宫颈癌调强放疗中膀胱体积改变及其剂量学变化测量
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摘要
目的:测量并研究宫颈癌调强放疗中膀胱体积改变及其剂量学变化。方法:基于锥形束CT(CBCT)图像对膀胱结构进行重新勾画,获取反映实际治疗情况的膀胱形状;将该结构移植至计划CT图像中比较并计算剂量受量,获取体积和剂量学变化测量结果。结果:CBCT图像膀胱体积大体上较计划CT图像小,且随着疗程进行呈减小趋势;受体积变化的影响,CBCT图像膀胱剂量受量大体上较计划CT图像高。膀胱结构和靶区(PTV2)相交体积百分比与Dmean及V50呈强相关关系(相关系数=0.700, 0.785),且具有显著性意义(P=0.000),显示明显线性关系。结论:本研究测量结果可为宫颈癌放疗计划设计中膀胱剂量限量提供参考。
Objective To measure and study the changes in bladder volume and dosimetric variations during intensity-modulated radiotherapy for cervical cancer. Methods The bladder was segmented based on cone beam(CBCT) image to obtain the shape of bladder that reflects the actual treatment condition. The segmented structure was transplanted into a planning CT image for comparison, and the dose was calculated to obtain the changes in bladder volume and dosimetric variations. Results The bladder volume in CBCT image was generally smaller than that in planning CT image, and the bladder volume showed a decreasing trend with the increase of the course of treatment. Because of the effects of volume changes, the bladder dose in CBCT image was generally higher than that in planning CT image. The intersection volume percentage of bladder structure and PTV2 was strongly correlated with Dmeanand V50(correlation coefficient=0.700, 0.785), with statistical significance(P=0.000), which indicated that there was an obvious linear relationship. Conclusion The measurement results of this study provides references for the limitation of bladder dose in radiotherapy plan for cervical cancer.
Objective To measure and study the changes in bladder volume and dosimetric variations during intensity-modulated radiotherapy for cervical cancer. Methods The bladder was segmented based on cone beam(CBCT) image to obtain the shape of bladder that reflects the actual treatment condition. The segmented structure was transplanted into a planning CT image for comparison, and the dose was calculated to obtain the changes in bladder volume and dosimetric variations. Results The bladder volume in CBCT image was generally smaller than that in planning CT image, and the bladder volume showed a decreasing trend with the increase of the course of treatment. Because of the effects of volume changes, the bladder dose in CBCT image was generally higher than that in planning CT image. The intersection volume percentage of bladder structure and PTV2 was strongly correlated with Dmeanand V50(correlation coefficient=0.700, 0.785), with statistical significance(P=0.000), which indicated that there was an obvious linear relationship. Conclusion The measurement results of this study provides references for the limitation of bladder dose in radiotherapy plan for cervical cancer.
引文
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[2] FOLKERT M R, SHIH K K, ABURUSTUM N R, et al. Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate-and high-risk cervical cancer[J]. Gynecol Oncol,2013, 128(2):288-293.
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[4]郁志龙,索志敏,阎瑞敏,等. 240例放射治疗宫颈癌回顾性分析[J].内蒙古医学杂志, 2004, 36(10):786-788.YU Z L, SUO Z M, YAN R M, et al. Retrospective analysis on 240cervical cancer patients treated with radiotherapy[J]. Inner Mongolia Medical Journal, 2004, 36(10):786-788.
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[7] CENGIZ M, GüRDALLI S, SELEK U, et al. Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer:three-dimensional computed tomography plan evaluation[J]. Int J Radiat Oncol Biol Phys, 2008, 70(2):464-468.
[8]吴冰,马广栋,王亮和. IGRT技术在放射治疗摆位中的应用[J].中国医疗设备, 2012, 27(9):122-124.WU B, MA G D, WANG L H. Application of image-guided radiation therapy technology for setup errors in radiotheraphy[J]. China Medical Devices, 2012, 27(9):122-124.
[9]段晶晶,孔为民.放射性膀胱炎的诊治进展[J].医学综述, 2015, 21(14):2588-2590.DUAN J J, KONG W M. The advances of diagnosis and treatment of radiation cystitis[J]. Medical Recapitulate, 2015, 21(14):2588-2590.
[10]AHN P H, CHEN C C, AHN A I, et al. Adaptive planning in intensitymodulated radiation therapy for head and neck cancers:singleinstitution experience and clinical implications[J]. Int J Radiat Oncol Biol Phys, 2011, 80(3):677-685.
