锎-252中子内照射治疗宫颈癌时直肠和膀胱受量与晚期放射性并发症的相关性  

Dose-correlated late rectum and bladder complications following ^(252)Californium neutron intracavitary brachytherapy for cervical cancer

作　　者：杨梅[1] 张杨[1] 雷新[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肿瘤中心,重庆400042

出　　处：《第三军医大学学报》2016年第24期2652-2655,共4页Journal of Third Military Medical University

摘　　要：目的观察锎-252中子内照射治疗宫颈癌时直肠和膀胱受量与晚期放射性并发症(直肠炎和膀胱炎)的相关性。方法选取2007年1月至2010年8月采取锎-252中子内照射治疗的286例宫颈癌患者作为研究对象。给予A点剂量10 Gy/f×4f,总量为40 Gy,分别确定直肠前壁和膀胱后壁的最大受量,测量直肠和膀胱最大受量参考点与宫腔施源器中心点之间的距离。以记录的4次内照射时直肠和膀胱最大受量值的平均值高低为标准把患者分为高、中、低剂量组;观察严重(≥G2级)晚期放射性直肠炎和膀胱炎的发生率。结果直肠最大受量点和宫腔施源器中心的距离是随着放疗时治疗次数的增加而增加,呈正相关关系(r=0.990,P<0.05),而直肠受量是随着放疗时治疗次数的增加而降低,呈负相关关系(r=-0.959,P<0.05);膀胱最大受量点和宫腔施源器中心的距离以及膀胱受量与放疗时治疗次数没有相关关系。直肠高、中、低剂量组严重晚期放射性直肠炎发生率分别为13.2%(12/91)、2.0%(2/100)和1.1%(1/95),3组间比较差异均有统计学意义(P<0.01),膀胱高、中、低剂量组晚期放射性膀胱炎发生率分别为4.2%(6/143)、2.6%(2/77)和4.5%(3/66),3组间比较差异无统计学意义(P=0.270)。结论通过监测锎-252中子内照射时直肠和膀胱受量的高低,可预测晚期放射性直肠炎和膀胱炎的发生情况。Objective To determine the correlation of radiation dose to late side effects in rectum （proetitis） and bladder （cystitis） following the 252Californium （2s2 Cf） neutron intracavitary braehytherapy （ICBT） combined with external beam radiotherapy （EBT） in patients with cervical cancer. Methods A total of 286 cervical cancer patients treated by 252Cf neutron ICBT combined with EBT between January 2007 and August 2010 were enrolled into this study. A total dose of 40 Gy （10 Gy per fraction x 4 fractions） was given at point A to determine the maximum dose delivered to the rectal anterior and bladder posterior walls. The distance from the maximum dose point of rectum and bladder to tandem center was measured, respectively. Furthermore, all patients were divided into high-, moderate- and low-dose groups according to the dose they received in comparison to the reference maximum radiation dose. The incidence of severe （≥grade 2 ） late radiation-induced proctitis and cystitis was observed. Results In rectum, the distance between the maximum dose point and the center of intrauterine applicator was positively correlated to increased number of treatment （ r = 0. 990, P 〈 0. 05 ）, whereas a negative correlation was deciphered between the radiation dose and treatment number （ r = - 0. 959, P 〈 0.05 ）. No such correlation was found in the bladder. The incidences of late radiation-induced proctitis for high-, moderate- and low-dose groups were 13.2%,2.0%,and 1.1%. The difference among groups was statistically significant（P〈0.01）.Correspondingly, the incidences of late radiation-induced cystitis were 4.2%,2.6%, and 4.5%,without significant difference （P=0.270）.Conclusion The incidences of late radiation proctitis and cystitis can be predicted through monitoring the delivered radiation dose to rectum and bladder by 252 Cf neutron ICBT.

关 键 词：宫颈癌 锎-252中子内照射 直肠受量 放射性直肠炎 放射性膀胱炎 

分 类 号：R730.55[医药卫生—肿瘤] R735.37[医药卫生—临床医学]