第三代宫颈癌腔内联合组织间插植近距离放疗施源器模板的应用  

Application of the Third-generation Intracavitary Combined With Interstitial Brachytherapy Applicator Template for Cervical Cancer

作　　者：周祥 黄晓丹 徐慧敏 欧阳翼[2] ZHOU Xiang;HUANG Xiaodan;XU Huimin;OUYANG Yi(Department of Oncology,YiYang Central Hospital,YiYang 413000,China;Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]湖南省益阳市中心医院肿瘤科,湖南益阳413000 [2]中山大学肿瘤防治中心放疗科,广东广州510060

出　　处：《中山大学学报(医学科学版)》2025年第2期354-360,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州地区临床特色技术项目(2023P‐TS26);新锐肿瘤支持治疗课题研究项目(cphcf‐2023‐119)。

摘　　要：【目的】评估第三代适用于局部晚期宫颈癌的腔内联合组织间插植近距离放疗(IC-ISBT)施源器模板,以期提升治疗效果。【方法】对中山大学肿瘤防治中心在2023年01月至2023年10月期间收治的IB3-ⅣB期宫颈癌患者进行回顾性研究,收集并分析这些患者接受外照射治疗前后的磁共振影像资料。根据外照射后肿瘤残留情况,勾画出高危临床靶区(HR-CTV),据此设计了一种第三代的IC-ISBT施源器模板。进一步比较使用该施源器模板(模板插植组)与传统徒手插植方式(徒手插植组)在治疗宫颈癌方面的剂量学和疗效差异。通过统计学方法分析两组数据,以检验两种方法的有效性及安全性。【结果】第三代施源器模板能够适配不同的宫颈结构,优化针道布局。模板插植组肿瘤体积明显大于徒手插植组,且具有统计学差异。在剂量学覆盖(V100%)方面,与徒手插植组相比,模板插植组显示出显著的统计学差异,表现出更优的剂量覆盖。同时,第三代模板在直肠和乙状结肠的保护方面显示出优势,潜在降低高剂量点,而在膀胱的剂量学方面与徒手插植方法没有显著差异。两组间的宫颈原发灶缓解率差异无统计学意义。【结论】第三代IC-ISBT施源器模板设计科学合理,尤其适用于肿瘤体积较大、分期较晚的患者。其操作简便,重复性强,在剂量分布和周围关键器官保护方面表现出明显优势,具备作为常规治疗模板推广应用的潜力。【Objective】To evaluate a third-generation applicator template for intracavitary combined with interstitial brachytherapy(IC-ISBT)suitable for locally advanced cervical cancer,aiming to improve therapeutic outcomes.【Methods】A retrospective study was conducted on patients with stage IB3-ⅣB cervical cancer treated at Sun Yat-sen University Cancer Center from January 2023 to October 2023.Magnetic resonance imaging data before and after external beam radiation therapy were collected and analyzed.According to the residual tumor after external beam radiation,high-risk clinical target volumes(HR-CTV)were delineated,based on which a third-generation IC-ISBT applicator template was designed.The dosimetric and therapeutic differences between using this applicator template(template implantation group)and traditional freehand interstitial implantation(freehand implantation group)were further compared.Statistical methods were used to analyze the data from both groups to test the efficacy and safety of the two approaches.【Results】The third-generation applicator template could accommodate different cervical structures and optimize needle path layout.The tumor volume in the template implantation group was significantly larger than in the freehand implantation group,showing statistical differences.In terms of dosimetric coverage(V 100%),the template implantation group exhibited significant statistical differences compared with the freehand implantation group,demonstrating superior dose coverage.Additionally,the third-generation template showed advantages in protecting the rectum and sigmoid colon by potentially reducing high dose points,while there were no significant differences in bladder dosimetry between the two methods.The primary cervical lesion remission rates were similar between the two groups.【Conclusion】The third-generation IC-ISBT applicator template is scientifically and rationally designed,especially for patients with larger tumor volumes and later stages.It is easy to operate,highly reproducible,an

关 键 词：宫颈癌 近距离放疗(IC-ISBT) 施源器模板 徒手插植 剂量学 

分 类 号：R737.33[医药卫生—肿瘤]