宫颈癌近距离治疗施源器位移差异性研究  

Study on the heterogeneity of applicator in brachytherapy for cervical cancer

作　　者：王倩 孟英涛 李振 王微丽 张学良 赵静 谢近亮 王哲 李爱华[9] 谢鹏 WANG Qian;MENG Yingtao;LI Zhen;WANG Weili;ZHANG Xueliang;ZHAO Jing;XIE Jinliang;WANG Zhe;LI Aihua;XIE Peng(Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan,Shandong 250117,China;Department of Nephrology,Fifth People's Hospital of Jinan City,Jinan,Shandong 250022,China;Department of Urology,Linyi People's Hospital,Linyi,Shandong 276000,China;Department of Obstetrics and Gynecology,Liaocheng People's Hospital,Liaocheng,Shandong 252000,China)

机构地区：[1]山东省肿瘤防治研究院(山东省肿瘤医院,卵巢肿瘤病区),山东第一医科大学(山东省医学科学院),山东济南250117 [2]山东省肿瘤防治研究院(山东省肿瘤医院,妇科肿瘤放疗病区),山东第一医科大学(山东省医学科学院),山东济南250117 [3]山东省肿瘤防治研究院(山东省肿瘤医院,护理管理部),山东第一医科大学(山东省医学科学院),山东济南250117 [4]山东省肿瘤防治研究院(山东省肿瘤医院,乳腺外一病区),山东第一医科大学(山东省医学科学院),山东济南250117 [5]山东省肿瘤防治研究院(山东省肿瘤医院,后装治疗室),山东第一医科大学(山东省医学科学院),山东济南250117 [6]山东省肿瘤防治研究院(山东省肿瘤医院,放疗科),山东第一医科大学(山东省医学科学院),山东济南250117 [7]济南市第五人民医院肾内科,山东济南250022 [8]临沂市人民医院泌尿外科,山东临沂276000 [9]聊城市人民医院妇产科,山东聊城252000

出　　处：《中华肿瘤防治杂志》2024年第7期426-431,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省自然科学基金(ZR2022MH288);山东省医药卫生科技发展计划(202009030673);中国博士后科学基金(2022M721446);山东省博士后创新项目(SDCX-ZG-202303064);山东医学会临床科研基金(YXH2022ZX02151);山东第一医科大学教育教学改革研究(XM2022163);白求恩肿瘤放疗转化医学研究基金(flzh202125);吴阶平医学基金(320.6750.2023-17-26);新锐肿瘤支持治疗基金(FB2023031673)。

摘　　要：目的分析宫颈癌近距离治疗患者施源器位置的差异性,为精准近距离治疗提供理论依据。方法选取山东省肿瘤医院2022-01-01-2023-03-31行二维近距离治疗的50例宫颈癌患者为研究对象,对施源器位置在患者身体左右、头脚、腹背三个方向进行重复评价。结果50例宫颈癌患者221分次近距离治疗中,仅有15例患者各分次宫腔施源器置入深度一致,一致率为30.00%,置入深度3~8cm,平均置入深度(5.79±0.72)cm。ab、bc、ac和od平均值分别为(15.2±4.19)、(15.16±3.97)、(30.37±5.68)和(5.78±0.72)mm;角1和角2平均值分别为(1.27±1.15)°和(228.56±4.48)°;距离1和距离2平均值分别为(4.56±3.78)和(1.8±1.75)mm。施源器在不同方向均有位移,左右方向位移发生率为34.84%,Z=-12.111,P<0.001。头脚方向:角1和距离1的位移发生率分别为36.65%(Z=-0.467,P=0.640)和37.56%(Z=-7.945,P<0.001)。腹背方向:角2和距离2位移发生率分别为18.10%(Z=-3.968,P<0.001)和4.07%(Z=-8.898,P<0.001)。结论宫颈癌近距离放疗中,不同分次间施源器位置有较大差异,从而影响肿瘤及正常组织剂量分布,对患者治疗造成一定影响,是保证近距离治疗质量需要解决的关键问题。Objective To analyze the heterogeneity of applicator position in patients with cervical cancer treated with brachytherapy,and to provide theoretical basis for precision bracytherapy.Methods From 2022-01-01 to 2023-03-31 in Shandong Cancer Hospital,50 patients with cervical cancer who received brachytherapy were analyzed,and the repeatability of the position of the applicator in the left and right,head and foot,ventral and dorsal direction was evaluated.Results Among 50 cervical cancer patients who underwent 221 times of brachytherapy,only 15 patients had the same depth of placement of the intrauterine applicator in each time,with a consistency rate of 30.00%,The placement depth was 3-8 cm,with an average placement depth of(5.79±0.72)cm.The average values of ab,bc,ac and od were(15.2±4.19),(15.16±3.97)、(30.37±5.68)and(5.78±0.72)mm,respectively.The average values of angle 1 and angle 2 were(1.27±1.15)°and(228.56±4.48)°,respectively.The average values of distance 1 and distance 2 were(4.56±3.78)and(1.8±1.75)mm,respectively.The applicator had displacement in different directions,with a displacement occurrence rate of 34.84%in the left and right directions,Z=-12.111,P<0.001.Head and foot directions:The displacement rates of angle 1 and distance 1 were 36.65%(Z=-0.467,P=0.640)and 37.56%(Z=-7.945,P<0.001),respectively.Ventral and dorsal directions:The displacement rates of angle 2 and distance 2 were 18.10%(Z=-3.968,P<0.001)and 4.07%(Z=-8.898,P<0.001),respectively.Conclusion In brachytherapy for cervical cancer,there are great heterogeneity in the position of applicator among different grades,which affects the dose distribution of tumor and normal tissue and affects the treatment of patients to a certain extent,which is an important problem to be solved to ensure brachytherapy.

关 键 词：宫颈癌 施源器 位移 近距离治疗 

分 类 号：R737.33[医药卫生—肿瘤]