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不同位置子宫颈癌三维与二维近距离放疗剂量学研究和最适治疗人群探讨
刘采虹, 刘利, 曾曼婷, 刘琼, 朱红
410008 长沙,中南大学湘雅医院放疗科(刘采虹现单位:415000常德,湘雅常德医院 肿瘤科)
Dosimetric study and suitable population between 3-and 2-dimensional brachytherapy for cervical cancer at different locations
Liu Caihong, Liu Li, Zeng Manting, Liu Qiong, Zhu Hong
Department of Radiation Oncology,Xiangya Hospital,Central South University,Changsha,410008,China (Liu CH now unit:Department of Oncology,Xiangya Changde Hospital,Changde 415000,China)
Abstract：Objective To investigate the effect of different uterine positions upon the dose distribution and target area conformability of organ at risk (OAR) and explore the population suitable for 2-dimensional brachytherapy by comparing the dosimetry between CT-guided 3-and 2-dimensional brachytherapy for cervical cancer. Methods Thirty patients with cervical cancer received 72 cycles of 3-dimensional brachytherapy and then 2-dimensional brachytherapy was designed. The deviation angle of the uterus from the longitudinal asix on the coronal and sagittal CT images was measured. The obtained data were divided into the A to D and the groupⅠ to Ⅳ according to the deviation angle (T) of uterus position from the longitudinal axis on the sagittal CT images and the volume of HRCTV (VHRCTV) to identify the optimal uterine position and range of VHRCTV for 2-dimensional brachytherapy. Statistical analysis was performed by paired t-test. Results The deviation angle of uterine position was not significantly correlated with the target CI index or D90 of HRCTV in both brachytherapy plans (P value between 0.077-0.633), whereas it was positively correlated with the D2 cm3 of bladder (P value between 0.001-0.030) and negatively associated with the D2 cm3 of rectum in both 2-and 3-dimensional brachytherapy (P value between 0.011-0.016).In group B (|T|≤10°) and group Ⅲ(VHRCTVvalue between 86-96 cm3),the OAR parameters and CI index did not significantly differ between two brachytherapy plans (P value between 0.040-0.463), whereas varying degree of statistical differences was observed among other groups (P value between 0.000-0.940). Conclusions Although uterine position exerts no effect upon the conformal index of target area, it can affect the dose distribution of OAR. No statistical significance is noted in the dosimetry between 3-and 2-dimensional brachytherapy plans when the uterine position is almost flat (|T|≤10°) and the radiotherapy target area is appropriate (VHRCTVvalue between 86-96 cm3). In this situation, 2-dimensional brachytherapy is the optimal option.
Liu Caihong,Liu Li,Zeng Manting et al. Dosimetric study and suitable population between 3-and 2-dimensional brachytherapy for cervical cancer at different locations[J]. Chinese Journal of Radiation Oncology, 2018, 27(11): 1004-1008.
[1] Eifel PJ,Winter K,Morris M,et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer:an update of radiation therapy oncology group trial (RTOG) 90-01[J].J Clin Oncol,2004,22(5):872-880.DOI:10.1200/JCO.2004.07.197. [2] Morris M,Eifel PJ,Lu J,et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer[J].N Engl J Med,1999,340(15):1137-1143.DOI:10.1056/NEJM199904153401501. [3] Charra-Brunaud C,Harter V,Delannes M,et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France:results of the French STIC prospective study[J].Radiother Oncol,2012,103(3):305-313.DOI:10.1016/j.radonc.2012.04.007. [4] Schoeppel SL,LaVigne ML,Martel MK,et al. Three-dimensional treatment planning of intracavitary gynecologic implants:analysis of ten cases and implications for dose specification[J].Int J Radiat Oncol Biol Phys,1994,28(1):277-283.DOI:10.1016/0360-3016(94)90168-6. [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] Rijkmans EC,Nout RA,Rutten IH,et al. Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy[J].Gynecol Oncol,2014,135(2):231-238.DOI:10.1016/ j.ygyno.2014.08.027. [7] Lindegaard JC,Fokdal LU,Nielsen SK,et al. MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective[J].Acta Oncol,2013,52(7):1510-1519.DOI:10.3109/0284186X.2013.818253. [8] Nomden CN,de Leeuw AA,Roesink JM,et al. Clinical outcome and dosimetric parameters of chemo-radiation including MRI guided adaptive brachytherapy with tandem-ovoid applicators for cervical cancer patients:a single institution experience[J].Radiother Oncol,2013,107(1):69-74.DOI:10.1016/j.radonc.2013.04.006. [9] Taylor A, Powell ME.An assessment of interfractional uterine and cervical motion:implications for radiotherapy target volume definition in gynaecological cancer[J].Radiother Oncol,2008,88(2):250-257.DOI:10.1016/j.radonc.2008.04.016. [10] Ahmad R,Hoogeman MS,Bondar M,et al. Increasing treatment accuracy for cervical cancer patients using correlations between bladder-filling change and cervix-uterus displacements:proof of principle[J].Radiother Oncol,2011,98(3):340-346.DOI:10.1016/j.radonc.2010.11.010. [11] van de Bunt L,Jurgenliemk-Schulz IM,de Kort GA,et al. Motion and deformation of the target volumes during IMRT for cervical cancer:what margins do we need?[J].Radiother Oncol,2008,88(2):233-240.DOI:10.1016/ j.radonc.2007.12.017. [12] 魏爱云.器械子宫复位法在人工流产术中的应用[J].安徽医药,2008,12(3):233-234.DOI:10.3969/j.issn.1009-6469.2008.03.020. Wei AY. Application of instrumental uterine reduction method in artificial abortion[J].Anhui Med,2008,12(3):233-234.DOI:10.3969/j.issn.1009-6469.2008.03.020. [13] Tanderup K,Fokdal LU,Sturdza AE,et al. Dose and volume response for local control in locally advanced cervical cancer treated with EBRT combined with mri-guided adaptive brachytherapy[J].Int J Radiat Oncol Biol Phys,2014,90(1):S91-S92.DOI:10.1016/ j.ijrobp.2014.05.488.
2018, Vol. 27 
