124例宫颈癌放疗后的放射性直肠损伤分析

笔者回顾分析了我院 1997年 1月至 1999年 12月的 12 4例宫颈癌放疗所致放射性直肠损伤的临床资料 ,报道如下。一、临床资料1 年龄 :患者年龄 2 4～ 80岁 ,中位数 5 2岁 ;其中 2 0～ 30岁 4名 ;31～ 4 0岁 2 4名 ;4 1～ 5 0岁 30名 ;5 1～ 6 0岁 36名 ;6 1～ 70岁 18名 ;>70岁 12名。2 临床分期 :按ＦＩＧＯ 1994年临床分期标准 :Ⅰ期 6例占 5 % ;Ⅱ期 6 6例占 5 3% ;Ⅲ期 4 2例占 34% ;Ⅳ期 10例占8%。3 病理类型 :腺癌 2 5例占 2 0 % ;鳞癌 86例占 6 9% ;腺鳞癌 13例占 11%。4 治疗方法 :采用体外照射和 (或 )近距离 (腔内 )照射 ,体外…     

宫颈癌容积旋转调强放射治疗中膀胱与直肠实际受照剂量影响研究

目的 探讨宫颈癌容积旋转调强放射治疗中膀胱与直肠实际受照剂量的影响.方法 选取香港大学深圳医院2018年4—10月收治的41例行容积旋转调强放射治疗的宫颈癌患者为研究对象.在首次放射治疗摆位的锥形束CT(CBCT)图像中勾画出直肠和膀胱.定位CT扫描膀胱充盈状态下图像及排空状态下图像,分别勾画出膀胱和直肠.根据首次摆位...     

膀胱充盈度对宫颈癌术后放疗靶区照射剂量的影响分析

目的 探究膀胱充盈度对宫颈癌术后放疗靶区照射剂量的影响。方法 选取2019年7月～2020年8月接收的行宫颈癌根治术及盆腔淋巴结清除术的56例宫颈癌患者,所有患者术后有盆腔放疗指征,进行调强放疗,分别两种不同状态的膀胱(排空和充盈)进行CT扫描。比较两种状态下,不同部位照射剂量及不同部位的体积变化。结果 CTV、PTV、股骨头、小肠、直肠体积在膀胱充盈状态和膀胱排空状态时比较,差异不显著(P>0.05);但在膀胱的体积方面,差异显著(P<0.05);照射剂量比较,两种状态各项指标两组间均无显著差异(P>0.05);但在膀胱充盈状态时膀胱和小肠的照射剂量明显低于排空状态时,差异显著(P<0.05)。结论 对宫颈癌患者进行术后调强放疗时,当膀胱处于充盈状态时,小肠及膀胱的照射剂量可明显减少,具有一定的保护作用。     

经直肠超声在前列腺癌近距离放疗中的作用

目的:探讨经直肠超声在前列腺癌近距离放疗中的作用.材料和方法:31例术前穿刺证实前列腺癌病人,在经直肠超声或在经直肠超声及X线透视双重引导下,进行了前列腺癌近距离放疗术.结果:所有病例术后CT均显示种子植入位置良好.结论:经直肠超声在前列腺癌近距离放疗术中有三大功能:第一,能准确计算前列腺体积;第二,能确定耻骨弓与前列腺之间关系;第三:能实时监控同位素放射源的植入.     

