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中国癌症防治杂志

中国癌症防治杂志 ›› 2018, Vol. 10 ›› Issue (1): 38-41.doi: 10.3969/j.issn.1674-5671.2018.01.08

• 临床研究 • 上一篇    下一篇

宫颈癌术后限定骨盆骨髓剂量调强放疗剂量学研究

  

  1. 焦作煤业（集团）有限责任公司中央医院放疗科
  • 出版日期:2018-02-25 发布日期:2018-03-23

Dosimetric study of bone marrow sparing intensity modulated radiotherapy for patients with cervical cancer after hysterectomy

  • Online:2018-02-25 Published:2018-03-23

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摘要：

目的 比较非限定骨髓剂量的调强放疗（intensity modulated radiotherapy，IMRT）和限定骨髓剂量的调强放疗（bone marrow sparing intensity modulated radiotherapy，BMS-IMRT）在宫颈癌术后靶体积剂量覆盖及危及器官保护中的差异，探讨BMS-IMRT治疗计划的临床应用价值。方法 对13例宫颈癌术后患者进行CT模拟定位，在医师工作站勾画临床靶体积（clinical target volum，CTV），CTV 均匀外扩1 cm 生成计划靶体积（planning target volum，PTV），勾画小肠、直肠、膀胱、骨髓等危及器官（organ at risk，OAR）。利用Monaco 5.11计划系统设计IMRT和BMS-IMRT两种治疗计划，PTV 95％体积要求达到处方剂量50 Gy，比较靶区各项指标及OAR体积剂量参数。结果 BMS-IMRT计划的靶区剂量均匀性不如IMRT，靶区平均剂量提高0.36%，差异有统计学意义（P<0.05）。BMS-IMRT治疗计划的通过率下降，其中绝对剂量通过率差异有统计学意义［（99.466±0.150）% vs （99.750±0.175）%，t=3.576，P=0.016］。BMS-IMRT治疗计划中骨髓的V10、V20、V30、V40分别比IMRT下降1.99％、10.30％、13.79％、26.46％，差异有统计学意义（P<0.05）。两种治疗计划小肠V45和V30、膀胱V40、直肠V40和V50等差异无统计学意义（P>0.05）。结论 宫颈癌术后BMS-IMRT和IMRT计划剂量差别不明显，BSM-IMRT可降低骨髓剂量受照体积，值得临床推广应用。

关键词: 子宫肿瘤, 限定骨髓剂量, 调强放疗, 剂量学

Abstract:

Objective The purpose of this study was to investigate the dosimetric benefits of bone marrow-sparing intensity-modulated radiotherapy （BMS-IMRT） compared with conventional intensity-modulated radiotherapy （IMRT） without dose constraint of pelvic bone marrow in the treatment of patients with cervical cancer after hysterectomy. Methods 13 patients with cervical cancer after hysterectomy were selected. BMS-IMRT and IMRT planns were designed for every patient respectively. The clinical target volume （CTV）was delineated at the doctor workstation，and CTV was uniformly expanded 1 cm to generate the planned target volume（PTV）. The organs at risk included small bowel，rectum，bladder，femoral head and bone marrow. The prescribed dose to the PTV was 50 Gy. All plans had 95% of PTV volume received the prescription. The dosimetric comparisons of target and organs at risk were performed among two plans. Results BMS-IMRT was inferior than IMRT in terms of HI，the average target dose increased by 0.36%（P<0.05）.The planned pass rate has declined，pass rate of absolute dose had significant difference ［（99.466±0.150）% vs（99.750±0.175）%，t=3.576，P=0.016］. When compared with IMRT，V10，V20，V30 and V40 of bone marrow in BMS-IMRT were reduced by 1.99％，10.30％，13.79％ and 26.46％，respectively（P<0.05）. There were no significant differences in theV45 and V30 of small bowel，the V40 of bladder，the V40 and V50 of rectum between the two plans（P>0.05）. Conclusions For patients with cervical cancer after hysterectomy，BSM-IMRT can reduce the bone marrow irradiated volume.

Key words: Uterine neoplasms, Bone marrow-sparing, Intensity modulated radiation therapy, Dosimetry