膀胱不同充盈状态在宫颈癌调强放疗中的应用分析  

Analysis of different bladder filling statuses in intensity-modulated radiotherapy for cervical cancer

作　　者：黄家文 张梅芳[1] 傅万凯 刘利彬[1] 陈彩霞 林金容 HUANG Jiawen;ZHANG Meifang;FU Wankai;LIU Libin;CHEN Caixia;LIN Jinrong(Fujian Medical University Cancer Hospital,Fujian Cancer Hospital,Fujian Fuzhou 350014,China;Wuping County Hospital,Fujian Wuping 364300,China)

机构地区：[1]福建医科大学附属肿瘤医院,福建省肿瘤医院,福建福州350014 [2]武平县医院,福建武平364300

出　　处：《现代肿瘤医学》2023年第17期3242-3247,共6页Journal of Modern Oncology

基　　金：国家临床重点专科建设项目(编号:2021);福建省肿瘤放射与免疫治疗临床医学研究中心(编号:2020Y2012)。

摘　　要：目的:研究膀胱不同充盈状态在宫颈癌调强放疗中的临床应用,为提高宫颈癌调强放射治疗精确度提供临床依据。方法:选取2020年07月至2021年10月福建省肿瘤医院放射治疗中心收治的90例宫颈癌患者作为研究对象,根据膀胱充盈状态不同将其分为膀胱排空组、直接灌注组及自主憋尿组,每组30例。然后进行CT定位扫描及勾画靶区,对比分析三组间临床靶体积(CTV)、计划靶体积(PTV)和直肠、膀胱、小肠及股骨头体积变化。放射治疗实施过程中利用医科达容积成像系统每周进行一次CBCT扫描,采集三组病例的位移误差进行对比分析。结果:膀胱排空组中膀胱与小肠的体积分别为:(73.30±7.93)mL、(361.63±29.07)mL;直接灌注组中膀胱与小肠的体积分别为:(348.30±20.87)mL、(302.00±28.41)mL;自主憋尿组中膀胱与小肠的体积分别为:(307.73±74.65)mL、(328.23±59.35)mL。三组间膀胱与小肠体积变化有显著性统计学差异(P<0.01)。CTV、PTV、直肠、股骨体积变化无显著性统计学差异(P>0.05);三组间膀胱体积离散系数分别为10.82%、6.00%、24.26%,小肠体积离散系数分别为8.04%、9.41%、18.08%。膀胱排空组在三维方向(X、Y、Z、Rx、Ry、Rz)上的放疗摆位误差分别为:(0.20±0.11)cm、(0.23±0.15)cm、(0.18±0.11)cm、(0.97±0.71)°、(0.88±0.70)°、(0.88±0.55)°,直接灌注组为(0.21±0.14)cm、(0.27±0.18)cm、(0.19±0.11)cm、(1.09±0.76)°、(1.16±0.77)°、(0.74±0.60)°,自主憋尿组为(0.26±0.15)cm、(0.36±0.25)cm、(0.32±0.20)cm、(1.65±1.10)°、(1.44±0.98)°、(0.98±0.64)°,三组病例Y、Z、Rx(pitch)、Ry(yaw)方向上摆位误差有显著性统计学差异(P<0.05),X、Rz(roll)方向上摆位误差没有显著性统计学差异(P>0.05)。结论:宫颈癌调强放治疗时膀胱排空时摆位误差最小,膀胱灌注时小肠受照体积最小,保持膀胱稳定的充盈状态有利于提高放疗精确性。Objective:To study the clinical application of different bladder filling states in intensity-modulated radiotherapy for cervical cancer for improving the accuracy of intensity-modulated radiotherapy for cervical cancer.Methods:A total of 90 patients with cervical cancer in Radiotherapy Center of Fujian Tumor Hospital between July 2020 to October 2021 were enrolled as the research objects,and were divided into the bladder emptying group,direct perfusion group and autonomous holding urine groups according to different bladder filling status,with 30 cases in each group.Then,CT positioning and target area delineation were performed,and the clinical target volume(CTV),planned target volume(PTV),rectum,bladder,small intestine,and femoral head volume changes were relatively analyzed between the three groups.During the implementation of radiotherapy,the displacement errors of the three group were collected for comparative analysis using CBCT scans performed weekly using Eeta's XVI imaging system.Results:The volume of the bladder and small intestine in the bladder emptying group respectively were(73.30±7.93)mL,(361.63±29.07)mL.The volume of bladder and small intestine in the direct perfusion group respectively were(348.30±20.87)mL,(302.00±28.41)mL.The volume of bladder and small intestine in the autonomous urine group respectively were(307.73±74.65)mL,(328.23±59.35)mL.There was a significant difference in bladder and small bowel volume changes between the three groups(P<0.01).There was no significant difference in CTV,PTV,rectum and femur volume changes(P>0.05).The dispersion coefficient of bladder volume respectively were 10.82%,6.00%and 24.26%,and the small intestine volume respectively were 8.04%,9.41%and 18.08%.The setting errors of three-dimensional(X,Y,Z,Rx,Ry,Rz)radiotherapy for bladder emptying group were respectively(0.20±0.11)cm,(0.23±0.15)cm,(0.18±0.11)cm,(0.97±0.71)°,(0.88±0.70)°,(0.88±0.55)°.The translation errors and the rotation errors in the direct perfusion group respectively were(0.21±0.1

关 键 词：宫颈癌 调强放疗 摆位误差 膀胱充盈方式 

分 类 号：R737.33[医药卫生—肿瘤]