膀胱和肠道准备情况对前列腺癌放疗精准实施的影响  

The impact of bladder and bowel preparation on the precise implementation of radiotherapy for prostate cancer

作　　者：麻亚茹 林茂盛[2,3] 陈炯佳 丁振华 MA Yaru;LIN Maosheng;CHEN Jiongjia;DING Zhenhua(Department of Radiology,School of Public Health,Southern Medical University,Guangzhou 510515 China;Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060 China;State Key Laboratory of Oncology in South China,Guangzhou 510060 China)

机构地区：[1]南方医科大学公共卫生学院放射医学系,广东广州510515 [2]中山大学肿瘤防治中心放疗科,广东广州510060 [3]华南恶性肿瘤防治全国重点实验室,广东广州510060

出　　处：《中国辐射卫生》2024年第2期123-128,共6页Chinese Journal of Radiological Health

摘　　要：目的通过锥形束CT(cone beam computed tomography,CBCT)观察每日前列腺癌患者膀胱和肠道的准备情况,分析对前列腺癌放疗精准实施的影响和副反应情况。方法回顾性分析38例行容积调强放射治疗的前列腺癌患者治疗实施过程,处方分次25~35次/例,患者每日放疗前均行CBCT扫描,25~40次/例。观察患者准备情况,根据“不脱靶和直肠壁不能进入前列腺高剂量靶区”的临床需求调整摆位误差,有93次显示不能成功治疗,需重新准备后再行CBCT扫描。统计患者每日是否能成功治疗和摆位误差,分析不同膀胱和肠道准备情况下放射治疗师调整误差值的差异,并统计患者的副反应情况。结果38例患者成功治疗频率为(92.14±5.25)%,有93次准备严重不足,其中48.4%是膀胱充盈过少,30.1%是肠道胀气。副反应与成功治疗频率成负相关(r=−0.393,P=0.015)。膀胱充盈较多时,肠道准备良好和准备不充分在左右(LR)、头脚(SI)、前后(AP)方向治疗师调整的误差值无统计学差异(P>0.05);膀胱充盈适中和较少时,二者在LR、SI、AP方向治疗师调整的误差值均有统计学差异(P<0.05)。结论膀胱充盈过少和肠道胀气是影响前列腺癌患者成功放疗的主要因素,膀胱充盈稍多时,肠道的准备情况对前列腺体内位置变化无影响。Objective To observe the daily bladder and bowel preparation of patients with prostate cancer by cone-beam computed tomography(CBCT),and analyze its impact on the precise implementation of radiotherapy for prostate cancer and side effects.Methods We retrospectively analyzed 38 patients with prostate cancer who underwent volumetric modulated arc therapy.The number of radiation fractions for each patient ranged from 25 to 35.A CBCT scan was performed before each daily radiation therapy,and the number of scans for each patient ranged from 25 to 40.Setup errors were adjusted to ensure that the tumor was targeted and the rectum wall was not in the high-dose target area of the prostate.There were 93 instances where treatment could not be successfully implemented and re-preparation and re-scanning were required.We calculated the success rate of treatment and setup errors,compared radiotherapist-adjusted error values under different bladder and bowel preparation conditions,and recorded radiotherapy-related side effects.Results The success rate of treatment in the 38 patients was(92.14±5.25)%.Among the 93 instances of seriously inadequate preparation,48.4%were due to insufficient bladder filling,and 30.1%were due to intestinal bloating.Radiotherapy side effects were negatively correlated with the success rate of treatment(r=−0.393,P=0.015).When bladder filling was sufficient,there were no significant differences in radiotherapist-adjusted error values in the left-right(LR),superior-inferior(SI),and anterior-posterior(AP)directions between adequate and inadequate bowel preparation(P>0.05).When the bladder was moderately or insufficiently filled,there were significant differences in radiotherapist-adjusted error values in the LR,SI,and AP directions between adequate and inadequate bowel preparation(P<0.05).Conclusion Insufficient bladder filling and intestinal bloating are the main factors influencing the successful implementation of radiotherapy for prostate cancer.When the bladder is sufficiently filled,bowel preparati

关 键 词：前列腺癌 CBCT 摆位误差 膀胱和肠道准备 放疗副反应 

分 类 号：R816.7[医药卫生—放射医学]