宫颈癌二维近距离后装治疗中危及器官参考点剂量与三维体积剂量的相关性研究

目的 利用宫颈癌二维近距离后装治疗中危及器官（OARs）点剂量预测其三维体积剂量,评估在特定条件下,二维计划OARs体积剂量能否满足三维后装剂量限值要求。方法 回顾性分析基于CT图像的10例宫颈癌患者近距离后装治疗计划,将处方参考点剂量定为600 cGy,膀胱和直肠参考点剂量<360 cGy,设计并优化得到二维后装治疗计划。采用Pearson相关分析法对膀胱、直肠参考点剂量及OARs体积受量做相关性分析,利用线性回归方法得出膀胱、直肠参考点与其体积剂量的线性方程。结果 膀胱、直肠参考点剂量分别与其D_{1 cm³}、D_{2 cm³}、D_{5 cm³}和平均剂量显著正相关（r=0.559~0.668,P<0.05）;膀胱、直肠参考点剂量分别是其D_{2 cm³}的1.404和1.181倍;内外照射完成后膀胱、直肠D_{2 cm³}的相当于200 cGy分次等效生物剂量（EQD2）分别为8 410.0和6 827.0 cGy,均低于二者体积剂量限值。结论 利用膀胱、直肠参考点剂量能在一定程度上预测其体积剂量,对于满足膀胱、直肠参考点剂量低于处方剂量60%二维近距离后装计划,可将膀胱、直肠体积受量控制在相对安全的剂量范围内。而由于缺乏对小肠、乙状结肠剂量检测,二维后装计划在临床使用上仍然具有很大局限性。     

形变配准在宫颈癌近距离放疗分次间剂量评估中的可行性研究

目的:比较近距离放疗分次间靶区和正常组织在形变配准(DIR)和简单累加剂量体积直方图(DVH)情况下,累积剂量的剂量学差异,分析在宫颈癌三维近距离放疗计划中,形变配准技术应用于靶区和正常组织剂量评估的可行性。方法:回顾性选取13例宫颈癌近距离放疗病例,每个病例均进行了4次CT定位的近距离放疗。对每个病例的4次CT进行形...     

宫颈癌三维后装中膀胱体积对剂量分布影响的研究

目的探讨宫颈癌三维后装中膀胱体积对剂量分布的影响。方法选取我科181例次宫颈癌后装治疗患者,按膀胱体积大小排列,顺序分为8组,统计各组D90,V100,膀胱D0.1cc、D2cc,直肠D0.1cc、D2cc,对比各组间差异性。结果膀胱体积与D90、V100、直肠D2cc、直肠D0.1cc之间无相关影响。膀胱D2cc、D0.1cc方面,膀胱体积<30 cm3的剂量明显较低,30~60 cm3与60~90 cm3之间差异无统计学意义(P>0.05)。而膀胱体积>90 cm3时,剂量明显升高,且对膀胱D0.1cc、D2cc无明显相关影响。结论膀胱体积对D90、V100、直肠D2cc、直肠D0.1cc无相关影响,对膀胱D2cc、膀胱D0.1cc有一定影响。     

肛管直肠膀胱后尿道贯通伤的诊治

目的 探讨肛管直肠膀胱后尿道贯通伤的诊断与治疗。方法 回顾性总结1995年－2000年肛管直肠膀胱后尿道贯通伤12例，行肛管直肠膀胱伤口清创缝合，粪便尿液有效转流、充分骶前引流。结果 本组12例均治愈，其中2例术后并发骶前间隙感染，经充分引流而愈；1例肛门括约肌修补失败，行Ⅱ期修补治愈；1例发生直肠膀胱瘘，保守治疗而愈。无肛门狭窄、排尿困难、阳瘘等并发症。结论 掌握肛管直肠膀胱后尿道贯通伤的临床特点，及时作出准确诊断，选择合理的手术方案，加强围手术期治疗，是提高疗效的关键。     

结直肠、膀胱贯通伤的救治探讨

结直肠、膀胱器官虽然相邻,由于所处位置的特殊性,两器官同时损伤的机遇较少。我院从2004～2008年间,共收治结直肠、膀胱贯通伤52例,由于伤道深,探查难,易忽略,感染高,并发症多等特点,给救治工作增加难度。为总结经验,现将我院结直肠、膀胱贯通伤救治情况结合文献报道分析如下。     

