宫颈癌术后三维适形放射治疗膀胱受照射剂量的分析研究  

Analysis of the bladder dose in three dimensional conformal radiotherapy for postoperative treatment of cervical cancer

作　　者：董云[1] 任俊丽[2] 韩晓栋[2] 李莉莉[2] 范立[2] 

机构地区：[1]山西医科大学研究生学院,山西太原030001 [2]山西省肿瘤医院放疗五科,山西太原030013

出　　处：《中国现代医生》2012年第2期40-42,共3页China Modern Doctor

摘　　要：目的分别比较研究宫颈癌术后患者三维适形放射治疗(3D-CRT)膀胱与膀胱壁受照剂量的差异,探讨3D-CRT放疗计划中评估膀胱受照剂量的合理方法。方法选择FIG0分期Ia-Ⅱb期20例宫颈癌术后患者入组,在计划系统内勾画临床靶体积(CTV),将CTV在三维方向上均匀外放1cm获得计划靶区(PTV),同时勾画危及器官,单独勾画膀胱和膀胱壁,在ADAC Pinnacle3 Version 7.4f三维计划系统中设计3D-CRT治疗计划,并把膀胱和膀胱壁分别作为独立危及器官进行剂量评估。处方剂量为45Gy、50Gy,2Gy/次,要求95%PTV达到处方剂量。应用剂量体积直方图获得膀胱与膀胱壁的最大受量、最小受量、平均受量以及90%、70%、50%、40%、30%、10%、5%体积的受量(分别以D90、D70、D50、D40、D30、D10、D5表示),采用配对样本t检验进行比较,剂量参数用χ±s表示。结果 3D-CRT计划中,处方剂量45 Gy时膀胱与膀胱壁受照剂量的最大值、最小值、平均值、D5差别无统计学意义(P>0.05),膀胱与膀胱壁受照剂量的D90、D70、D50、D40、D30、D10差别有统计学意义(P<0.05),前者比后者分别低10.39%、10.51%、14.49%、14.60%、6.03%、3.46%;处方剂量为50Gy时,膀胱与膀胱壁受照剂量的最大值、最小值、D5差别无统计学意(P>0.05),膀胱与膀胱壁受照剂量的平均值、D90、D70、D50、D40、D30、D10差别有统计学意义(P<0.05),前者比后者分别低4.04%、7.75%、11.63%、12.62%、7.80%、4.41%、1.63%。结论从剂量学角度分析,三维适形放射治疗计划中以膀胱壁作为独立危及器官进行剂量评估较合理。Objective To analysis the difference of dose between bladder wall and bladder in three dimensional conformal radiotherapy（3D-CRT） plan, so as to provide the reliable method of evaluating the actual dose of bladder. Methods We selected twenty patients with stage IA- 11 B cervical cancer after hysterectomy. Eontouring clinical target volume （CTV） on the CT slices. CTV was then uniformly expanded by 1.0 cm to create the planning target volume （PTV）. Bladder and bladder wall was separately outlined for the organ at risk evaluation. The Pinnacle planning system version 7.4f was used to devel- op 3D-CRT plans,respectively. 95%of the PTV received The prescription dose 45Gy,50Gy. We used dose volume his- tograms （DVH） to compare the dose distribution in bladder and bladder wall. Results In 3D-CRT plan, on 45 Gy prescrip tion, there was no obvious difference in the most,the least, the mean and the D5 dose of bladder wall and bladder （P〉 0.05） while D90, D70, D50, 1）40, D30 and DIO of bladder was 10.39%, 10.51%,14.49%,14.60%,6.03%,3.46% lower than those of bladder wall,respectively （P〈0.05）. on 50 Gy prescription,there was no obvious difference in the most, the least and the D5 dose of bladder wall and bladder （P〉0.05） while mean, D90, D70, D50, D40, D30 and DIO of bladder was 4.04% ,7.75%, 11.63%, 12.62% ,7.80% ,4.41%, 1.63% lower than those of bladderwall, respectively （P〈0.05）. Conclusion Bladder wall should be separately outlined for the organ at risk evaluation in 3D-CRT plan.

关 键 词：宫颈癌 三维适形放射治疗 膀胱 剂量 

分 类 号：R737.33[医药卫生—肿瘤]