局部晚期宫颈癌腔内联合组织间插植3D-IGBT的剂量学研究

doi:10.3760/cma.j.issn.1004-4221.2015.03.009

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摘要目的探讨CT引导下腔内联合组织间插植3D-IGBT局部晚期宫颈癌的剂量学优势。方法分析2013—2014年于本院接受根治性外照射及腔内联合组织间插植3D-IGBT的局部晚期宫颈癌患者 45例,FIGO分期(2009年)为 Ⅰ_B2—Ⅳ_A期。同一患者行腔内联合组织间插植 ¹⁹²Ir治疗后,在原影像上去掉插植针作用,仅使用腔内施源器制定治疗计划。比较前后两组计划中高危CTV的 D_90%、中危CTV的 D_90%和膀胱、直肠、乙状结肠、小肠的 D_{2 cm³}剂量学差异,并行配对t检验。结果共制定260次后装治疗计划, 其中腔内联合组织间插植治疗计划 130例、腔内治疗计划 130例。腔内联合组织间插植治疗较腔内治疗高危CTV的 D_90%、中危CTV的 D_90%显著增高(P=0.000、0.000),膀胱、直肠的 D_{2 cm³}显著降低(P=0.000、0.006)。结论局部晚期宫颈癌使用腔内联合组织间插植3D-IGBT在获得更高靶区剂量的同时降低了膀胱、直肠受量。

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	张宁
	赵志鹏
	程光惠
	何明远
	赵红福
	葛禹平

关键词 ：宫颈肿瘤/三维近距离疗法, 腔内, 组织间, 剂量学

Abstract：Objective To explore the dosimetric advantages of computed tomography-based and ultrasound-guided three-dimensional image-quided brachytherapy (3D-IGBT) combined with intracavitary/interstitial (IC/IS) brachytherapy for locally advanced cervical cancer. Methods A total of 45 patients with FIGO (2009) stage I_B2-IV_A locally advanced cervical cancer who received radical external beam radiotherapy and 3D-IGBT combined with IC/IS brachytherapy in our hospital from 2013 to 2014 were analyzed. After the treatment with ¹⁹²Ir-based IC/IS brachytherapy, patients had needles removed from the original images and received treatment only from IC radiation sources. Dosimetric differences in the planning D₉₀ for high-risk clinical target volume (HR-CTV), D₉₀ for intermediate-risk CTV (IR-CTV), and D_{2 cm³} for the bladder, rectum, sigmoid colon, and small intestines were determined and analyzed by paired t-test. Results A total of 260 after-loading treatment plans, including IC/IS treatment plans for 130 patients and IC treatment plans for 130 patients, were made. The D₉₀ for HR-CTV and D₉₀ for IR-CTV in the IC/IS brachytherapy group were significantly higher than those in the IC brachytherapy group (P=0.000;P=0.000). Moreover, the average D_{2 cm³} values for the bladder and rectum were significantly reduced in the IC/IS brachytherapy group compared with those in the IC brachytherapy group (P=0.000;P=0.006). Conclusions The 3D-IGBT combined with IC/IS brachytherapy not only achieves a higher dose for the target volume, but also reduces the radiation dose to the bladder and rectum in the treatment of locally advanced cervical cancer.

Key words： Cervicalneoplasms/three-dimensional brachytherapy Intracavitary Interstitial Dosimetry

基金资助::吉林省科技厅项目(20090458);吉林大学白求恩医学科研支持计划-前沿交叉学科创新项目(2013107024);吉林省卫生计生委项目(2014ZC054);国家自然科学基金项目(81201737)

通讯作者: 程光惠,Emailchengguanghuifl@163.com

引用本文:

张宁,赵志鹏,程光惠等. 局部晚期宫颈癌腔内联合组织间插植3D-IGBT的剂量学研究[J]. 中华放射肿瘤学杂志, 2015, 24(3): 267-270.

Zhang Ning^*,Zhao Zhipeng,Cheng Guanghui et al. Dosimetric study of three-dimensional image-quided brachytherapy combined with intracavitary/interstitial brachytherapy in locally advanced cervical cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(3): 267-270.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2015.03.009 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2015/V24/I3/267

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