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| 膀胱体积变化对宫颈癌近距离放疗的影响 | |
| 引用本文： | 徐志渊,杨 利,刘 佳,农雅琴,沈 琳,周 勇. 膀胱体积变化对宫颈癌近距离放疗的影响[J]. 现代肿瘤医学, 2019, 0(23): 4269-4272. DOI: 10.3969/j.issn.1672-4992.2019.23.033 |
| 作者姓名： | 徐志渊 杨 利 刘 佳 农雅琴 沈 琳 周 勇 |
| 作者单位： | 香港大学深圳医院，广东 深圳 518053 |
| 基金项目： | 深圳市卫生计生系统科研项目（学科建设能力提升项目）（编号:SZXJ2018003）；香港大学深圳医院科研培育计划项目（编号:HKUSZH201902031） |
| 摘 要： | 目的:分析膀胱体积变化对宫颈癌近距离治疗中肿瘤和正常组织受量的影响。方法:2015年1月至2017年12月于本院首诊的66例拟行根治性放疗的宫颈癌患者，治疗方案采用外照射放疗同期化疗加近距离治疗。均采用同期顺铂40 mg/m2每周方案化疗，外照射均采用常规分割外照射放疗，1.8~2 Gy/次，1次/天，5次/周，盆腔预防放疗剂量45 Gy/25次，阳性区域转移淋巴结处方剂量55~57.5 Gy/25次。后装采用三维自适应近距离放疗，A点剂量6 Gy每次，共4次，采用宫腔管和双侧阴道穹窿管或环形施源器，在定位CT图像上勾画高危临床靶区（high risk clinical tumor volume，HRCTV）、膀胱、直肠、乙状结肠，制定后装治疗计划后行近距离放疗。结果:后装近距离治疗期间，随着膀胱体积增大，膀胱D1cc、D2cc接受的放疗剂量逐渐升高，有显著统计学差异（P<0.001），其中小于49.25 ml膀胱体积组膀胱受辐射量最小。而膀胱体积的变化不影响直肠D1cc和D2cc、乙状结肠D1cc和D2cc、HRCTV D90和HRCTV D95。随着后装次数的增加，膀胱体积有逐渐增加的趋势，虽然第一次后装时膀胱体积与第二、三次后装时膀胱体积无统计学差异，但是第一次后装时膀胱体积与第四次后装时膀胱体积有统计学差异(P=0.02)。结论:近距离治疗过程中控制膀胱体积可以减少膀胱受照射剂量，近距离治疗期间控制膀胱体积小于49.25 ml可能是一个更好地选择。 |
| 关 键 词： | 宫颈癌 近距离放疗 膀胱体积 放疗剂量 |
The effect of bladder volume on intracavitary brachytherapy for cervical cancer |
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| Xu Zhiyuan,Yang Li,Liu Jia,Nong Yaqin,Shen Lin,Zhou Yong. The effect of bladder volume on intracavitary brachytherapy for cervical cancer[J]. Journal of Modern Oncology, 2019, 0(23): 4269-4272. DOI: 10.3969/j.issn.1672-4992.2019.23.033 | |
| Authors: | Xu Zhiyuan Yang Li Liu Jia Nong Yaqin Shen Lin Zhou Yong |
| Affiliation: | HongKong University Shenzhen Hospital，Guangdong Shenzhen 518053，China. |
| Abstract: | Objective:To analyze the effect of bladder volume on tumor and normal tissue dose distribution during the period of intracavitary brachytherapy for cervical cancer.Methods:From January 2015 to December 2017，66 patients with cervical cancer were treated by concurrent chemoradiotherapy and intracavitary brachytherapy.All patients were treated with single-agent cisplatin 40 mg/m2 chemotherapy combined with external beam radiotherapy (1.8~2 Gy per time，1 time per day，5 times per week，45 Gy/25 fractions to pelvic regions，55~57.5 Gy to positive regional lymph node)and three dimensional adaptive intracavitary brachytherapy (6 Gy to point A for total 4 times).Brachytherapy applicators used ring or ovoid.Then high risk clinical tumor volume and nomal tissue included rectum，sigmoid，bladder contoured on planning CT.Results:The radiotherapy dose of bladder D1cc and D2cc gradually increased following the increase of bladder volume during the period of intracavitary brachytherapy with a statistically significant difference (P<0.001).The radiation dose to the bladder in the bladder volume less than 49.25 ml group was the lowest.However，bladder volume did not affect rectum D1ccand D2cc，sigmoid colon D1cc and D2cc，HRCTV D90 and HRCTV D95.With the increase of intracavitary brachytherapy times，the bladder volume showed a trend of gradual increase.Although there was no bladder volume statistical difference between the first brachytherapy and the second or third brachytherapy，but there was a bladder volume statistical difference between the first and the fourth brachytherapy (P=0.02).Conclusion:Bladder volume control during brachytherapy can reduce the exposure dose to the bladder，and controlling bladder volume less than 49.25 ml may be a better choice. |
| Keywords: | cervical cancer brachytherapy bladder volume radiotherapy dose |
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