膀胱体积对局限期前列腺癌质子放疗的剂量学影响  

Impact of bladder volume on dosimetry of CTV and OAR in localized prostate cancer treated with proton therapy

作　　者：王丹妮 李欢 许赪[1,2] 樊文栋 陈媚 钱晓芳 秦达伟[1,2] 施晨盛 赵若骓 祁伟祥 黄琦昀 陈佳艺 曹璐[1,2] Wang Danni;Li Huan;Xu Cheng;Fan Wendong;Chen Mei;Qian Xiaofang;Qin Dawei;Shi Chensheng;Zhao Ruozhui;Qi Weixiang;Huang Qiyun;Chen Jiayi;Cao Lu(Department of Radiation Oncology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Shanghai Key Laboratory of Proton-therapy,Shanghai 201801,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射治疗科,上海200025 [2]上海市质子治疗转化研究重点实验室,上海201801

出　　处：《中华放射肿瘤学杂志》2024年第6期524-531,共8页Chinese Journal of Radiation Oncology

基　　金：上海市卫生健康委员会卫生行业临床研究专项(20224Y0025);国家重点研发计划(2016YFC0105409);北京科创医学发展基金会项目(KC2021-JX-0170-9)。

摘　　要：目的:探究膀胱体积对局限期前列腺癌质子调强放疗(IMPT)的临床靶区(CTV)和危及器官(OAR)剂量的影响。方法:回顾性分析“质子治疗系统”(SAPT-PS-01)注册临床试验纳入的于2021年11月到2022年6月在上海交通大学医学院附属瑞金医院就诊的25例局限期前列腺癌根治性放疗患者的资料。患者均为男性,中位年龄72岁,共获取30套IMPT计划。基于定位CT(30套)和治疗期间每周验证CT(172套),收集膀胱体积和CTV、OAR的剂量学参数。用Spearman相关分析评估定位CT的膀胱体积与IMPT计划的CTV和OAR剂量学参数的相关性,用Wilcoxon-Mann-Whitney检验分析对不同膀胱体积变化值分组之间的CTV和OAR剂量学参数进行比较。结果:IMPT计划的CTV1和CTV2的V 95%均为100.0%±0.0%。膀胱体积与膀胱D mean、V 70 Gy(RBE)、V 60 Gy(RBE)、V 50 Gy(RBE)、V 40 Gy(RBE)(P<0.001、0.003、<0.001、<0.001、<0.001),以及小肠D mean、V 50 Gy(RBE)(P均<0.001)均呈显著负相关。治疗期间,膀胱体积较定位时基线增大>20%患者的膀胱D mean、V 70 Gy(RBE)、V 60 Gy(RBE)、V 50 Gy(RBE)、V 40 Gy(RBE)(P<0.001、0.001、<0.001、<0.001、<0.001),直肠D mean、V 50 Gy(RBE)、V 40 Gy(RBE)(P均<0.05),以及小肠D mean、V 50 Gy(RBE)(P均<0.001)均较IMPT计划显著降低,但是CTV1 V 100%和CTV2 V 95%也显著降低(P=0.029、0.020)。膀胱体积减小>20%患者的膀胱D mean和V 70 Gy(RBE)、V 60 Gy(RBE)、V 50 Gy(RBE)、V 40 Gy(RBE)均较IMPT计划显著增加(P均<0.001)。膀胱体积较基线减小≤20%组和增大≤20%组患者治疗期间的CTV和OAR剂量无显著改变。结论:局限期前列腺癌质子治疗患者行定位CT扫描时应保证一定的膀胱容量,治疗期间的膀胱体积建议保持在定位时基线膀胱体积的80%~120%之间,以保证良好的CTV覆盖和OAR保护。Objective To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume(CTV)and organs at risk(OAR)of intensity modulated proton therapy(IMPT)for localized prostate cancer during the treatment planning and daily treatment.Methods Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the"Proton Therapy System"(SAPT-PS-01)registered clinical trial were retrospectively analyzed.All patients were male and the median age was 72 years old.A total of 30 sets of IMPT plans were obtained.Based on the planning CT(30 sets)and weekly verification CT during treatment(172 sets),bladder volume,CTV and OAR dose parameters were collected.Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans,and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results The V95%of CTV1 and CTV2 were both 100.0%±0.0%in IMPT plans.Bladder volume was significantly negatively correlated with Dmean,V70 Gy(RBE),V60 Gy(RBE),V50 Gy(RBE),V40 Gy(RBE)of the bladder(P<0.001,0.003,<0.001,<0.001,<0.001),and Dmean,V50 Gy(RBE)of the small intestine(both P<0.001).During treatment,bladder Dmean,V70 Gy(RBE),V60 Gy(RBE),V50 Gy(RBE),V40 Gy(RBE)(P<0.001,0.001,<0.001,<0.001,<0.001),rectal Dmean,V50 Gy(RBE),V40 Gy(RBE)(all P<0.001),small intestine Dmean,V50 Gy(RBE)(both P<0.001)of patients with bladder volume increase>20%compared to baseline were significantly decreased compared to those in IMPT plans.But CTV1 V100%,and CTV2 V95%were significantly decreased too(P=0.029,0.020).In the bladder volume decreased>20%patients,the Dmean,V70 Gy(RBE),V60 Gy(RBE),V50 Gy(RBE),V40 Gy(RBE)of the bladder were significantly increased compared to those in IMPT plans(all P<0.001).However,a bladder volume reduction of≤20%and inc

关 键 词：前列腺肿瘤 局限期 质子调强放疗 膀胱体积 临床靶区 危及器官 

分 类 号：R737.25[医药卫生—肿瘤] R730.55[医药卫生—临床医学]