三维适形放疗与容积调强放疗治疗局部晚期宫颈癌比较研究

目的探讨三维适形放疗(3D-CRT)及容积调强放疗(VMAT)剂量分割方案的改变对靶区覆盖指数以及危险器官受量的影响。方法选取辽宁省肿瘤医院放疗科自2017年6月至2018年12月收治的81例局部晚期宫颈癌患者为研究对象。根据外照射治疗方案选择不同将所有患者分为A组(n=39)和B组(n=42)。A组采用三维适形放疗联合三维近距离治疗;B组采用容积调强放疗联合三维近距离治疗。比较两组患者靶区剂量覆盖指数及危及器官(OAR)受量。结果 B组靶区适形度指数(CI)显著高于A组,两组比较,差异有统计学意义(P<0.05);两组患者靶区均不匀性指数(HI)比较,差异无统计学意义(P>0.05)。B组的膀胱、结直肠、小肠受量均显著低于A组,两组比较,差异均有统计学意义(P<0.05)。结论宫颈癌容积调强放疗联合三维近距离治疗与三维适形放疗联合三维近距离治疗均能得到较好的靶区覆盖,使肿瘤得到良好的局部控制,但容积调强放疗联合三维近距离治疗的膀胱、结直肠、小肠等OAR受量更低。临床上应根据患者实际情况选择使用。     

Comparative analysis of rectal dose parameters in image-guided high-dose-rate brachytherapy for cervical cancer with and without a rectal retractor

PurposeThe objective of this study was to determine if use of a rectal retractor (RR) in high-dose-rate intracavitary brachytherapy for cervical cancer reduces rectal dose parameters.Methods and MaterialsWe reviewed data obtained from patients treated with intracavitary brachytherapy for cervical cancer with and without an RR. Treatment plans for each brachytherapy fraction were separated into two groups; R group with use of an RR and P group with use of vaginal packing. Dose–volume parameters for high-risk clinical target volume (HR-CTV), rectum, sigmoid, small bowel, and vaginal surface were collected for each fraction. Rectal D_2cc and International Commission on Radiation Units & Measurements (ICRU) rectal point doses were compared between groups using Student's t tests. Predictors of higher rectal D_2cc were determined by univariate and multivariate regression analyses.ResultsFour hundred sixty-three brachytherapy fractions from 114 patients were used for analysis, 377 fractions with a RR (R group) and 86 with vaginal packing only (P group). Both groups were similar except for slightly higher mean HR-CTV and mean bladder volume in P group. Both mean ICRU rectal point dose (241.1 vs. 269.9 cGy, p = 0.006) and rectal D_2cc (240.6 vs. 283.6 cGy, p < 0.001) were significantly higher in P group. Point A dose, HR-CTV, stage, and use of an RR were significant predictors of rectal D_2cc on multivariate analysis.ConclusionsOur data show that use of an RR leads to lower rectal dose parameters compared with vaginal packing. Further study is needed to determine if this will lead to less long-term toxicity.     

Comparison between DVH-based doses and ICRU point-based doses to the rectum and the bladder using CT-based high-dose rate brachytherapy to the cervix

Traditionally, doses to the bladder and the rectum were quantified using the bladder and rectal reference points defined by the International Commission on Radiation Units and Measurements (ICRU) in Report No. 38. In this study, we compared the 0.1-, 1.0-, 2.0-cc doses to the bladder and the rectum with the corresponding ICRU point doses using computed tomography (CT)-based planning in the intracavitary brachytherapy of carcinoma of the cervix. CT datasets of 136 consecutive intracavitary brachytherapy insertions between January and May 2015 were analyzed. The bladder and the rectum were contoured on consecutive CT slices as per Groupe Europeen de Curietherapie and the European Socie Ty for Radiotherapy and Oncology recommendations. Dose volume histograms were generated and doses of 0.1, 1.0, and 2.0?cc to the bladder and the rectum were recorded. ICRU bladder and rectal points were identified in the treatment plan. Mean doses of 0.1, 1.0, and 2.0?cc to the bladder was found to be 2.02, 1.57, and 1.35 times the ICRU point dose, respectively. The maximum dose received by the bladder was found to be 5.83 times the average ICRU point dose. Mean doses of 0.1, 1.0, and 2.0?cc to the rectum were found to be 1.12, 0.90, and 0.78 times the ICRU rectal point dose, respectively. The maximum dose received by the rectum was 4.79 times the average ICRU point dose. The Pearson correlation coefficient value (r) was found to be 0.639 for D2cc and ICRU bladder point values. The Pearson correlation coefficient value was found to be 0.752 for D2cc and ICRU rectal point values. Our results show that the ICRU bladder points underestimated the dose to the bladder, which is in agreement with other studies. ICRU rectal point doses were higher than the corresponding D2cc doses. However, there was a good correlation between D2cc and ICRU point doses for both the bladder and the rectum.     

