宫颈癌放疗中段取金属节育环的安全性研究  

Safety of taking out metal contraceptive ring during cervical cancer radiotherapy

作　　者：单蓉 朱婷 张敏[1] 周卫兵[1] SHAN Rong;ZHU Ting;ZHANG Min;ZHOU Weibing(Department of Oncology,Xiangya Hospital of Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院肿瘤科,湖南长沙410008

出　　处：《中国医学工程》2019年第8期31-35,共5页China Medical Engineering

摘　　要：目的通过分析金属节育器对宫颈癌容积调强放疗剂量及副反应的影响,探讨放疗中段取环是否更加安全。方法收集2017年7月至2018年5月在中南大学湘雅医院肿瘤科进行根治性放疗的宫颈癌带宫内金属节育环的患者10例。行增强定位CT后勾画靶区,包括大体肿瘤体积(GTV)、临床靶区(CTV)、计划靶区(PTV)及危及器官(直肠、膀胱、小肠和股骨头)。对每一位患者制定第一套容积弧形调强放射治疗(VMAT)计划(子宫带节育环),记录正常组织和PTV的剂量,以及靶区适形度指数(CI)和靶区剂量均匀性指数(HI);再将每一位患者节育环区域单独勾画,通过Varian Eclipse 8.6治疗计划系统假定为正常子宫密度,然后制定第二套VMAT计划,获得子宫不带节育环的VMAT计划,记录正常组织和PTV的剂量,以及CI和HI。进行PTV靶区及危及器官剂量比较。结果有节育环组与无节育环组CI及HI差异无统计学意义(P>0.05)。除两组最大剂量差异有统计学意义(P=0.024)以外,其余差异均无统计学意义(P>0.05)。无节育环组的膀胱、直肠及小肠的剂量与有节育环组比较差异无统计学意义(P>0.05)。另对比无节育环组10例患者与有节育环组10例患者的放疗毒副反应,差异无统计学意义(P=0.530)。结论金属宫内节育环对VMAT放疗的剂量分布和副反应与无节育环比较差异无统计学意义(P>0.05),提示等待放疗中段肿瘤缩小后取环,可避免治疗前取环时取环失败、肿瘤大出血等风险。【Objective】Through the analysis of the effect of the metal contraceptive ring on the dose and side effects of volumetric modulated arc therapy for cervical cancer,to explore whether it is more secure to take out the metal contraceptive ring during the process of radiotherapy.【Methods】Ten patients were collected from July 2017 to May 2018,in the Department of Oncology in Xiangya Hospital of Central South University,who underwent radical radiotherapy for cervical cancer with metal contraceptive ring.After enhanced positioning CT,the target area was outlined,including gross target volume(GTV),clinical target volume(CTV),planning target volume(PTV)and organs at risk(rectum,bladder,small intestine and femoral head).The first set of volumetric-modulated arc radiotherapy(VMAT)programs(with metal contraceptive ring)for each patient was developed,and the normal tissue and PTV doses,CI and HI were recorded;each patient's contraceptive ring area which alone outlined,is assumed to be normal uterine density through the Varian Eclipse 8.6 treatment planning system,and then the second set of VMAT programs for uterus without a contraceptive ring was made,at last,the normal tissue and PTV doses were recorded,as well as CI and HI.The dose of PTV and organs at risk were compared.【Results】There was no significant differences for CI and HI between the group with metal contraceptive ring and the group without(P>0.05).The difference for maximum dose between the two groups was statistically significant(P=0.04),the other differences were not statistically significant(P>0.05).In addition,when we compared the radiation toxicity in 10 patients without contraceptive ring and 10 patients with contraceptive ring,there was no significant differences between the two groups(P=0.530).【Conclusion】There was no significant difference in the dose distribution and side effects of VMAT radiotherapy in cervical cancer with or without metal contraceptive ring.It suggests that taking out the metal contraceptive ring after the tumor shrink d

关 键 词：宫颈癌 节育环 容积调强放疗 剂量学 

分 类 号：R737.33[医药卫生—肿瘤]