不同HR-CTV下单纯腔内治疗与腔内联合组织间插植治疗在宫颈癌三维后装治疗中的对比研究  

Comparative study of intracavitary therapy and combined intracavitary/interstitial therapy in different HR-CTV in three-dimensional brachytherapy for cervical cancer

作　　者：贺先桃 陈绍俊[1] 谭军文 李钢 冯永富 龙雨松[1] He Xiantao;Chen Shaojun;Tan Junwen;Li Gang;Feng Yongfu;Long Yusong(Department of Oncology,the Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)

机构地区：[1]广西医科大学第四附属医院肿瘤科,柳州545005

出　　处：《国际放射医学核医学杂志》2022年第5期290-297,共8页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：广西重点研发计划项目(2021AB12004);柳州市重点研发计划项目(2018BJ10505)。

摘　　要：目的研究不同高危临床靶体积(HR-CTV)下单纯腔内治疗与腔内联合组织间插植(腔内+插植)治疗技术在宫颈癌三维后装治疗中的剂量学差异,并探讨HR-CTV是否存在阈值。方法回顾性分析2019年10月至2021年2月于广西医科大学第四附属医院接受根治性放疗的100例中晚期宫颈癌患者的临床资料,年龄35~63岁,中位年龄51岁。根据后装治疗技术不同将患者分为单纯腔内治疗组(45例)、腔内+插植治疗组(55例)。按患者每个计划的HRCTV大小分为6个体积范围进行分析,即HR-CTV≤40 cm^(3)、40 cm^(3)<HR-CTV≤50 cm^(3)、50 cm^(3)<HR-CTV≤60 cm^(3)、60 cm^(3)<HR-CTV≤70 cm^(3)、70 cm^(3)<HR-CTV≤80 cm^(3)、HR-CTV>80 cm^(3)。采用独立样本t检验比较2种后装治疗技术在不同体积范围内的靶区和危及器官(OAR)的剂量学参数。结果当HR-CTV≤40 cm^(3)时,单纯腔内治疗组的靶区剂量(D90、D100)、靶区覆盖度(V100)及靶区高量(D50、V_(150)、V_(200))均高于腔内+插植治疗组,且差异均有统计学意义(t=2.826~3.927,均P<0.05),但靶区适形指数(CI)、OAR膀胱和直肠D2 cm^(3)(2 cm^(3)的OAR体积接受的最低照射剂量)的差异均无统计学意义(t=0.186、1.871、0.258,均P>0.05)。当70 cm^(3)<HR-CTV≤80 cm^(3)和HR-CTV>80 cm^(3)时,腔内+插植治疗组的靶区剂量(D90、D100)、靶区覆盖度(V100)、CI、OAR直肠和膀胱D2 cm^(3)剂量均显著优于单纯腔内治疗组,且差异均有统计学意义(t=−6.872~3.782,均P<0.05),而2种治疗技术的靶区高量(D50、V_(150)、V_(200))相近,差异无统计学意义(t=0.613~1.918,均P>0.05)。当40 cm^(3)<HR-CTV≤70 cm^(3)时,2组的靶区剂量(D90、D100)、靶区覆盖度(V100)以及直肠D2 cm^(3)的差异均无统计学意义(t=−1.759~0.710,均P>0.05),但腔内+插植治疗组的CI显著优于单纯腔内治疗组,且差异均有统计学意义(t=−2.590、−4.577、−3.144,均P<0.05)。结论对于小体积靶区(≤40 cm^(3)),单纯腔内治疗技术在不增�Objective To study the dosimetric differences between intracavitary therapy and combined intracavitary/interstitial therapy in three-dimensional brachytherapy for cervical cancer at different high-risk clinical target volumes(HR-CTV)and to explore whether HR-CTV has a threshold value.Methods The clinical data of 100 patients with advanced cervical cancer who received radical radiotherapy in the Fourth Affiliated Hospital of Guangxi Medical University from October 2019 to February 2021 were retrospectively analyzed.The age range was 35–63 years,with a median age of 51 years.According to different brachytherapy techniques,the patients were divided into two groups:intracavitary therapy group(45 cases)and intracavitary/interstitial therapy group(55 cases).According to the size of HR-CTV of each plan of a patient,the volume interval of 10 cm^(3)was used and divided into six volume ranges for analysis,namely,HR-CTV≤40 cm^(3),40 cm^(3)<HR-CTV≤50 cm^(3),50 cm^(3)<HR-CTV≤60 cm^(3),60 cm^(3)<HR-CTV≤70 cm^(3),70 cm^(3)<HR-CTV≤80 cm^(3),HR-CTV>80 cm^(3).Independent sample t-test was used in comparing the target dose(D90 and D100),target coverage(V100),target high dose(D50,V_(150),and V200),target conformity index(CI),and D2 cm 3 of organ at risks(OAR)(bladder,rectum,sigmoid colon,and small intestine)of the two brachytherapy techniques in various volume ranges.Results When HR-CTV≤40 cm^(3),the target dose(D90 and D100),target coverage(V100),and high dose of target(D50,V_(150),and V200)in the intracavitary group were higher than those in the intracavitary/interstitial therapy group,and the differences were statistically significant(t=2.826–3.927,all P<0.05),but no significant difference in CI and D2 cm^(3)(mininum radiation dose received by the OAR volume of 2 cm^(3))of the bladder and rectum(t=0.186,1.871,0.258;all P>0.05).When 70 cm^(3)<HR-CTV≤80 cm^(3)and HR-CTV>80 cm^(3),the target dose(D90 and D100),target coverage(V100),and CI and D2 cm 3 of rectum and bladder in the intracavitary/interstitial group wer

关 键 词：宫颈肿瘤 三维后装治疗 腔内治疗 组织间插植治疗 高危临床靶体积 剂量学 

分 类 号：R737.33[医药卫生—肿瘤]