[11]PARK S S, YAN D, MCGRATH S, et al. Adaptive image-guided radiotherapy(IGRT)eliminates the risk of biochemical failure caused by the bias of rectal distension in prostate cancer treatment planning:clinical evidence[J]. Int J Radiat Oncol Biol Phys, 2012, 83(3):947-952.
[12]SHIH H A, JIANG S B, ALJARRAH K M, et al. Internal target volume determined with expansion margins beyond composite gross tumor volume in three-dimensional conformal radiotherapy for lung cancer[J]. Int J Radiat Oncol Biol Phys, 2004, 60(2):613-622.
[13]王瑜,曲雅勤,贾晓晶,等.膀胱不同充盈状态下Rapid Arc与IMRT对早期宫颈癌靶区剂量的影响[J].中国肿瘤临床, 2013, 40(17):1064-1067.WANG Y, QU Y Q, JIA X J, et al. Effect of Rapid Arc and IMRT target doses at various bladder filling status on early cervical cancer[J].Chinese Journal of Clinical Oncology, 2013, 40(17):1064-1067.
[14]付庆国,邓烨,杨海明,等.膀胱充盈度对宫颈癌术后放疗靶区照射剂量的影响[J].中国肿瘤临床与康复, 2015, 22(2):167-169.FU Q G, DENG Y, YANG H M, et al. Effect of bladder filling on target dose in cervical cancer post-operative pelvic radiotherapy[J]. Chinese Journal of Clinical Oncology&Rehabilitation, 2015, 22(2):167-169.
[15]李俨,孔令玲.宫颈癌调强放疗中膀胱状态对靶区及危及器官影响[J].安徽医学, 2015, 36(6):656-659.LI Y, KONG L L. Impacts of bladder status on target volume and OAR inintensity-modulated radiotherapy for cervical cance[J]. Anhui Medical Journal, 2015, 36(6):656-659.
[16]吴虹,翟福山,刘明,等.应用CBCT研究膀胱体积大小对直肠癌术后放疗剂量学的影响[J].中国医学物理学杂志, 2013, 30(4):4253-4256.WU H, ZHAI F S, LIU M, et al. Application of CBCT research the influence of bladder volume size on postoperative rectal cancer radiotherapy dosimetry[J]. Chinese Journal of Medical Physics, 2013,30(4):4253-4256.
[17]GUAN H, DONG H. Dose calculation accuracy using cone-beam CT(CBCT)for pelvic adaptive radiotherapy[J]. Phys Med Biol, 2009,54(20):6239.
[18]吴君心,谢志原,林育毅,等.应用锥形束CT对盆腔肿瘤放疗计划靶区外放距离的研究[J].中华放射肿瘤学杂志, 2010, 19(4):328-330.WU J X, XIE Z Y, LIN Y Y, et al. Cone-beam CT scanning in study of setup margin for pelvic carcinoma irradiation[J]. Chinese Journal of Radiation Oncology, 2010, 19(4):328-330.
[19]吴钦宏,李高峰,王婵,等.基于锥形束CT体部肿瘤图像引导放疗的摆位误差分析[J].中华放射肿瘤学杂志, 2012, 21(1):68-71.WU Q H, LI G F, WANG C, et al. Analysis of setup errors on CBCTbased image guided radiation therapy for body tumors patients[J].Chinese Journal of Radiation Oncology, 2012, 21(1):68-71.
[20]胡逸民.肿瘤放射物理学[M].北京:原子能出版社, 1999:487-490.HU Y M. Radiation oncology physics[M]. Beijing:Atomic Energy Press, 1999:487-490.
[2] FOLKERT M R, SHIH K K, ABURUSTUM N R, et al. Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate-and high-risk cervical cancer[J]. Gynecol Oncol,2013, 128(2):288-293.
[3] PAPP Z, CSAPóZ, MAYER A, et al. Wertheim-operation:5-year survival of 501 consecutive patients with cervical cancer[J]. Orvosi Hetilap, 2006, 147(12):537.
[4]郁志龙,索志敏,阎瑞敏,等. 240例放射治疗宫颈癌回顾性分析[J].内蒙古医学杂志, 2004, 36(10):786-788.YU Z L, SUO Z M, YAN R M, et al. Retrospective analysis on 240cervical cancer patients treated with radiotherapy[J]. Inner Mongolia Medical Journal, 2004, 36(10):786-788.
[5] KOKAWA K, TAKEKIDA S, KANIURA S, et al. The incidence,treatment and prognosis of cervical carcinoma in young women:a retrospective analysis of 4 975 cases in Japan[J]. Eur J Gynaecol Oncol, 2010, 31(1):37.
[6] MUNDT A J, LUJAN A E, ROTMENSCH J, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 52(5):1330-1337.
