妇科恶性肿瘤调强放疗中盆腔淋巴结引流区勾画研究  

A study of delineation of pelvic lymph node drainage area in intensity-modulated radiotherapy for gynecologic malignancies

作　　者：黄容 李丹 庞皓文 杜秀举 陈霄 文庆莲 HUANG Rong;LI Dan;PANG Hao-wen;DU Xiu-ju;CHEN Xiao;WEN Qing-lian(Department of Oncology,the Affiliated Hospital of Southwest Medical University,Sichuan Province,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000

出　　处：《河北医科大学学报》2023年第7期830-835,共6页Journal of Hebei Medical University

摘　　要：目的 利用治疗期间的CT图像评估妇科恶性肿瘤患者在全盆腔调强放疗期间小肠位置的变化,探讨妇科恶性肿瘤盆腔淋巴结引流区勾画时是否需要避开小肠。方法 31例妇科恶性肿瘤患者接受盆腔放疗,分为手术组(n=15)和非手术组(n=16)。获取治疗期间第10、15和20次放疗时的CT图像,与初始计划CT图像相比,记录观察区域与小肠相交形成规避区域的变化。将初始计划扫描图像中盆腔血管外扩形成的盆腔淋巴结引流区CTV放射治疗范围定义为观察区域,其与小肠的相交体积定义为小肠规避区域。结果 放射治疗期间小肠停留在计划靶区肠道规避区域的体积占比在未手术组的左侧髂总、右侧髂总、左侧髂内、右侧髂内、左侧髂外、右侧髂外、左侧闭孔、右侧闭孔、骶前观察区域分别为16.52%、28.05%、18.65%、37.16%、39.18%、49.67%、23.74%、50.07%、42.65%;手术组分别为39.57%、34.41%、18.45%、31.21%、44.21%、43.39%、31.32%、49.67%、27.59%。结论 无论患者是否接受过妇科恶性肿瘤手术,放疗期间观察区域内小肠停留在计划靶区肠道规避区域的体积占比为50%或更低。结合肠道本身的移动性以及重叠体积的占比,对于妇科恶性肿瘤的盆腔淋巴结的勾画,建议是无需规避小肠。Objective To evaluate changes in small intestine position during whole pelvic intensity-modulated radiation therapy for patients with gynecologic malignancies using computed tomographic(CT)images during treatment and to investigate whether the small intestine should be avoided for delineation of pelvic lymph node drainage area in patients with gynecologic malignancies.Methods Thirty-one patients with gynecologic malignancies were included for pelvic radiotherapy and divided into surgical group(n=15)and non-surgical group(n=16).The 10th,15th,and 20th fractions of the CT images during treatment were reviewed and changes in the avoidance area formed by the intersection of the observation area with the small intestine compared with the initially planned CT scan images were recorded.We defined the scope of CTV radiation therapy in the drainage area of the pelvic lymph nodes formed by pelvic vascular expansion in the initially planned scan images as the observation area and its intersecting volume with the small bowel as avoidance area of the small intestine.Results During radiotherapy,the volume ratio of small intestine staying in its avoidance area of planned target area in the observation area,which included the left common iliac region,right common iliac region,left internal iliac region,right internal iliac region,left external iliac region,right external iliac region,left obturator region,right obturator region,and presacral region,was 16.52%,28.05%,18.65%,37.16%,39.18%,49.67%,23.74%,50.07%,and 42.65%,respectively,for the non-surgical group,and 39.57%,34.41%,18.45%,31.21%,44.21%,43.39%,31.32%,49.67%,and 27.59%,respectively,for the surgical group.Conclusion The volume ratio of small intestine staying in its avoidance area of planned target area accounted for 50%or less in patients during radiotherapy,regardless of whether they had received surgery for gynecological malignancies.Combined with the mobility of the intestine itself and the percentage of overlapping volume,it is recommended that the small intestines do

关 键 词：生殖器肿瘤 女(雌)性 放射疗法 高能 淋巴结 

分 类 号：R737.3[医药卫生—肿瘤]