瘤床加量在侵犯全层宫颈癌术后放射治疗中的初步剂量学及毒性反应研究  

Preliminary study on the dosimetry and toxicity of tumor bed boost in postoperative radiotherapy for cervical cancer with full-thickness stromal invasion

作　　者：丁文评 王惠丽 陆元元 周蔼斌 阮俊 王朝霞 陈意红 DING Wenping;WANG Huili;LU Yuanyuan;ZHOU Aibin;RUAN Jun;WANG Zhaoxia;CHEN Yihong(Department of Radiotherapy,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院放疗科,安徽芜湖241001

出　　处：《皖南医学院学报》2024年第4期330-333,共4页Journal of Wannan Medical College

基　　金：弋矶山医院三新项目(Y22051)。

摘　　要：目的:探讨瘤床加量在侵犯全层宫颈癌术后放射治疗中的初步剂量学和毒性反应。方法:回顾性分析2020年5月~2023年8月在弋矶山医院采用瘤床加量治疗的侵犯宫颈全层宫颈癌患者15例,分析瘤床加量前后靶区、危及器官(OAR)剂量学指标及患者的毒副反应。结果:患者瘤床区域加量后,计划瘤床靶区(PGTVtb)的最小剂量(D_(min))、平均剂量(D_(mean))及最大剂量(D max)均高于加量前(P<0.05)。患者瘤床区域加量后,膀胱的V_(30)、V_(40)、V_(50)和直肠的V_(40)、V_(50)较加量前均增加(P<0.05),而小肠V_(30)、V_(40)、V_(50)及左右侧股骨头V_(40)、V_(50)加量前后差异均无统计学意义(P>0.05)。瘤床加量治疗后,患者出现了轻度(1、2级)急性生殖泌尿道和下消化道不良反应。9例(60.00%)和5例(33.33%)患者分别出现中度(3级)白细胞和中性粒细胞下降,出现1例3级血小板下降。所有患者均未出现重度(4级)急性不良反应。结论:宫颈癌术后行瘤床加量,瘤床区域剂量得到提升,毒副反应可接受,具有潜在的临床应用价值。Objective:To preliminarily investigate the dosimetry and toxicity response of tumor bed boost in postoperative radiotherapy for cervical cancer with full-thickness stromal invasion.Methods:A retrospective analysis was conducted in 15 patients with full-thickness stromal invasion suggested by postoperative pathology,who received tumor bed boost therapy in our hospital between May 2020 and August 2023.The dosimetry indexes of target areas and organs involved as well as toxicological reaction were analyzed before and after the application of tumor bed boost.Results:After boost irradiation to the tumor bed area,the minimum dose(D_(min)),mean dose(D_(mean)),and maximum dose(D max)of the planning target volume of tumor bed(PGTVtb)were significantly higher than those before the boost(P<0.05).V_(30),V_(40)and V_(50)of bladder and V_(40)and V_(50)of rectum were significantly increased compared to those before the boost(P<0.05).There was no significant difference in V_(30),V_(40)and V_(50)of the small intestine(P>0.05)and V_(40),V_(50)of the bilateral femoral heads before and after the boost(P>0.05).After tumor bed boost therapy,patients experienced mild(grade 1 and 2)acute genitourinary and lower gastrointestinal adverse reactions.Nine(60.00%)and 5 patients(33.33%)respectively experienced moderate(grade 3)decreases in white blood cells and neutrophils,and another one experienced a grade 3 platelet decrease.No severe(grade 4)acute adverse reactions were observed.Conclusion:Tumor bed boost after cervical cancer surgery has potential clinical application value,for this therapy can increase the dose in the tumor bed area,with tolerable toxic and side effects.

关 键 词：宫颈癌 瘤床加量 放射治疗 危及器官 

分 类 号：R730.55[医药卫生—肿瘤] R737.33[医药卫生—临床医学]