肠道膀胱准备下前列腺癌精准放疗膀胱直肠变化分析  

Analysis of the rectum and bladder changes in prostate precise radiotherapy under the bowel and bladder preparation

作　　者：李婷 郭雨军 杨鑫[1] 武曼莉 何梦雪 戴心仪 田玥 张墅靖 麦秀滢 何立儒[1] 黄思娟[1] Li Ting;Guo Yujun;Yang Xin;Wu Manli;He Mengxue;Dai Xinyi;Tian Yue;Zhang Shujing;Mai Xiuying;He Liru;Huang Sijuan(State Key Laboratory of Oncology in South China,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Guangzhou Xinhua College,Guangzhou 510520,China;Department of Radiation Oncology,Anhui Wanbei Coal-Electricity Group General Hospital(The Third Affiliated Hospital of Bengbu Medical College),Suzhou 234000,China)

机构地区：[1]中山大学肿瘤防治中心、华南肿瘤学国家重点实验室、广东省鼻咽癌诊治研究重点实验室放射治疗科,广州510060 [2]广州新华学院,广州510520 [3]安徽皖北煤电集团总医院(蚌埠医学院第三附属医院)放射治疗科,宿州234000

出　　处：《中华放射肿瘤学杂志》2023年第2期124-130,共7页Chinese Journal of Radiation Oncology

基　　金：中山大学肿瘤防治中心青年优创项目(QNYCPY32);广东省基础与应用基础研究基金企业联合基金(2021A1515220140);国家自然科学基金面上项目(12075329);大学生创新创业训练计划项目(S202113902030)。

摘　　要：目的分析肠道膀胱准备下,前列腺癌患者放疗过程中临床可接受且具有良好可重复性的膀胱、直肠体积,为放疗前后肠道膀胱的准备提供定量指标。方法回顾性分析2015年4月—2020年12月在中山大学肿瘤防治中心经肠道膀胱准备且完成全程根治性放疗的275例前列腺癌患者。患者每次治疗前进行锥形线束CT(CBCT)扫描,记录临床可接受情况下的摆位误差。简单随机抽样选取66例患者,使用MIM软件勾画患者CBCT上膀胱、直肠,分析每日膀胱或直肠体积与计划膀胱或直肠体积的比值(体积相对值)及其与摆位误差之间的关系。定量资料以x¯±s表示,符合正态分布的数据使用配对t检验,否则使用非参数检验(Kruskal-Wallis检验)分析。结果275例患者计划CT膀胱、直肠体积分别为(370.87±110.04)、(59.94±25.07)ml。66例患者共获得1611套CBCT影像,计划CT膀胱、直肠体积分别为(357.51±107.38)、(65.28±35.37)ml,治疗过程中患者每日CBCT膀胱、直肠体积分别为(258.96±120.23)、(59.95±30.40)ml。治疗过程中,膀胱体积平均每天减少3.59 ml,直肠体积平均每天减少0.37 ml。根据计划膀胱体积将患者分为<250 ml、250~450 ml、>450 ml三组,其中250~450 ml组在放疗过程中膀胱体积相对值范围最小,头脚、左右方向摆位误差分别为(0.28±0.24)、(0.19±0.17)cm,均明显低于其他两组(P值均≤0.027)。根据计划直肠体积将患者分为<50 ml、50~<80 ml、80~120 ml、>120 ml四组,其中<50 ml组在放疗过程中直肠体积相对值范围最小,头脚、腹背方向摆位误差分别为(0.26±0.22)、(0.24±0.22)cm,均明显小于其他三组(P值均≤0.003)。入组66例患者头脚、左右、腹背方向摆位误差分别为(0.30±0.25)、(0.20±0.18)、(0.28±0.27)cm。其中,腹背方向摆位误差在<0.3 cm组的膀胱体积相对值(0.73±0.37)与0.3~0.5 cm、>0.5 cm组的差异有统计学意义(P值均<0.05)。结论肠道膀胱准备下扫描计划CT前,Objective To analyze the clinically acceptable and reproducible bladder and rectum volumes of prostate cancer patients during radiotherapy under bladder and bowel preparation,aiming to provide quantitative indicators for bowel and bladder preparation before and after radiotherapy.Methods Clinical data of 275 prostate cancer patients with strict bladder and bowel preparation and completion of whole course radical radiotherapy at Sun Yat-sen University Cancer Center from April 2015 to December 2020 were retrospectively analyzed.Patients were scanned with cone beam CT(CBCT)before each treatment and the setup error was recorded.Sixty-six patients were selected by simple random sampling and the bladder and rectum on daily CBCT was outlined using MIM software.The relationship between the ratio of daily bladder or rectum volume to the planned bladder or rectum volume(relative value of volume)and setup error was analyzed.Quantitative data were expressed as mean±SD.Normally distributed data were analyzed by paired t-test while non-normally distributed data were assessed by Kruskal-Wallis test.Results The bladder and rectum volume on planning CT were(370.87±110.04)ml and(59.94±25.07)ml of 275 patients.The bladder and rectum volumes on planning CT were(357.51±107.38)ml and(65.28±35.37)ml respectively of the 66 selected patients with 1611 sets of CBCT images.And the bladder and rectum volumes on daily CBCT were(258.96±120.23)ml and(59.95±30.40)ml.The bladder volume of patients was decreased by 3.59 ml per day on average during the treatment and 0.37 ml for the rectum volume.According to the bladder volume on planning CT,all patients were divided into three groups:<250 ml,250-450 ml and>450 ml groups.The relative value of volume in the 250-450 ml group during the course of radiotherapy was the smallest.And the setup error in the superior and inferior(SI)direction was(0.28±0.24)cm and(0.19±0.17)cm in the left and right(LR)direction,significantly lower than those in the other two groups(both P≤0.027).According to the

关 键 词：前列腺肿瘤 肠道膀胱准备 膀胱 直肠 摆位误差 

分 类 号：R737.25[医药卫生—肿瘤]