李小文,高冬梅,阿依努尔·色义提

• 1:新疆医科大学附属肿瘤医院妇科肿瘤放疗二病区
• 2:新疆医科大学附属肿瘤医院妇外五科

摘要(Abstract)：

目的探讨CT引导的三维插植腔内高剂量率后装放疗(HDR-ISBT)在宫颈癌治疗中对膀胱、直肠的影响。方法随机选取25例中晚期宫颈癌病例为试验组,设计第一程行体外盆腹腔三维适形调强放疗(IMRT)照射计划,处方剂量45~50Gy,共18~25次,在完成处方剂量20~30Gy后加入CT引导的三维插植腔内高剂量率后装放疗。另20例加入常规单管后装放疗计划为对照组,利用体积剂量直方图(DVH)分别评价膀胱壁、直肠壁的受照剂量,比较两组间膀胱壁、直肠壁受照剂量的差别。结果 (1)CT引导的高剂量率三维插植腔内后装治疗计划中,膀胱壁的平均剂量在肿瘤直径<4cm时,0.1、1、2、5cm3和10cm3分别为62.82、55.20、51.85、46.01Gy和40.26Gy;在肿瘤直径≥4cm时,0.1、1、2、5cm3和10cm3分别为66.63、58.49、54.70、48.26Gy和41.82Gy。直肠壁平均剂量在肿瘤直径<4cm时,0.1、1、2、5cm3和10cm3分别为59.98、52.96、48.63、40.20Gy和30.74Gy;在肿瘤直径≥4cm时,0.1、1、2、5cm3和10cm3分别为59.74、46.64、41.38、32.75Gy和21.98Gy。(2)常规后装膀胱壁平均剂量在肿瘤直径<4cm时,0.1、1、2、5cm3和10cm3分别为70.24、66.58、60.64、53.49Gy和46.36Gy;在肿瘤直径≥4cm时,0.1、1、2、5cm3和10cm3分别为107.24、86.45、79.15、66.82Gy和55.39Gy。常规后装直肠壁的平均剂量在肿瘤直径<4cm时0.1、1、2、5cm3和10cm3分别为58.74、49.12、45.59、39.53Gy和32.85Gy;在肿瘤直径≥4cm时,0.1、1、2、5cm3和10cm3分别为63.90、58.02、55.20、50.23Gy和44.14Gy。在肿瘤直径<4cm或≥4cm时,两组膀胱壁及直肠壁受照剂量差异均有统计学意义(P<0.05)。结论在宫颈癌CT引导的三维插植腔内后装计划设计中,膀胱壁、直肠壁受照剂量明显低于常规后装放疗。对膀胱、直肠损伤减少,从而可能降低膀胱、直肠并发症发生概率。

关键词(KeyWords)： 宫颈肿瘤;组织间放疗;放射治疗剂量;放射治疗计划

Abstract:

Keywords:

基金项目(Foundation): 新疆维吾尔自治区自然科学基金(2012211A047)

作者(Author): 李小文,高冬梅,阿依努尔·色义提

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