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作 者:成坚强 安永伟[1] 陶娜[1] 牛瑞军 魏玺仪[1] 张春林[1] 高力英[1] 魏世鸿[1] CHENG Jianqiang;AN Yongwei;TAO Na;NIU Ruijun;WEI Xiyi;ZHANG Chunlin;GAO Liying;WEI Shihong(Department of Radiation Oncology,Gansu Provincial Cancer Hospital,Lanzhou 730050,China)
出 处:《中国医学物理学杂志》2022年第10期1199-1203,共5页Chinese Journal of Medical Physics
基 金:中华国际医学交流基金会肿瘤精准放疗星火计划(2019-N-11-17);甘肃省科技厅重点研发项目(20YF3FA017)。
摘 要:目的:基于三维后装不同模式近距离治疗方案,分析研究不同技术后装治疗过程中靶区和危及器官(OARs)的物理剂量差异。方法:选取72例宫颈癌患者进行回顾性分析,根据施源器的不同模式分为以下3类:常规三维腔内治疗(ICBT)组、徒手插植(ISBT)组和3D打印阴道塞(3DP-ISBT)组。分析不同组别的OARs受量情况。结果:ISBT组平均4根插植针,3DP-ISBT组平均6根插植针,3D打印阴道塞针数多于徒手插植针数量,差异有统计学意义(P<0.001)。3组两两比较,HR-CTV靶区剂量D_(90)和HR-CTV靶区体积差异均没有统计学意义(P>0.05)。以ICBT组作为对照,膀胱受量(D_(0.1 cc)、D_(1 cc)和D_(2 cc))ISBT组和3DP-ISBT组均显著低于ICBT组(P<0.01),但是ISBT组和3DP-ISBT组之间差异没有统计学意义(P=0.993)。直肠D_(0.1 cc)、D_(1 cc)和D_(2 cc)3组之间差异没有统计学意义。以ICBT组作为对照,小肠受量(D_(0.1 cc)、D_(1 cc)和D_(2 cc))ISBT组和3DP-ISBT组显著低于ICBT组(P<0.01)。ISBT组和3DP-ISBT组比较,小肠D_(0.1 cc)、D_(1 cc)和D_(2 cc)3DP-ISBT组显著低于ISBT组(P<0.01)。结论:通过分析3种近距离治疗模式的OARs受照剂量情况,ISBT技术相比ICBT技术在保护膀胱和小肠方面有较大的优势,其中3DP-ISBT在膀胱和小肠的保护方面是最优的,在直肠保护方面没有显示出明显优势。Objective To analyze the differences in doses to target areas and organs-at-risk during brachytherapy in different modes.Methods According to the different modes of the applicator,72 patients with cervical cancer were divided into 3 groups,namely conventional three-dimensional intracavitary brachytherapy(ICBT)group,interstitial brachytherapy(ISBT)group and 3D printing interstitial brachytherapy(3DP-ISBT)group.The doses to organs-at-risk in different groups were analyzed.Results The average number of interstitial needles in 3DP-ISBT group was more than that of ISBT group(6 vs 4,P<0.001).The comparison between any 2 groups showed that there was no significant difference in D_(90) and target volume of HR-CTV(P>0.05).The D_(0.1 cc),D_(1 cc)and D_(2 cc)of the bladder in ISBT group and 3DP-ISBT group were significantly lower than those in ICBT group(P<0.01),but the differences between ISBT group and 3DP-ISBT group were trivial(P=0.993).No significant difference was found in the D_(0.1 cc),D_(1 cc)and D_(2 cc)of the rectum among 3 groups.The D_(0.1 cc),D_(1 cc)and D_(2 cc)of the small intestine in ISBT group and 3DP-ISBT group were significantly lower than those of ICBT group(P<0.01),and the D_(0.1 cc),D_(1 cc)and D_(2 cc)of the small intestine in 3DP-ISBT group were significantly lower than those of ISBT group(P<0.01).Conclusion By analyzing the exposure doses to organs-at-risk in 3 brachytherapy modes,ISBT is advantageous over ICBT in sparing of bladder and small intestine.Among them,3DP-ISBT has the optimal performance in the protection of the bladder and small intestine,but it shows no advantages in rectal sparing.
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