【摘要】 目的膀胱是一个体积可变的器官,膀胱状态对宫颈癌体外放射治疗有重要影响。本研究比较膀胱充盈与空虚状态对宫颈癌调强放射治疗计划临床靶体积、计划靶体积、危及器官受照体积剂量变化的影响。方法选取2014-12-01-2015-10-31昆明医科大学第三附属医院收治的自愿接受俯卧位调强放射治疗的21例初治ⅡB~ⅢB期宫颈癌患者为研究对象,比较膀胱充盈及排空状态下调强放射治疗计划临床靶体积(clinical target volume,CTV)、计划靶体积(planing target volume,PTV)及危及器官受照射体积剂量变化。结果膀胱不同状态,CTV、PTV及小肠、直肠、股骨头体积差异均无统计学意义,P>0.05。同一患者膀胱充盈较空虚状态,小肠平均受照射剂量降低,分别为(2 056.7±364.7)和(2 319.5±451.58)cGy,P<0.001;而直肠平均受照射剂量增加,分别为(4 663.7±68.94)和(4 621.6±54.86)cGy,P=0.039。同一患者膀胱充盈时,小肠各剂量段受照射体积百分比较膀胱排空时低,P<0.001;直肠45Gy受照射体积的百分比(V45)较膀胱排空时高,P=0.023;有淋巴结转移时,膀胱充盈较排空状态,小肠V45降低(P<0.001)而直肠V45升高(P=0.04),膀胱V45差异无统计学意义(P=0.053);无淋巴结转移时,膀胱充盈较排空状态,小肠和膀胱V45均降低(P值分别为0.002和0.01),直肠V45差异无统计学意义,P=0.275。结论ⅡB~ⅢB宫颈鳞癌患者俯卧位行根治性调强放射治疗,膀胱充盈状态可减少小肠照射剂量,对小肠起一定保护作用。有盆腔淋巴结引流区照射时,膀胱充盈状态虽然可降低小肠受照剂量,但同时增加直肠受照剂量。更多还原

【Abstract】 OBJECTIVE The purpose of this study was to compare the IMRT plan based on full bladder with that on empty bladder for cervical cancer,in term of the volume of CTV,PTV and dose-volume parameters of organs at risk.METHODS From December 1st,2014 to October 31 th,2015,21 patients with cervical cancer in the Third Affiliated Hospital of Kunming Medical University who were willing to be treated with IMRT by prone position were selected for this study.IMRT treatment plans were conducted on CT images with full and empty bladder respectively.Data were collected to compare the differences of the volume of CTV,PTV and the percentage of irradiated volume of bladder,small bowel,rectum and femoral heads between full and empty bladder.RESULTS The volume of CTV,PTV,small bowel,rectum and femoral heads had no significant differences between full bladder and empty bladder(P>0.05).The mean radiation doses of small bowel in filling bladder were significantly lower than that in empty bladder(P<0.05),while the mean radiation dose of rectum in full bladder was higher than that in empty bladder(P<0.05).The percentage of irradiated volume of small bowel was lower with full bladder than those with empty bladder(P<0.001),while the percentage of irradiated volumes received 45Gy(V45)of rectum were higher with full bladder(P<0.05).Data with pelvic and para-aortic lymph node metastasis showed that with full bladder,the V45 of small bowel was lower(P<0.001)while V45 of rectum elevated(P=0.04).Data without lymph node metastasis indicated that V45 of small bowel and bladder were lower with full bladder than those with empty bladder(P=0.002,P=0.01),and no differences were showed in V45 of rectum(P=0.275).CONCLUSIONS IMRT with full bladder by prone position for cervical cancer reduces the percentage of irradiation volume of intestine.For patients with pelvic and para-aortic lymph node metastasis,although IMRT with a filling bladder may reduce the percentage of irradiated volume of intestine,but it also increases the percentage of irradiated volume of rectum.更多还原