剂量表面积直方图对宫颈癌图像引导放疗致急性放射性直肠炎的预测价值  

Predictive value of dose surface histogram for acute radiation proctitis induced by image guided radiotherapy for cervical cancer

作　　者：刘庆啸 朱月香[1] 魏伟 田龙[1] 杨松林 王晸 赵御森[1] 王素丽 常茂叶[1] LIU Qing-xiao;ZHU Yue-xiang;WEI Wei;TIAN Long;YANG Song-lin;WANG Zheng;ZHAO Yu-sen;WANG Su-li;CHANG Mao-ye(Medical Imaging Center,the First Affiliated Hospital of Hebei Northern University,Zhangjiakou 075000,Hebei Province,China;Hebei Radiation Environment Safety Technology Center,Shijiazhuang 050081,China)

机构地区：[1]河北北方学院附属第一医院医学影像中心,河北张家口075000 [2]河北省辐射环境安全技术中心,石家庄050081

出　　处：《医疗卫生装备》2025年第3期48-53,共6页Chinese Medical Equipment Journal

基　　金：张家口市重点研究计划项目(2421018D)。

摘　　要：目的:探究宫颈癌(cervical cancer,CCA)图像引导放疗(image guided radiotherapy,IGRT)中剂量表面积直方图(dose surface histogram,DSH)对放疗致急性放射性直肠炎(acute radiation proctitis,ARP)的预测价值。方法:前瞻性选取2019年5月至2023年5月某院收治的380例CCA IGRT患者,随机分为对照组(n=180)和试验组(n=200)。对2组患者进行随访,统计ARP的发生率。对照组采用剂量体积直方图(dose volume histogram,DVH)评价直肠剂量分布,试验组采用DSH评价直肠剂量分布。使用ROC曲线评价和比较DVH及DSH对ARP的预测价值。采用SPSS 21.0软件进行统计学分析。结果:2组患者ARP的发生率比较差异无统计学意义(P>0.05),直肠剂量分布评价指标差异有统计学意义(P<0.05)。V_(40)、V_(50)、S_(40)和S_(50)对Ⅰ~Ⅳ级ARP发生进行预测时AUC≤0.700,提示低等预测价值(P<0.05);V_(60)和S_(60)对Ⅰ~Ⅳ级ARP发生进行预测时0.700<AUC≤0.900,提示中等预测价值(P<0.05);V_(70)、V_(78)和S_(70)、S_(78)对Ⅰ~Ⅳ级ARP发生进行预测时AUC>0.900,提示高等预测价值(P<0.05)。Delong检验结果显示,DVH和DSH预测Ⅰ~Ⅳ级ARP发生的AUC差异无统计学意义(P均>0.05)。结论:DSH对CCA IGRT致Ⅰ~Ⅳ级ARP发生的预测价值同DVH基本一致,DSH可用于放疗计划系统的补充和优化。Objective To explore the predictive value of dose surface histogram(DSH)in image guided radiotherapy(IGRT)for radiotherapy-induced acute radiation proctitis(ARP)in cervical cancer(CCA).Methods Totally 380 patients with CCA IGRT admitted to some hospital from May 2019 to May 2023 were selected prospectively and randomly divided into a control group(n=180)and an experimental group(n=200).The patients in the 2 groups were followed up and the incidence rates of ARP were counted,and rectal dose distribution was evaluated using dose volume histogram(DVH)in the control group and DSH in the experimental group.The predictive values of DVH and DSH for ARP were evaluated and compared using ROC curves.Statistical analysis was performed using SPSS 21.0 software.Results The two groups did not have statistically significant difference in the incidence rate of ARP(P>0.05),while there were significant differences in the evaluation indicators of the rectal dose distribution(P<0.05).V_(40),V_(50),S_(40) and S_(50) proved to have low predictive values for grade Ⅰ-Ⅳ ARP with AUC≤0.700(P<0.05);V_(60) and S_(60) had moderate predictive values for grade Ⅰ-Ⅳ ARP with AUC greater than 0.700 and less than or equal to 0.900(P<0.05);V_(70),V_(78),S_(70) and S_(78) showed high predictive values for grade Ⅰ-Ⅳ ARP with AUC higher than 0.900(P<0.05).Delong's test results indicated that DVH and DSH had no significant differences in AUC when used to predict grade Ⅰ-Ⅳ ARP(all P>0.05).Conclusion DSH is essentially the same as DVH when used for the prediction of grade Ⅰ-Ⅳ ARP due to CCA IGRT,and thus can be used for the supplementation and optimization of radiotherapy planning systems.

关 键 词：宫颈癌 图像引导放疗 剂量表面积直方图 急性放射性直肠炎 剂量体积直方图 

分 类 号：R318[医药卫生—生物医学工程] R815[医药卫生—基础医学]