插植针植入棒在妇科肿瘤术后残端近距离腔内放疗的应用  

Clinical application of new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytheraypy after hysterectomy for gynecological cancer

作　　者：凌宝珍 麦苗青[1] 曹新平[1] 叶伟军[1] 欧阳翼[1] 郭旋 Ling Baozhen;Mai Miaoqing;Cao Xinping;Ye Weijun;Ouyang Yi;Guo Xuan(Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心放疗科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州51006

出　　处：《中华放射肿瘤学杂志》2022年第7期622-627,共6页Chinese Journal of Radiation Oncology

摘　　要：目的探讨自制插植针植入棒施源器在妇科肿瘤术后阴道残端近距离腔内放疗的可行性和安全性,评估其临床应用价值。方法收集中山大学肿瘤防治中心收治的妇科肿瘤术后患者62例,所有患者均有术后放疗指征,需接受三维近距离后装放疗补量。根据患者阴道残端情况选用不同型号插植针植入棒模板,依照预设通道在模板内放置阴道管和插植针。按照统一标准勾画靶区及危及器官,制定放疗计划,高危临床靶区(HR-CTV)处方剂量为5.5 Gy/次,通过剂量体积参数图评估靶区和危及器官体积、受照剂量等参数。结果62例患者均在插植针植入棒模板引导下顺利完成后装放疗,共行140次插植治疗,剂量参数HR-CTV包绕90%靶区体积的平均剂量D_(90%)为(575.48±22.30)cGy,包绕膀胱、直肠、乙状结肠2 cm^(3)体积的平均剂量D_(2cm^(3))分别为(328.69±102.71)cGy、(369.14±46.59)cGy、(27.28±71.27)cGy,小肠未进入靶区照射范围无统计,靶区体积大小、危及器官剂量之间的差异具有统计学意义(P<0.05)。结论插植针植入棒施源器在妇瘤术后残端近距离腔内放疗有明显临床优势,满足预计划剂量要求,操作简易,具有良好应用前景。Objective Investigate the safety and feasibility of using the new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer,and to explore the clinical value of the self-designed implanting applicator.Methods Sixty-two gynecological cancer patients who underwent brachytherapy in Sun Yat-sen University Cancer Center were selected in this study.Each patient received three-dimensional intracavitary brachytherapy because of the indication of postoperative radiotherapy.Each patient was treated with different types of self-designed implanting applicators according the condition of postoperative vagina,and the vaginal tube and implant needle were placed in the template according to the preset channnel.Based on the actual CT images,the high-risk clinical target volume(HR-CTV),and organs at risk were defined according to unified target area delineation criteria and then the brachytherapy plan was conducted.The prescription dose of high-risk clinical target volume(HR-CTV)was 5.5 Gy/time.The parameters such as target area,organs at risk volume and irradiated dose were evaluated by DVH diagram.Results Sixty-two patients successfully completed brachytherapy under the guidance of self-designed implanting applicator.A total of 140 implantation treatments were performed.The total average dose of HR-CTV D_(90%)was(575.48±22.30)cGy,the mean dose D_(2cm^(3))of bladder,rectum and sigmoid colon were(328.69±102.71),(369.14±46.59)and(27.28±71.27)cGy,the small intestine did not drop the target area,so there was no statistics.There was statistical significance between target volume and organs at risk dose(P<0.05).Conclusions The new self-designed implanting applicator has obvious clinical advantages in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer,meets the requirements of the preset planning dose,and it is sample to operate and highly safe,which indicated a bright future of the clinical application.

关 键 词：腔内放疗 施源器 妇科肿瘤 

分 类 号：R737.3[医药卫生—肿瘤]