组织非均匀性对宫颈癌近距离治疗剂量评估影响研究

目的:比较近距离治疗两种临床常用的剂量计算方法和基于CT影像的蒙特卡罗程序计算的剂量差异,探讨组织非均匀性对宫颈癌近距离治疗剂量评估的影响。方法:回顾性选取2018年1月至2020年6月在安徽省肿瘤医院接受三维近距离治疗的宫颈癌患者11例,分别采用美国医学物理师协会(AAPM)TG43号报告的纯水剂量计算方法(TG43...     

胃镜引导插管小肠双对比造影方法研究

目的：探讨小肠双对比造影检查的有效方法。方法：72例受检者被随机分成2组；试验组(36例)应用研制的小肠造影导管，在胃镜直视下钳夹导管头端并送达十二指肠水平部，头端气囊充气固定导管，退出胃镜后，经导管灌注适量稀钡胶浆及空气行小肠双对比造影。对照组(36例)采用改进的F9心导管在透视下插管。结果：实验组插管成功35例(成功率97．1％)，对照组插管成功27例(成功率75％)。结论：研制专用的小肠造影导管并经胃镜引导插管行小肠双对比造影检查，其成功率明显高于普通插管方法。     

Gastrointestinal stromal tumor of the small intestine with lung metastasis

Gastrointestinal stromal tumours (GISTs) represent 1% of primary gastrointestinal cancers. These tumors most frequently metastasise to the liver and peritoneum and rarely to the lungs. We report the case of a 79-year-old woman with gastrointestinal stromal tumor of the small intestine and pulmonary metastases. Contrast-enhanced computed tomography (CT) revealed a focal mass centered around the last intestinal loop associated with pulmonary bilateral masses. The diagnosis of gist of the small bowel was confirmed by histopathological and immunohistochemical analyses of bioptic material obtained from CT guided biopsy of pulmonary lesions. To the best of our knowledge, only few cases had been reported in medical literature as This mode of presentation is unusual, with computed tomography (CT) playing a significant role in the diagnosis and management.     

Improving dose delivery by adding interstitial catheters to fixed geometry applicators in high-dose-rate brachytherapy for cervical cancer

PurposeImage-guided brachytherapy (IGBT) is an essential component of the treatment of locally advanced cervical cancer. Interstitial (IS) catheters are being increasingly used for bulkier tumors. We have retrospectively assessed the dosimetric impact of IS catheters.Methods and MaterialsAll patients who received IGBT for cervical cancer between August 2014 and February 2017 were identified. Clinical and dosimetric data were collected. Patients were grouped into the intracavitary (IC) cohort or the IC and IS implant (IC/IS) cohort. Ten patients who had been treated with IS catheters (IC/IS plan) had their brachytherapy replanned without IS catheters (IC plan). The total D₉₀% received by the high-risk clinical target volume (CTV_HR) and the D₂cm³ (minimum dose received by the most irradiated 2 cm³) to the bladder, bowel, sigmoid, and rectum were compared.ResultsForty-two patients received IGBT in this period. Seventy-four percent of patients were treated with IS catheters. Sixty-one percent of patients in the IC/IS cohort had CTV_HR volumes ≥30 cm³ at Fraction 1 compared to 18% in the IC cohort (p = 0.014). There was no difference in cumulative D₉₀% to CTV_HR between the IC/IS cohort and the IC cohort. The replanned brachytherapy showed that the cumulative CTV_HR D₉₀% was on average 5.8 Gy higher when IS catheters were used (mean CTV_HR D₉₀% 86.1 compared to 80.3 Gy, p < 0.001). The D₂cm³ to the organs at risk was not significantly increased.ConclusionsIS catheters allow the dose to the CTV_HR to be escalated significantly without increasing the dose to the bladder, bowel, sigmoid, and rectum in patients with bulky tumors.     

