首次后装前行模拟计划对宫颈癌患者直肠膀胱的剂量学影响研究  

Dosimetric effect of the first loading and walking simulation program on rectum and bladder of patients with cervical cancer

作　　者：莫颖[1] 梁萍[1] 龙先凤 梁莉莉 石世合 曾玉婷[1] 廖超龙[1] MO Ying;LIANG Ping;LONG Xian-feng(Department of Radiotherapy,Clinical Tumor Center,Guangxi Academy of Medical Sciences·People's Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530001,China)

机构地区：[1]广西医学科学院·广西壮族自治区人民医院临床肿瘤中心放疗科,广西南宁530001

出　　处：《临床和实验医学杂志》2023年第1期91-94,共4页Journal of Clinical and Experimental Medicine

基　　金：广西壮族自治区卫生健康委员会科研课题项目(编号:Z20201000)。

摘　　要：目的 分析首次三维后装治疗前行模拟计划对宫颈癌患者直肠和膀胱的剂量学影响。方法 回顾性分析2020年6月至2022年1月于广西壮族自治区人民医院临床肿瘤中心放疗科首次接受腔内联合组织间插植三维后装治疗的84例宫颈癌患者的临床资料,根据首次后装前是否预扫描分为两组,各42例。实验组先行CT预扫描,在预扫描CT影像上模拟后装插植计划,指导医师进行首次后装插植操作;对照组为医师直接进行插植操作。观察对比两组患者实际首次治疗计划中靶区剂量评估参数D_(90)、D_(100)、V_(100),直肠、乙状结肠等肠道和膀胱的D_(2cm3)、D_(1cm3)等剂量评估指标,比较两种计划治疗时间、治疗有效率及不良反应发生率。结果 实验组和对照组的靶区D_(90)、D_(100)、V_(100)的剂量比较,差异均无统计学意义(P>0.05);实验组患者膀胱的D_(2cm3)和D_(1cm3)剂量为(3.12±0.41)、(3.68±0.68) Gy,直肠的D_(2cm3)和D_(1cm3)剂量为(4.12±0.44)、(4.37±0.55) Gy,均明显低于对照组[膀胱:(3.34±0.45)、(3.98±0.55) Gy;直肠:(4.38±0.49)、(4.66±0.56) Gy],差异均有统计学意义(P<0.05);两组患者乙状结肠的D_(2cm3)和D_(1cm3)剂量比较,差异均无统计学意义(P>0.05);实验组患者治疗时间为(319.52±45.69) s,显著短于对照组[(342.36±51.26)s],差异有统计学意义(P<0.05);实验组患者治疗有效率为80.95%,高于对照组(66.67%),放射性肠炎及膀胱炎发生率为11.90%、16.67%,均低于对照组(23.10%、21.90%),差异均有统计学意义(P<0.05),但两组患者治疗有效率及不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 在宫颈癌CT预扫描后行模拟后装插植计划设计中,膀胱及直肠受照剂量明显低于常规后装放疗,且减少治疗时间,提高治疗有效率,减少不良反应发生率。Objective To analyze the dosimetric effect of the first three-dimensional afterloading treatment simulation plan on rectum and bladder of cervical cancer patients. Methods The clinical data of 84 patients with cervical cancer who were first treated with intracavitary combined with three-dimensional brachytherapy between July 2020 and June 2022 in People’s Hospital of Guangxi Zhuang Autonomous Region were retrospectively analyzed. According to the pre-scanning before the first post-installation, the patients were divided into two groups, 42 cases in each group. The experimental group underwent CT pre-scanning first, and simulated the post-installation implant plan on the pre-scanned CT images, so as to guide doctors to perform the first post-installation implant operation.Patients in the control group were directly implanted.The target dose evaluation parameters D_(90), D_(100), V_(100) in the actual first treatment plan of the two groups were compared, and the dose evaluation indexes of rectum, sigmoid colon and other intestines and bladder such as D_(2cm3), D_(1cm3) were compared.The treatment time, effective rate and incidence of adverse reactions were compared between the two plans. Results There was no statistically significant difference in the dose of D_(90), D_(100) and V_(100) between the experimental group and the control group(P>0.05). The doses of D_(2cm3) and D_(1cm3) of bladder in the experimental group were(3.12±0.41) and(3.68±0.68) Gy, and and of rectum were(4.12±0.44) and(4.37±0.55) Gy respectively, which were significantly lower than those in the control group [bladder:(3.34±0.45),(3.98±0.55) Gy;rectum:(4.38±0.49),(4.66±0.56) Gy], and the differences were statistically significant(P<0.05);there was no statistically significant difference in the dosage of D2cm3and D1cm3in sigmoid colon between the two groups(P>0.05). The treatment time of the experimental group was(319.52±45.69) s, which was significantly shorter than that of the control group [(342.36±51.26) s], and the difference was

关 键 词：三维后装治疗 模拟计划 宫颈癌 直肠受量 膀胱受量 

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