调强放射治疗在子宫颈癌治疗中的剂量学分析  

Dosimetric analysis of intensity-modulated radiotherapy in cervical carcinoma

作　　者：于长华[1] 朱卫国[1] 吉雅玲[1] 潘鹏[1] 韩济华[1] 李涛[1] 

机构地区：[1]江苏省淮安市第一人民医院 南京医科大学附属淮安第一医院肿瘤放射治疗科,223300

出　　处：《肿瘤研究与临床》2012年第3期179-181,185,共4页Cancer Research and Clinic

基　　金：淮安市科技局基金

摘　　要：目的比较调强放疗（IMRT）、三维适形放疗（3D．CRT）在子宫颈癌放疗中危及器官（OAR）的剂量学差异。方法对36例子宫颈癌患者均同时制定IMRT放疗计划和3D—CRT放疗计划，临床靶区（CTV）包括子宫、子宫颈、阴道等原发肿瘤区域及其以下的淋巴结引流区域。淋巴结引流区的勾画主要以盆腔伴行血管外放1．0cm得到，闭孔淋巴结从骨盆内缘内外扩1．8cm，CTV不包括骨盆组织。比较计划靶区（胛v）在45Cv和50Gy情况下各敏感组织的受照剂量一体积情况。PTV由CTV边界在三维头脚方向外放1．0cm，其他方向外放0．7cm得到。结果通过剂量体积直方图比较两组计划敏感组织的受照体积变化，在处方剂量45Gy剂量时，30、40、45Gy的敏感组织剂量体积IMRT计划均优于3D—CRT计划。在盆壁淋巴结引流区剂量达到50Gy时，IMRT计划敏感组织受量亦优于45Cy时3D—CRT计划。结论子宫颈癌IMRT可以使周围OAR得到较好的保护，具备临床应用的剂量学优势。Objective To compare the dosimetric difference on organ at risk （OAR） in intensity- modulated radiotherapy （IMRT） with three-dimensional conformal radiotherapy （3D-CRT） in treatment with cervical carcinoma. Methods 36 cases of cervical cancer patients accepted radiotherapy both on IMRT and 3D-CRT in the same time, clinical target volume （CTV） focused on primary tumor and its lymphatic drainage area. Lymphatic drainage area was determined as follows： 1.0 cm extension were added to the margin of pelvic vessels, the obturator lymph nodes region was extended by 1.8 cm from the pelvis inner margin. CTV does not include pelvic tissue. Data of dose distribution and irradiation volume of OAR on the basis of distributing on 45 Gy and 50 Gy were analyzed individually. The margins of planning target volume （PTV） was obtained based on CTV margins by which added 1.0 cm extension in inferior and superior directions,0.7 cm were added in all other directions. Results With the comparison of variety on irradiation volume of organs at risk （OAR） by DVH in both groups, underlying the treatment dose 45 Gy, the individual volume of D~, D40 and D45 were all lesser in IMRT plan than that of 3D-CRT plan. Even on the dose 50 Gy at pelvic wall lymph nodes regions, the volume of OAR was lesser than that in 3D-CRT plan. Conclusion In the radiotherapy of cervical cancer, IMRT should have improved protections for tumor surrounding OAR which has domestic superiority in clinical application.

关 键 词：子宫颈肿瘤 放射疗法 调强适形 放射治疗剂量 危及器官 

分 类 号：R730.55[医药卫生—肿瘤]