无痛多通道3D模具引导的组织间插植联合腔内三维后装近距离放疗治疗难治性宫颈癌的剂量学研究  

Dosimetric study of multi-channel 3D mold guided anodynia intracavitary/interstitial combined with three-dimensional image-guided brachytherapy for refractory cervical cancer

作　　者：李凤虎 向梅 李杰慧 洪卫 梅烦 胡丽丽 杜燕军 许聪凤 刘雯 LI Fenghu;XIANG Mei;LI Jiehui;HONG Wei;MEI Fan;HU Lili;DU Yanjun;XU Congfeng;LIU Wen(Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guizhou Guiyang 550004,China;Department of Gynecological Oncology,Affiliated Cancer Hospital of Guizhou Medical University,Guizhou Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院肿瘤科,贵州贵阳550004 [2]贵州医科大学附属肿瘤医院妇科肿瘤科,贵州贵阳550004

出　　处：《现代肿瘤医学》2024年第22期4344-4349,共6页Journal of Modern Oncology

基　　金：贵州省抗癌协会科技计划项目[编号:抗协科计014(2023)]。

摘　　要：目的:评估无痛组织间插植联合三维后装近距离放疗治疗难治性宫颈癌的剂量学及安全性。方法:本研究收集从2022年03月至2023年06月间收治的50例盆腔外照射后评估肿瘤退缩不良的和偏心性难治性宫颈癌患者,治疗方式包括无痛多通道3D模具引导腔内/组织间插植(intracavitary/interstitial brachytherapy,IC/ISBT)治疗组和阴道卵圆体+宫腔管施源器(intracavitary brachytherapy,ICBT)治疗组。对于分类资料描述用率表示,两组计量资料比较采用两个独立样本t检验,P<0.05认为有统计学差异。结果:IC/ISBT组GTV-T_(res)体积、90%靶区所接受的处方剂量(D_(90))及100%处方剂量所包含靶区占整个靶区体积的百分比(V_(100))、HR-CTV体积、HR-CTV的D_(100)、D_(90)、V_(100)明显高于ICBT,差异具有统计学意义(P<0.05),100%靶区所接受的处方剂量(D_(100))两组无明显差异(P>0.05)。对于膀胱、直肠、乙状结肠、小肠1 cm^(3)接受的剂量(D_(1 cm^(3)))、2 cm^(3)接受的剂量(D_(2 cm^(3)))两组相近,无明显差异(P>0.05)。另外IC/ISBT组操作时间比ICBT组延长,CT扫描次数、插植针数及出血量均比ICBT组增多(P<0.05),但经采用无痛技术后,两组患者NRS评分差异无统计学意义(P>0.05)。结论:选择适合不同患者的个体化施源器组织间插植联合腔内三维后装近距离治疗技术,采用全麻下的无痛操作,一方面保证肿瘤靶区的体积剂量学覆盖,同时未明显增加周围危及器官的受照剂量,另一方面提高患者的治疗舒适感及依从性。Objective:To evaluate the dosimetry and safety of anodynia intracavitary/interstitial combined with three-dimensional image-guided brachytherapy for refractory cervical cancer.Methods:From March 2022 to June 2023,we collected 50 patients with poorly regressed and eccentric refractory cervical cancer after external pelvic radiotherapy.The treatment methods included painless multi-channel 3D mold guided intracavitary/interstitial brachytherapy(IC/ISBT)treatment group and intracavitary brachytherapy(ICBT)treatment group.Statistical description of categorical data was expressed by rate,the measurement data of two groups were compared by t test for comparison of two independent samples,P<0.05 was a statistical difference.Results:The volume of gross target volume(GTV-T_(res)),the prescribed dose received by 90%of the target(D_(90)),and the percentage of the target included in the entire target volume(V_(100))of the 100%prescribed dose and the volume,D_(100),D_(90),and V_(100) of high risk clinical target volume(HR-CTV)in the IC/ISBT group were significantly higher than those of ICBT group,with statistical significance(P<0.05).There was no significant difference in the prescribed dose received by 100%of the target(D_(100))between the two groups(P>0.05).Dose of 1 cm^(3)(D_(1 cm^(3)))and 2 cm^(3)(D_(2 cm^(3)))for bladder,rectum,sigmoid colon,and small intestine was similar between the two groups,with no significant difference(P>0.05).In addition,the time of operation was longer,the times of CT scanning,the number of inserted needles and the amount of bleeding of the IC/ISBT group were more than those of the ICBT group(P<0.05).However,through anesthesia techniques,there was no statistically significant difference in NRS scores between the two groups of patients(P>0.05).Conclusion:Choosing personalized source device intracavitary/interstitial combined with three-dimensional image-guided brachytherapy technology was selected for different patients.The application of painless operation under general anesthesia can ensure the

关 键 词：难治性宫颈癌 无痛组织间插植 三维后装 剂量学 

分 类 号：R737.33[医药卫生—肿瘤]