[an error occurred while processing this directive] | [an error occurred while processing this directive]
Effect of image guidance on doses to the rectum and bladder in radiotherapy for cervical cancer
Liu Qing, Zhang Zongkai, Wang Yadi, Lu Na, Zhang Fuli
Department of Radiotherapy,PLA Army General Hospital,Beijing 100700,China (Liu Q,Zhang ZK,Wang YD,Lu N,Zhang FL); Department of Radiotherapy,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China (Liu Qing)
AbstractObjective To analyze the effect of image guidance on the doses to the rectum and bladder in radical external beam radiotherapy for cervical cancer, and to investigate the reasonable application mode of image-guided radiotherapy (IGRT) in the treatment of cervical cancer. Methods A total of 20 patients with cervical cancer who underwent helical tomotherapy (HT) in PLA Army General Hospital from 2012 to 2016 were enrolled in this study. A megavoltage computed tomography (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose reconstruction in the adaptive module of HT to obtain the actual dose (Plan-1) and the non-image-guided dose was simulated (Plan-2). Each single dose distribution and the corresponding fused CT image were sent to the software MIM 6.0 to obtain the total radiation dose by dose superposition. The radiation doses and volumes of the rectum and bladder were compared between the two therapeutic plans. Results The radiation doses to the rectum and bladder in Plan-2 were significantly higher than those in Plan-1. There were significant differences in Dmax and V50 of the rectum and V50 of the bladder between Plan-1 and Plan-2(P=0.040;P=0.000;P=0.047). Compared with Plan-1, there were statistical differences in inter-fractional Dmax and V50 during the initial treatment (P=0.047,0.037), and V50 of the rectum within the 13th to 21st radiotherapy, respectively (P=0.009, 0.017, 0.028). Besides, differences regarding Vmax and V50 in the initial treatment and the 21st to 23rd radiotherapy were close to the statistical significance when compared to those in Plan-1, respectively (P=0.061,0.053;P=0.072,0.058). Conclusions IGRT can reduce the radiation doses and volumes of the rectum and bladder, especially the rectum. The therapeutic plan should be rescheduled when tumor retraction is evident at half of the total radiation dose (around 13th fraction) in external beam radiotherapy. If it is difficult to achieve image guidance in each treatment, selective image guidance could be performed to effectively reduce the injuries of the rectum and bladder.
Corresponding Authors:
Wang Yadi,Email wangyadi@hotmail.com
Cite this article:
Liu Qing,Zhang Zongkai,Wang Yadi et al. Effect of image guidance on doses to the rectum and bladder in radiotherapy for cervical cancer [J]. Chinese Journal of Radiation Oncology, 2018, 27(1): 68-73.
Liu Qing,Zhang Zongkai,Wang Yadi et al. Effect of image guidance on doses to the rectum and bladder in radiotherapy for cervical cancer [J]. Chinese Journal of Radiation Oncology, 2018, 27(1): 68-73.
