宫颈癌腔内近距离放疗中宫腔管的重建点研究  

Reconstruction points of intrauterine applicator in intracavitary brachytherapy for cervical cancer

作　　者：冯永富 陈绍俊 龙雨松 谭军文 贺先桃 李钢 冯成军 王占宇 Feng Yongfu;Chen Shaojun;Long Yusong;Tan Junwen;He Xiantao;Li Gang;Feng Chengjun;Wang Zhanyu(Room of Oncology Radiotherapy,Liuzhou Worker's Hospital,Liuzhou 545005,China;Ward One and Two,Department of Oncology,Liuzhou Worker's Hospital,Liuzhou 545005,China;Liuzhou Gynecological Oncology Brachytherapy Intelligent Guidance System Engineering Technology Research Center,Liuzhou 545005,China;Liuzhou Full Information Precision Radiotherapy Technology Engineering Technology Research Center,Liuzhou 545005,China)

机构地区：[1]柳州市工人医院肿瘤放射治疗室,柳州545005 [2]柳州市工人医院肿瘤科一、二病区,柳州545005 [3]柳州市妇科肿瘤近距离治疗智能引导系统工程技术研究中心,柳州545005 [4]柳州市全程信息化精准放疗技术工程技术研究中心,柳州545005

出　　处：《中华放射肿瘤学杂志》2024年第9期825-832,共8页Chinese Journal of Radiation Oncology

基　　金：广西重点研发计划(桂科AB21196014);柳州市科技计划项目(2022YRZ0101);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-B20241440)。

摘　　要：目的探讨宫颈癌腔内近距离放射治疗中宫腔管不同重建点对源驻留位置及计划剂量学的影响。方法回顾性分析2020年5月至2022年10月在柳州市工人医院完成根治性放射治疗的43例宫颈癌患者的资料。患者年龄32~79岁, 病理类型为鳞癌40例, 腺癌3例, 均接受外照射(50.4 Gy分28次)和CT引导下的腔内(45°宫腔管)近距离治疗(36 Gy分6次)。近距离治疗采用Fletcher施源器, 其宫腔管弯曲角度有15°、30°和45°。为每位患者模拟制订2套近距离治疗计划。一套计划提取患者近距离治疗CT模拟定位图像及原始计划, 将45°宫腔管弯曲部分重建点调整为逐层重建, 根据处方优化计划至符合临床要求, 称为逐层组。另一套计划以逐层组为模板, 仅调整45°宫腔管弯曲部分重建点至1、3、5、7个, 不修改驻留权重及其他参数, 分别称为平均1、3、5、7组。对15°、30°和45°宫腔管分别进行不同重建点个数时的偏差分析, 比较45°、30°与15°宫腔管在不同重建点时的重建偏差。采用配对样本t检验或Wilcoxon符号秩检验比较45°宫腔管的两组计划的高危临床靶区(HR-CTV)D_(50%)、D_(90%)、D_(100%)、V_(100%)、V_(150%)、V_(200%)和适形指数(CI), 及膀胱、直肠和小肠的D_(2 cm^(3))、D_(1 cm^(3))、D_(0.1 cm^(3))的差异。结果 45°宫腔管平均组重建偏差主要来源于宫腔管垂直方向。45°(1、3、5、7个重建点)、30°(1、3、5个重建点)与15°(1、2个重建点)宫腔管的平均重建偏差分别为1.30、0.32、0.14、0.08 mm, 0.57、0.14、0.06 mm, 0.14、0.06 mm。逐层组的HR-CTV参数与平均5组、平均7组的差异均无统计学意义(均为P>0.005), 平均5组与平均7组间的剂量学参数差异也无统计学意义(均为P>0.005)。膀胱和直肠的剂量学参数在逐层组与平均组之间或在各平均组之间差异均无统计学意义(均为P>0.005)。逐层组的小肠剂量学参数较平均1组增加, 差异有统计学�Objective To evaluate the effect of different reconstruction points of intrauterine applicator on the source dwell positions and plan dosimetry in intracavitary brachytherapy for cervical cancer.Methods Clinical data of 43 patients with cervical cancer who had completed radical radiotherapy in Liuzhou Workers'Hospital from May 2020 to October 2022 were retrospectively analyzed.Among 43 patients,aged 32-79 years,40 cases were diagnosed with squamous carcinoma and 3 cases of adenocarcinoma.All patients received external irradiation for 50.4 Gy/28 fractions and CT-guided intracavitary brachytherapy(45°intrauterine applicator)was 36 Gy/6 fractions.Brachytherapy was performed by using Fletcher applicator,the curvature of intrauterine applicator were 15°,30°and45°.Two sets of brachytherapy plans were simulated for each patient.One set of plans extracted the simulated CT positioning images and the original plan of the patient's brachytherapy.The reconstruction point of the curved part of the 45°intrauterine applicator was adjusted to slice-by-slice reconstruction.The plan was optimized to meet clinical requirements according to the prescription,which was called the slice-by-slice group.In the other set of plans,slice-by-slice group was used as a template.The reconstruction points of the curved section of the 45°intrauterine applicator were adjusted to 1,3,5,and 7,without modifying the applicator weights and other parameters,which was called the average group 1,3,5 and 7.The deviation analysis of 15°,30°and 45°intrauterine applicator with different number of reconstruction points was carried out,the reconstruction deviation of 45°,30°and 15°intrauterine applicator at different reconstruction points was compared.Paired-sample t-test or Wilcoxon signed rank test were used to compare the differences in high-risk clinical target volume(HR-CTV)D_(50%),D_(90%),D_(100%),V_(100%),V_(150%),V_(200%)and conformity index(CI)as well as D_(2cm^(3)),D1cm3 and D_(0.1cm^(3))in bladder,rectum,and small intestine between two gr

关 键 词：宫颈肿瘤 腔内近距离治疗 宫腔管 重建偏差 剂量学 

分 类 号：R737.33[医药卫生—肿瘤]