水凝胶在前列腺癌和宫颈癌放疗中对直肠的保护

放疗是前列腺癌和宫颈癌的重要治疗方法,但是有效治疗肿瘤的同时会造成周围危及器官损伤,以直肠损伤最为常见。有报道在前列腺癌和宫颈癌放疗中,将水凝胶注射在前列腺与直肠、阴道与直肠之间增加间隙距离,可以降低直肠照射剂量,减少发生放射性损伤的风险。本文就水凝胶在前列腺癌和宫颈癌放疗中的应用、对直肠等危及器官的保护以及生活质量的提高等进行综述。     

The 100 most cited articles in cervical cancer brachytherapy

PurposeThis study aimed to identify the 100 most cited research articles on cervical cancer brachytherapy.Methods and MaterialsThe Institute for Scientific Information Web of Science was used to identify the 100 most cited articles in cervical cancer brachytherapy as of July 5, 2019. The following important information was extracted: journal, year and month, country of region, author, type of article, type of dose rate, type of radionuclide, and image modality for brachytherapy planning.ResultsThe 100 most cited articles in cervical cancer brachytherapy were published between 1981 and 2016, and the citations ranged from 858 to 49, which collectively had been cited 11,372 times at the time of searching. The index of citations per year ranged from 63.56 to 1.43. These articles were from 16 countries or regions, with most publications being from the United States (n = 27), followed by Austria (n = 26), Japan (n = 10), France (n = 7), and the Netherlands (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 46), followed by Radiotherapy and Oncology (n = 39) and Gynecologic Oncology (n = 5). These articles were categorized as original studies (n = 75), reviews (n = 2), editorials (n = 2), surveys (n = 2), guidelines (n = 3), and recommendations (n = 6). A high dose rate (n = 69) was the most widely used, dose rate followed by a low dose rate (n = 20) and pulsed dose rate (n = 16).ConclusionsThe bibliometric analysis presents a detailed list of the 100 most cited articles in cervical cancer brachytherapy. This analysis provides an insight into historical developments and enables the important advances in this field to be recognized.     

Vaginal cuff brachytherapy in the adjuvant setting for patients with high-risk early-stage cervical cancer

PurposeTo evaluate local control and survival of high-risk patients with early-stage cervical cancer submitted or not to vaginal cuff brachytherapy in the postoperative setting.Methods and MaterialsIn this retrospective cohort of patients treated from 2010 to 2017, patients were eligible if they had confirmed histological diagnosis of cervical cancer treated with surgery and adjuvant radiotherapy with or without chemotherapy. Vaginal cuff brachytherapy (VCB) was indicated according to the radiation oncologist discretion.ResultsSeventy-nine patients were selected, with a median age at diagnosis of 47.5 years (26–77). Brachytherapy was delivered to 59 patients (74.7%). There were no significant differences between the VCB and the no-VCB groups. A total of 13 (16.5%) patients presented one or more events, 5 (25%) and 8 (13.5%) events in the no-VCB and VCB group, respectively. Most recurrences were pelvic and/or vaginal: 7/20 (35%) in the no-VCB group and 9/59 (10.2%) in the VCB group. There were eight systemic relapses with eight deaths. With a median followup of 45 months, mean overall survival and disease-free survival were, respectively, 85.1 and 83.8 months. No variables were correlated with overall survival. The only factor positively correlated to disease-free survival was VCB, with a mean of 86.9 and 68.4 months for patients who did and did not receive brachytherapy, respectively (p = 0.043). Vaginal recurrence was lower in the brachytherapy group, but with no statistical significance (p = 0.065).ConclusionVCB was associated with a reduced recurrence rate in the postoperative setting of high-risk patients with early-stage cervical cancer.