system used for high dose rate (HDR) prostate brachytherapy[J]. Radiother Oncol, 2012, 103(2):261-265. DOI:10.1016/j.radonc.2011.09.022.
[16] Jamema SV, Sharma S, Mahantshetty U, et al. Comparison of IPSA with dose-point optimization and manual optimization for interstitial template brachytherapy for gynecologic cancers[J]. Brachytherapy, 2011, 10(4):306-312. DOI:10.1016/j.brachy.2010.08.011.
[17] Baker C, Dini SA, Kudrimoti M, et al. Dosimetric evaluation of a newly designed low dose rate brachytherapy applicator for treatment of cervical cancer with extension into the lower vagina[J]. J Appl Clin Med Phys, 2007, 8(2):37-46. DOI:10.1120/jacmp.v8i2.2400.
[18] Wazer DE, Lowther D, Boyle T, et al. Clinically evident fat necrosis in women treated with high-dose-rate brachytherapy alone for early-stage breast cancer[J]. Int J Radiat Oncol Biol Phys, 2001, 50(1):107-111. DOI:10.1016/s0360-3016(00)01541-8.
[19] Vikram B, Deore S, Beitler JJ, et al. The relationship between dose heterogeneity ("hot" spots) and complications following high-dose rate brachytherapy[J]. Int J Radiat Oncol Biol Phys, 1999, 43(5):983-987.
[20] Wachter-Gerstner N, Wachter S, Reinstadler E, et al. The impact of sectional imaging on dose escalation in endocavitary HDR-brachytherapy of cervical cancer:results of a prospective comparative trial[J]. Radiother Oncol, 2003, 68(1):51-59. DOI:10.1016/s0167-8140(03)00083-5.