局部晚期宫颈癌三维适形近距离放疗 CT与 MRI 定位的对比研究  

A comparative study of CT-and MRI-based three-dimensional conformal brachytherapy for locally advanced cervical cancer

作　　者：朱永刚[1] 赵红福[1] 程光惠[1] 何明远[1] 施丹[1] 赵志鹏[1] 

机构地区：[1]吉林大学中日联谊医院放疗科,长春130000

出　　处：《中华放射肿瘤学杂志》2015年第4期408-413,共6页Chinese Journal of Radiation Oncology

基　　金：吉林省科技厅项目（20090458）;吉林大学白求恩医学科研支持计划一前沿交叉学科创新项目（2013107024）;吉林省卫生计生委项目（2014ZC054）;国家自然科学基金项目（81201737）

摘　　要：目的：比较 CT 与 MRI 图像引导的局部晚期宫颈癌三维适形近距离放疗靶区及剂量学的差异，为优化影像引导方式及改进治疗方案提供依据。方法2014年本院行宫颈癌根治性放疗的局部晚期患者13例，均行外照射＋MRI 引导三维适形腔内＋插植近距离治疗。每次后装均实施 MRI和 CT 扫描，并分别进行靶区勾画、腔内＋插植和模拟去除插植针单纯腔内治疗计划设计。对两组扫描数据进行配对 t 检验。结果 MRI 比 CT 的高危 CTV 的宽度、体积小[（38．0±9.4） mm ∶（45．1±8.7） mm （P＝0.000）、（34．2±15.3） cm3∶42．9±20.4 cm3（P＝0.002）]，中危 CTV 的宽度、厚度、体积也小[（58．8±9.4） mm ∶（65．4±10.3） mm （ P＝0.000）、（34．8±6.3） mm ∶（37．5±6.3） mm （ P＝0.001）、（90．9±28.5） cm3∶（109．0±36.4） cm3（P＝0.000）]。 MRI 较 CT 的高危、中危 CTV 的 D90％均增高[87.6 Gy ∶85.8 Gy （P＝0.013）、67.7 Gy ∶66.3 Gy （P＝0.005）]，而膀胱、直肠 D2 cm3均降低[73.1 Gy ∶75.5 Gy （P＝0.011）、61.0 Gy ∶65.7 Gy （P＝0.000）]。结论 CT 比 MRI 定位过度评估靶区宽度；应用 MRI 定位靶区和正常组织剂量有明显优势；腔内＋插植可弥补 CT 引导造成的靶区剂量下降。Objective To compare target volume and dosimetry between computed tomography （CT）.and magnetic resonance imaging （MRI）.guided three.dimensional （3D） conformal brachytherapy for locally advanced cervical cancer, and to provide evidence for optimization of the image.guided approach and improvement of treatment regimen. Methods Thirteen patients with locally advanced cervical cancer who were treated with radical radiotherapy in our hospital in 2014 were enrolled as subjects. All patients received MRI.guided 3D conformal intracavitary/ interstitial brachytherapy. All patients received MRI and CT scans for each brachytherapy fraction, based on which the target volume delineation, intracavitary/ interstitial regimen design, and intracavitary.only treatment regimen design were performed. Comparison of data between MRI and CT scans was performed using paired t test. Results The width and volume of the high.risk clinical target volume （ HR.CTV） were significantly smaller in the MRI simulation than in the CT simulation （（38.0±9. 4） mm vs. （45.1±8. 7） mm, P= 0. 000;（34.2±15. 3） cm3 vs. （42.9±20. 4） cm3 , P= 0. 002）, and the width, thickness, and volume of the intermediate.risk clinical target volume （IR.CTV） were also significantly smaller in the MRI simulation than in the CT simulation （（58.8±9. 4） mm vs. （65.4±10. 3） mm, P= 0. 000;（34.8±6. 3） mm vs. （37.5±6. 3） mm, P= 0. 001;（90.9±28. 5） cm3 vs. （109.0±36. 4） cm3 , P= 0. 000）. The D90 values for HR.CTV and IR.CTV were significantly higher in the MRI simulation than in the CT simulation （87. 6 Gy vs. 85. 8 Gy, P= 0. 013;67. 7 Gy vs. 66. 3 Gy, P= 0. 005）, while the average D2 cm3 values for the bladder and rectum were significantly lower in the MRI simulation than in the CT simulation （ 73. 1 Gy vs . 75. 5 Gy , P= 0. 011 ; 61. 0 Gy vs . 65. 7 Gy , P= 0. 000 ） . Conclusions Compared with the MRI simulation, the CT simulation overestimates the width of target volume. MRI has substantial adva

关 键 词：宫颈肿瘤 图像引导近距离放射疗法 靶区勾画 剂量学 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]