[7] CENGIZ M, GüRDALLI S, SELEK U, et al. Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer:three-dimensional computed tomography plan evaluation[J]. Int J Radiat Oncol Biol Phys, 2008, 70(2):464-468.
[8]吴冰,马广栋,王亮和. IGRT技术在放射治疗摆位中的应用[J].中国医疗设备, 2012, 27(9):122-124.WU B, MA G D, WANG L H. Application of image-guided radiation therapy technology for setup errors in radiotheraphy[J]. China Medical Devices, 2012, 27(9):122-124.
[9]段晶晶,孔为民.放射性膀胱炎的诊治进展[J].医学综述, 2015, 21(14):2588-2590.DUAN J J, KONG W M. The advances of diagnosis and treatment of radiation cystitis[J]. Medical Recapitulate, 2015, 21(14):2588-2590.
[10]AHN P H, CHEN C C, AHN A I, et al. Adaptive planning in intensitymodulated radiation therapy for head and neck cancers:singleinstitution experience and clinical implications[J]. Int J Radiat Oncol Biol Phys, 2011, 80(3):677-685.
[11]PARK S S, YAN D, MCGRATH S, et al. Adaptive image-guided radiotherapy(IGRT)eliminates the risk of biochemical failure caused by the bias of rectal distension in prostate cancer treatment planning:clinical evidence[J]. Int J Radiat Oncol Biol Phys, 2012, 83(3):947-952.
[12]SHIH H A, JIANG S B, ALJARRAH K M, et al. Internal target volume determined with expansion margins beyond composite gross tumor volume in three-dimensional conformal radiotherapy for lung cancer[J]. Int J Radiat Oncol Biol Phys, 2004, 60(2):613-622.
[13]王瑜,曲雅勤,贾晓晶,等.膀胱不同充盈状态下Rapid Arc与IMRT对早期宫颈癌靶区剂量的影响[J].中国肿瘤临床, 2013, 40(17):1064-1067.WANG Y, QU Y Q, JIA X J, et al. Effect of Rapid Arc and IMRT target doses at various bladder filling status on early cervical cancer[J].Chinese Journal of Clinical Oncology, 2013, 40(17):1064-1067.
[14]付庆国,邓烨,杨海明,等.膀胱充盈度对宫颈癌术后放疗靶区照射剂量的影响[J].中国肿瘤临床与康复, 2015, 22(2):167-169.FU Q G, DENG Y, YANG H M, et al. Effect of bladder filling on target dose in cervical cancer post-operative pelvic radiotherapy[J]. Chinese Journal of Clinical Oncology&Rehabilitation, 2015, 22(2):167-169.
[15]李俨,孔令玲.宫颈癌调强放疗中膀胱状态对靶区及危及器官影响[J].安徽医学, 2015, 36(6):656-659.LI Y, KONG L L. Impacts of bladder status on target volume and OAR inintensity-modulated radiotherapy for cervical cance[J]. Anhui Medical Journal, 2015, 36(6):656-659.
[16]吴虹,翟福山,刘明,等.应用CBCT研究膀胱体积大小对直肠癌术后放疗剂量学的影响[J].中国医学物理学杂志, 2013, 30(4):4253-4256.WU H, ZHAI F S, LIU M, et al. Application of CBCT research the influence of bladder volume size on postoperative rectal cancer radiotherapy dosimetry[J]. Chinese Journal of Medical Physics, 2013,30(4):4253-4256.
[17]GUAN H, DONG H. Dose calculation accuracy using cone-beam CT(CBCT)for pelvic adaptive radiotherapy[J]. Phys Med Biol, 2009,54(20):6239.
[18]吴君心,谢志原,林育毅,等.应用锥形束CT对盆腔肿瘤放疗计划靶区外放距离的研究[J].中华放射肿瘤学杂志, 2010, 19(4):328-330.WU J X, XIE Z Y, LIN Y Y, et al. Cone-beam CT scanning in study of setup margin for pelvic carcinoma irradiation[J]. Chinese Journal of Radiation Oncology, 2010, 19(4):328-330.
[19]吴钦宏,李高峰,王婵,等.基于锥形束CT体部肿瘤图像引导放疗的摆位误差分析[J].中华放射肿瘤学杂志, 2012, 21(1):68-71.WU Q H, LI G F, WANG C, et al. Analysis of setup errors on CBCTbased image guided radiation therapy for body tumors patients[J].Chinese Journal of Radiation Oncology, 2012, 21(1):68-71.
[20]胡逸民.肿瘤放射物理学[M].北京:原子能出版社, 1999:487-490.HU Y M. Radiation oncology physics[M]. Beijing:Atomic Energy Press, 1999:487-490.