[1] 殷蔚伯,谷铣之.肿瘤放射治疗学[M].3版.北京:中国协和医科大学出版社,2002:1035.Yin WB,Gu XZ.Radiation Onclogy[M].3ed. Beijing:China union medical university press,2002:1035 [2] Wang YM,Wang CJ,Fang FM,et al. Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy-a propensity score-matched study[J].Gynecol Oncol,2017,145(2):277-283.DOI:10.1016/j.ygyno.2017.02.034 [3] Mundt AJ,Mell LK,Roeske JC.Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy[J].Int J Radiat Oncol Biol Phys,2003,56(5):1354-1360.DOI:10.1016/S0360-3016(03)00325-0 [4] 杨乐伟,陈上求,陈嘉洛.1496例宫颈癌放疗患者放射性直肠炎及膀胱炎发生率的分析[J].实用临床医学,2014,15(5):73-74,76.Yang LW,Chen SQ,Chen JL.The incidence of 1496 cases of cervical cancer radiotherapy in patients with radiation proctitis and cystitis[J].Pract Clin Med,2014,15(5):73-74,76 [5] Du XL,Tao J,Sheng XG,et al. Intensity-modulated radiation therapy for advanced cervical cancer:a comparison of dosimetric and clinical outcomes with conventional radiotherapy[J].Gynecol Oncol,2012,125(1):152-157.DOI:10.1016/j.ygyno.2011.12.432 [6] Gandhi AK,Sharma DN,Rath GK,et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma:a prospective randomized study[J].Int J Radiat Oncol Biol Phys,2013,87(3):542-548.DOI:10.1016/j.ijrobp.2013.06.2059 [7] Chen MF,Tseng CJ,Tseng CC,et al. Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy:comparison with conventional radiotherapy[J].Int J Radiat Oncol Biol Phys,2007,67(5):1438-1444.DOI:10.1016/j.ijrobp.2006.11.005 [8] Kidd AE,Siegel BA,Dehdashti F,et al. Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer[J].Int J Radiat Oncol Biol Phys,2010,77(4):1085-1091.DOI:10.1016/j.ijrobp.2009.06.041 [9] 乔文娟,靳红,成海燕,等.调强放射治疗在中晚期宫颈癌放疗中的临床价值[J].中国实用妇科与产科杂志,2010,26(12):950-952.Qiao WJ,Jin H,Cheng HY,et al. Comparision of intensity-modulated rdiation therapy and conventional radiotherapy for advanced cervical cancer without lymph node metastasis[J].Chin J Pract Gynecol Obstetr,2010,26(12):950-952 [10] 庞皓文,邱杰,孙帅,等.宫颈癌调强放疗中直肠体积与位置变化及对吸收剂量影响[J].中华放射肿瘤学杂志,2012,21(3):258-261.DOI:10.3760/cma.j.issn.1004-4221.2012.03.019.Pang HW,Qiu J,Sun S,et al. Changes of rectal volume and location and their influence on rectal dose during the course of intensity-modulated radiotherapy of cervical cancer[J].Chin J Radiat Oncol,2012,21(3):258-261.DOI:10.3760/cma.j.issn.1004-4221.2012.03.019 [11] Renard-Oldrini S,Brunaud C,Huger S,et al. Dosimetric comparison between the intensity modulated radiotherapy with fixed field and Rapid Arc of cervix cancer[J].Cancer Radiother,2012,16(3):209-214.DOI:10.1016/j.canrad.2012.02.002 [12] Toita T,Ohno T,Kaneyasu Y,et al. A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer[J].Jpn J Clin Oncol,2011,41(9):1119-1126.DOI:10.1093/jjco/hyr096 [13] 张勇乾,张富利,王雅棣,等.头颈部肿瘤HT剂量学研究[J].中华放射肿瘤学杂志,2014,23(6):519-522.DOI:10.3760/cma.j.issn.1004-4221.2014.06.016.Zhang YQ,Zhang FL,Wang YD,et al. Dosimetric evaluation for head and neck cancer patients treated with helical TomoTherapy[J].Chin J Radiat Oncol,2014,23(6):519-522.DOI:10.3760/cma.j.issn.1004-4221.2014.06.016 [14] Lee J,Lin JB,Sun FJ,et al. Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients:an observational study of 10-year[J].Medicine (Baltimore),2017,96(10):e6158.DOI:10.1097/MD.0000000000006158 [15] Bondar L,Hoogeman M,Mens JW,et al. Toward an individualized target motion management for IMRT of cervical cancer based on model-predicted cervix-uterus shape and position[J].Radiother Oncol,2011,99(2):240-245.DOI:10.1016/j.radonc.2011.03.013 [16] Kim H,Beriwal S,Huq MS,et al. Evaluation of set-up uncertainties with daily kilovoltage image guidance in external beam radiation therapy for gynaecological cancers[J].Clin Oncol,2012,24(2):e39-e45.DOI:10.1016/j.clon.2011.09.007 [17] Fiorino C,Fellin G,Rancati T,et al. Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer:preliminary results of a multicenter prospective study[J].Int J Radiat Oncol Biol Phys,2008,70(4):1130-1137.DOI:10.1016/j.ijrobp.2007.07.2354 [18] Peeters STH,Lebesque JV,Heemsbergen WD,et al. Localized volume effects for late rectal and anal toxicity after radiotherapy for prostate cancer[J].Int J Radiat Oncol Biol Phys,2006,64(4):1151-1161.DOI:10.1016/j.ijrobp.2005.10.002 [19] 王静,许可葵,史百高,等.4374例宫颈癌患者预后及其影响因素分析[J].中国肿瘤,2014,23(4):281-288.DOI:10.11735/j.issn.1004-0242.2014.04.A003.Wang J,Xu KK,Shi BG,et al. An analysis of the prognostic factors in 4374 cases with cervical cancer[J].China Cancer,2014,23(4):281-288.DOI:10.11735/j.issn.1004-0242.2014.04.A003 [20] 刘艳,张洁,佐合拉古丽·木塔力甫,等.宫颈癌常规放疗与图像引导的调强放疗近期并发症及疗效的对比[J].实用医学杂志,2016,32(2):211-214.DOI:10.3969/j.issn.1006-5725.2016.02.013.Liu Y,Zhang J,Zuohelaguli Mutalifu,et al. Recent complications and efficacy of conventional radiotherapy and image-guided radiotherapy for cervical carcinoma[J].J Pract Med,2016,32(2):211-214.DOI:10.3969/j.issn.1006-5725.2016.02.013 [21] 李奕彤,王雅棣,张富利,等.宫颈癌调强放疗中靶区变化与剂量分析[J].中华放射医学与防护杂志,2015,35(10):751-755.DOI:10.3760/cma.j.issn.0254-5098.2015.10.007.Li YT,Wang YD,Zhang FL,et al. Variation of organ position and dose for cervical cancer patients treated with helical tomotherapy[J].Chin J Radiol Med Prot,2015,35(10):751-755.DOI:10.3760/cma.j.issn.0254-5098.2015.10.007 [22] Lim K,Kelly V,Stewart J,et al. Pelvic radiotherapy for cancer of the cervix:is what you plan actually what you deliver?[J].Int J Radiat Oncol Biol Phys,2009,74(1):304-312.DOI:10.1016/j.ijrobp.2008.12.043 [23] Pisani C,Deantonio L,Surico D,et al. Quality of life in patients treated by adjuvant radiotherapy for endometrial and cervical cancers:Correlation with dose-volume parameters[J].Clin Transl Oncol,2015,18(9):901-908.DOI:10.1007/s12094-015-1458-9 [24] Du XL,Tao J,Sheng XG,et al. Intensity-modulated radiation therapy for advanced cervical cancer:a comparison of dosimetric and clinical outcomes with conventional radiotherapy[J].Gynecol Oncol,2012,125(1):151-157.DOI:10.1016/j.ygyno.2011.12.432 [25] Harsolia A,Vargas C,Yan D,et al. Predictors for chronic urinary toxicity after the treatment of prostate cancer with adaptive three-dimensional conformal radiotherapy:dose-volume analysis of a phase ii dose-escalation study[J].Int J Radiat Oncol Biol Phys,2007,69(4):1100-1109.DOI:10.1016/j.ijrobp.2007.04.076 [26] 庞皓文,邱杰,全红,等.宫颈癌调强放疗中膀胱解剖结构变化及对其吸收剂量影响研究[J].中华放射肿瘤学杂志,2011,20(3):218-221.DOI:10.3760/cma.j.issn.1004-4221.2011.03.014.Pang HW,Qiu J,Quan H,et al. Bladder anatomical changes and dose variation during the course of intensity-modulated radiation therapy of cervical cancer[J].Chin J Radiat Oncol,2011,20(3):218-221.DOI:10.3760/cma.j.issn.1004-4221.2011.03.014
2018, Vol. 27 
