儿童阴道横纹肌肉瘤60 Co高剂量率三维后装治疗应用价值研究  

Significance of 60 Co high-dose-rate three-dimensional brachytherapy in treatment of pediatric vaginal rhabdomyosarcoma

作　　者：查元梓[1] 陆冬青[1] 张松方[1] 蒋马伟[1] Zha Yuanzi Lu Dongqing Zhang Songfang Jiang Mawei(Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical School, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院肿瘤科,200092

出　　处：《中华放射肿瘤学杂志》2016年第11期1214-1217,共4页Chinese Journal of Radiation Oncology

摘　　要：目的：探讨60 Co高剂量率三维后装在儿童阴道横纹肌肉瘤放疗中的应用流程，并从剂量学角度分析可行性。方法选取5例已行儿童阴道横纹肌肉瘤放疗患儿CT定位图像，分别设计3种治疗计划：计划A为3DCRT外照射，计划B为后装治疗，计划 C为后装治疗联合外照射。根据EQD2评估CTV和OAR剂量学参数并单因素方差分析。结果与计划 A相比，计划 C的 CTV的D90、D50、Dmean更高（P＝0.00），直肠、膀胱和股骨头剂量低，卵巢剂量略高（P＝0.00）。与计划B相比，计划C的CTV 的D90更高，D50、Dmean较低，卵巢剂量较低，直肠、膀胱和股骨头剂量略高。计划B的直肠、膀胱D2 cm3最低。结论儿童阴道横纹肌肉瘤的放疗需根据原发肿瘤位置及手术后是否残留选择合适的治疗方式。 CT引导的60 Co高剂量率三维后装治疗方式流程简单快捷，患儿耐受性好，靶区剂量高，正常组织保护好。Objective To explore the treatment procedure of pediatric vaginal rhabdomyosarcoma （ RMS） using 60 Co high.dose.rate three.dimensional （ 3D ） brachytherapy, and to analyze its dosimetric feasibility. Methods Computed tomography （ CT ） images were collected from five children undergoing radiotherapy for vaginal RMS. Three treatment plans were designed：plan A using 3D conformal radiotherapy with external beam irradiation, plan B using brachytherapy, and plan C using brachytherapy combined with external beam irradiation. Dosimetric parameters for clinical target volume （ CTV ） and organs at risk （ OARs ） were evaluated based on EQD 2 and analyzed using one . way analysis of variance . Results Compared with plan A, plan C had significantly larger D90, D50, and Dmean for CTV （ all P=0.00）, significantly lower doses to the rectum, bladder, and femoral head, and a significantly higher dose to the ovary （ all P=0.00） . Compared with plan B, plan C had a larger D90 for CTV, smaller D50 and Dmean for CTV, a lower dose to the ovary, and higher doses to the rectum, bladder, and femoral head. Among the three plans, plan B had the smallest D2 cm3 for the rectum and bladder. Conclusions The optimal radiotherapy plan for pediatric vaginal RMS should be based on the primary tumor location and residual tumor after surgery. CT image.guided 60 Co high.dose.rate 3D brachytherapy is convenient, effective, and well tolerated by children. It also achieves a high dose to CTV as well as good protection of normal tissue.

关 键 词：阴道横纹肌肉瘤/放射疗法 阴道横纹肌肉瘤/近距离疗法 剂量学 

分 类 号：R737.34[医药卫生—肿瘤]