宫颈癌腔内联合组织间插植近距离放疗施源器模板的应用  

Design and clinical application of intracavitary-interstitial brachytherapy applicator template in locally advanced cervical cancer

作　　者：欧阳翼[1] 黄晓丹 陈佛平 伍海莹 叶伟军[1] 陈锴 李珺芸 刘红英 麦苗青[1] 顾慧宽 林焕新[1] 曹新平[1] Ouyang Yi;Huang Xiaodan;Chen Foping;Wu Haiying;Ye Weijun;Chen Kai;Li Junyun;Liu Hongying;Mai Miaoqing;Gu Huikuan;Lin Huanxin;Cao Xinping(Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Guangdong Provincial Clinical Research Center for Cancer,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心放疗科、华南肿瘤学国家重点实验室、广东省恶性肿瘤临床医学研究中心,广州510060

出　　处：《中华放射肿瘤学杂志》2024年第2期137-144,共8页Chinese Journal of Radiation Oncology

基　　金：广州地区临床特色技术项目(2023P-TS26);新锐肿瘤支持治疗课题研究项目(cphcf-2023-119)。

摘　　要：目的设计适用于局部晚期宫颈癌的腔内联合组织间插植近距离放疗(IC-ISBT)施源器模板,并评估其应用价值。方法收集2019年3月至2020年9月中山大学肿瘤防治中心收治的100例ⅡB-ⅣA期(国际妇产科协会2018分期)宫颈癌患者的外照射前后磁共振影像资料,对宫颈原发病灶范围进行回顾性阅片分析对比。基于外照射后肿物残留情况,勾画近距离放疗高危临床靶区(HR-CTV),设计腔内联合组织间插植近距离放疗(IC-ISBT)的施源器模板,并进一步评估施源器模板插植组(37例)与徒手插植组(63例)治疗宫颈癌的剂量和疗效差异。分类变量采用卡方检验或Fisher精确检验,连续变量采用t检验或U检验。结果100例宫颈癌患者外照射后残留肿物边缘按顺时针3、6、9、12点方向与宫颈管中心的距离中位数为16.5、14.0、17.0、13.0 mm。将对应的HR-CTV叠加重建三维图,设计制作蘑菇头圆柱体式IC-ISBT施源器模板:头部长径为35 mm,短径为20 mm,中心适配宫腔管,内圈C1-C12为表盘式排列,两侧拓展B1-B5及A1-A4针道。在剂量方面,模板插植组与徒手插植组的HR-CTV D90%[(635.12±22.65)∶(635.80±25.84)cGy]、膀胱D_(2cm^(3))[(473.79±44.78)∶(463.55±66.43)cGy],直肠D_(2cm^(3))[(396.99±73.54)∶(408.00±73.94)cGy]及乙状结肠D_(2cm^(3))[(293.07±152.72)∶(311.31±135.77)cGy]无明显差异(P>0.05),但前者的HR-CTV D98%较高[(544.78±32.07)∶(536.78±32.04)cGy,P=0.007],直肠D1 cm3及D0.1 cm3较低[(438.62±69.65)∶(453.97±67.89)cGy,P=0.016;(519.46±70.67)∶(543.82±81.24)cGy,P=0.001]。两组的宫颈原发灶完全缓解率(86%∶83%,P>0.05)无差异。结论该IC-ISBT施源器模板设计合理,与徒手插植疗效相当,靶区剂量覆盖符合临床需求,可更好地保护危及器官。其使用操作简便,可重复性强,有望作为常规模板推广应用。Objective To design and evaluate the application value of intracavitary-interstitial brachytherapy(IC-ISBT)applicator template for locally advanced cervical cancer.Methods MRI data of 100 patients withⅡB-ⅣA stage cervical cancer(International Federation of Gynecology and Obstetrics 2018 staging system)before and after external beam radiation therapy(EBRT)admitted to Sun Yat-sen University Cancer Center from March 2019 to September 2020 were collected.The range of primary cervical lesions was retrospectively analyzed and compared.Based on the residual mass of patients,the corresponding high-risk clinical target volume(HR-CTV)was delineated,and the IC-ISBT applicator template was designed and initially applied to cervical cancer patients.Dosimetry analysis and efficacy evaluation were compared between the applicator template-guided(n=37)and free-hand implantation groups(n=63).Chi-square test or Fisher exact test was performed for categorical variables,and t-test or U-test for continuous variables.Results The median distance between the residual tumor margin(clockwise 3,6,9,12 o'clock)and the center of 100 patients withⅡB-ⅣA stage cervical cancer after EBRT was 16.5,14.0,17.0 and 13.0 mm,respectively.The corresponding HR-CTV was superimposed to reconstruct the three-dimensional diagram,and the cylindrical IC-ISBT applicator template with mushroom-like head was designed and manufactured:the longest and shortest diameter of the head was 35 and 20 mm,respectively;the central channel was adapted to the uterine tube,the C1-C12 channels was arranged in inner circle,and the peripheral B1-B5 and A1-A4 pin channels were expanded bilaterally.In terms of dose coverage,there was no significant difference between the HR-CTV D90%[(635.12±22.65)vs.(635.80±25.84)cGy],bladder D_(2cm^(3))[(473.79±44.78)vs.(463.55±66.43)cGy)],rectum D_(2cm^(3))[(396.99±73.54)vs.(408.00±73.94)cGy]and sigmoid colon D_(2cm^(3))[(293.07±152.72)vs.(311.31±135.77)cGy]between the template-guided and free-hand implantation groups(all P>0.05),b

关 键 词：宫颈肿瘤 局部晚期 近距离放射疗法 腔内联合组织间插植 施源器模板 徒手插植 剂量分析 

分 类 号：R737.33[医药卫生—肿瘤]