多通道施源器用于晚期宫颈癌三维腔内放疗的剂量学研究  

Dosimetric impacts of multichannel applicator in three-dimensional brachytherapy for advanced cervical carcinoma

作　　者：雷呈志[1] 黄曼妮[1] 徐英杰[2] 安菊生[1] 熊随阳 戴建荣[2] 吴令英[1] 

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院妇瘤科,北京100021 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2017年第4期414-418,共5页Chinese Journal of Radiation Oncology

基　　金：北京希望马拉松专项基金资助（LC2014A09）

摘　　要：目的 探讨中晚期宫颈癌三维后装腔内放疗中三通道施源器的通道设计与OAR、靶区剂量间关系.方法 调取2015-2016年我院三维腔内治疗的15例中晚期宫颈癌数据,其中30次“阴道卵形两半球＋宫腔管”的三通道施源器剂量参数纳入研究.在原靶区和OAR勾画、处方剂量不变基础上保留宫腔管单通道施源器,重新进行三维腔内照射设计的剂量参数作为对照组,配对t检验两组OAR剂量参数.结果 三通道、单通道施源器组直肠D2cc分别为（387.8±96.8）、（340.8±88.1）cGy;两组膀胱和乙状结肠D2cc分别为（443.2±87.5）、（719.4±243.0） cGy和（330.3±88.8）、（383.1±105.6） cGy.三通道组满足直肠（D2cc≤500 cGy）、膀胱（D2cc≤550 cGy）和乙状结肠（D2cc≤500 cGy）计划限量,单通道组膀胱和乙状结肠D2cc受量分别为大于和部分大于计划限量.单通道组膀胱和乙状结肠D2cc受量高于三通道组（P均＜0.05）.结论 宫颈癌三维腔内放疗中“阴道卵形两半球＋宫腔管”三通道施源器比宫腔管单通道可有效降低膀胱和乙状结肠受量,有利于计划优化和剂量实施.Objective To investigate the relationship between the channel design of tandem-andovoid （T＆O） applicator and the doses to organs at risk （OARs） and target volume in three-dimensional brachytherapy for advanced cervical carcinoma.Methods The data on 15 patients with advanced cervical carcinoma treated with three-dimensional brachytherapy in our hospital from 2015 to 2016 were collected,and 30 randomly selected high-dose-rate titanium T＆O plans were retrospectively studied.CT-guided,conformal brachytherapy plans were generated.To simulate T＆O applicator,the tandem applicator was virtually compared with the T＆O plans with the target volume and OARs remaining unchanged.The DVH parameters of the rectum,bladder,and sigmoid were compared using the paired t test.Results For T＆O plans and tandem applicator plans,the mean D2cc of the rectum was 387.8±96.8 cGy and 340.8±88.1 cGy,respectively;the mean D2cc of the bladder was 443.2± 87.5 cGy and 719.4± 243.0 cGy,respectively;the mean D2cc of the sigmoid was 330.3±88.8 cGy and 383.1±105.6 cGy,respectively.In the T＆O plans,the doses to the rectum,bladder,and sigmoid were within the limits （rectum：D2cc ≤ 500 cGy;bladder：D2cc ≤ 550 cGy;sigmoid：D2c ≤ 500 cGy）,while D2cc of the bladder and sigmoid was higher or partially higher than the limits.T＆O plans showed a significant reduction in bladder D2cc and sigmoid D2cc compared with the tandem applicator plans （all P＜0.05）.Conclusions Compared with tandem applicator plans,plans using T＆O applicator provide significant sparing of bladder and sigmoid tissues in three-dimensional brachytherapy for cervical carcinoma,but the toxicities require further investigation.

关 键 词：宫颈肿瘤/三维腔内放疗 腔内施源器 剂量学 

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