CT引导下局部晚期宫颈癌组织间插植近距离治疗剂量学分析  

CT-guided interstitial brachytherapy for locally advanced cervical cancer：introduction of the technique and report of dosimetry

作　　者：刘忠山[1] 赵杨祉[2] 郭杰[1] 林霞[1] 路双臣[1] 王红勇[1] 邱玲[1] 李云峰[1] 任晓俊[1] 张冰雅 王铁君[1] 

机构地区：[1]吉林大学附属第二医院肿瘤放疗科,长春130041 [2]吉林大学附属第一医院肿瘤中心,长春130021

出　　处：《中华放射肿瘤学杂志》2017年第5期550-554,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨CT引导下组织间插植近距离治疗对局部晚期宫颈癌靶区及周围正常组织剂量学优势,提供一种简单、有效的临床治疗方式.方法 共纳入52例经体外放疗后肿瘤消退不明显、剩余肿瘤仍〉5 cm的局部晚期宫颈癌患者.应用宫腔管和自由金属针组成的＂混合＂施源器对患者进行CT引导下组织间插植近距离治疗.勾画高危CTV （HR-CTV）、中危CTV （IR-CTV）及OAR.将体外照射与近距离治疗的EQD2相加.评价HR-CTV和IR-CTV的D90、D100及膀胱、直肠及乙状结肠的D2 cc值.结果 HR-CTV的D90平均值为（88.4±3.5） Gy.膀胱、直肠、乙状结肠的D2 cc分别为（81.1±5.6）、（65.7±5.1）、（63.1±5.4） Gy.100%患者膀胱、乙状结肠的D2 cc≤90、≤70 Gy,89%患者直肠的D2 cc≤70 Gy.结论 CT引导下组织间插植近距离治疗对局部晚期宫颈癌有明显剂量学优势,临床或许可行,但远期疗效及不良反应尚待进一步观察.Objective To examine the dosimetric advantages of three-dimensional （3D） computed tomography （CT）-guided interstitial brachytherapy （BT） for target volume and surrounding normal tissue in patients with locally advanced cervical cancer,and to provide a simple and effective clinical treatment approach.Methods A total of 52 patients who had poor tumor response to external beam radiotherapy （EBRT） with a residual tumor greater than 5 cm at the time of BT were included.The patients were treated by 3D CT-guided interstitial BT using a ＂hybrid＂ applicator comprised of uterine tandem and free metal needles.The high-risk clinical target volume （HR-CTV）,intermediate-risk clinical target volume （IR-CTV）,and organs at risk （OAR） were contoured.The total dose,including external beam radiotherapy and high dose-rate BT,was biologically normalized to conventional 2 Gy fractions （EQD2）.D90and D100for both HR-CTV and IR-CTV,and D2 ccfor the bladder,rectum,and sigmoid were analyzed.Results The mean D90value for HR-CTV was 88.4±3.5 Gy.The D2 ccfor the bladder,rectum,and sigmoid were 81.1±5.6,65.7±5.1,and 63.1±5.4 Gy,respectively.D2 cc≤90 Gy for the bladder and D2 cc≤70 Gy for the sigmoid were observed in all the patients.D2 cc≤70 Gy for the rectum was observed in 89% of patients.Conclusions 3DCT-guided interstitial BT has a significant dosimetric advantage for target volume accompanied by few minor complications,and thereby may be clinically feasible for treating locally advanced cervical cancer.However,its long-term efficacy and possible toxicities will require further clinical observation.

关 键 词：宫颈肿瘤/组织间插植近距离疗法 体层摄影术 X线计算机 引导 剂量学 

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