摘要
目的:分析采用调强放射治疗(Intensity modulated radiation therpy,IMRT)技术治疗的宫颈癌患者不同的膀胱充盈程度以及治疗期间病变退缩对宫颈动度的影响,为临床应用提供参考。方法:收集IIB期以上的初治宫颈癌患者10例,分成两组,第一组为在直肠保持充盈状态下,分别在膀胱充盈,半充盈和空虚的三种状态下做带膜CT,分析宫颈病变及宫体在膀胱不同充盈状态下的动度。第二组为在自然状态下观察治疗期间宫颈病变缩小对宫颈病变和宫体动度的影响。结果:(1)膀胱不同充盈状态对宫颈病变动度的影响为在左右方向运动幅度最小,运动最大幅度为1.48mm;在前后方向其运动幅度大,随着膀胱充盈状态的增加,宫颈病变主要向身体的背侧运动,最大幅度为19.10mm;在头脚方向其运动幅度大,随着膀胱充盈状态的增加,宫颈病变主要向身体的脚方向运动,最大幅度为18.50mm。对宫体的动度的影响为在左右方向其运动幅度最小,运动最大幅度为3.43mm;在前后方向其运动幅度大,随着膀胱充盈状态的增加,宫体主要向身体的背侧运动,最大幅度为20.83mm;在头脚方向其运动幅度大,随着膀胱充盈状态的增加,宫体主要向身体的头方向运动,最大幅度为12.23mm。(2)宫颈病变在治疗前、治疗中(外照射治疗20Gy完成后)动度差别不大,宫体在治疗过程中运动变化大,最大差值为30.12mm。结论:(1)随着膀胱充盈程度的增加,宫颈病变主要向后下方运动;宫体主要向后上方运动;(2)在治疗过程中,宫颈病变退缩对其动度的影响小但对宫体的影响大;(3)宫颈癌IMRT治疗时,CTV至PTV的外放边界是不均匀的,需要考虑器官的动度以及病变退缩等因素。
Objective： To analyze the impact of intensity-modulated radiotherapy （IMRT） to the motion of cervix for the cervical cancer patients with different states of bladder and the cervix cancer regression, and to provide reference for the clinical application. Methods： 10 initial cervical caner patients with IIB stage or above were enrolled in this study, and the staging was performed according to the international Federation of Gynecology and Obstetrics （ FIGO）. Patients were allocated into two groups. The rectum in first group was kept in the full states, receiving CT scanning with thermoplastic model with full, semi-full and empty states of bladder, SPSS15.0 statistical software was used to analyze the cervix cancer and uterus motion in differrent states of bladder. In the second group, the cervix cancer and uterus motion were analyzed when the tumor was shrunk after the radiotherapy in the natural states. Resuits： （ 1 ） when the rectum was kept in full states, different states of bladder had different effects on the ,lotion of cervix cancer. In the direction of R/L （Right/Left）, the motion was minimum; in the direction of A/P （Anteriorly/Posteriorly） , when bladder＇ s volume was gradually increased, the cervix gradually moved to the posterior. The maximum motion was 19.10mm; in the direction of S/ I（ Superiorly/Inferiorly）, when the bladder＇s volume was gradually increased, the cervix gradually moved to the direction of inferior.The maximum motion was 18.50mm. When the rectum was kept in full states, different states of bladder had different effects on the motion of uterus. In the direction of R/L, the motion was minimum ; in the direction of A/P, when bladder＇ s volume gradually increased, the uterus gradually moved to the posterior. The maximum motion was 20.83mm; in the direction of S/I, when the bladder＇s volume gradually increased, the uterus gradually moved to the direetion of superior. The maximum motion was 12.23mm. （2）when we used IMRT to treat cervical cancer, the cervix regression was considerably evident. During the treatment, the motion of the cervix cancer was small, the motion of uterus was large, and gradually moved to the inferior. The maximum motion was 30.12mm. Conclusion： （ 1 ） The cervix cancer gradually moves to the Posterior-lynferiorly direction with baldder＇ s volume gradually increased. At the same time, the uterus gradually moves to the Posteriorly-Superiorly direction. （2） During the course of radiotherapy, the cervix regression has small effects on cervix cancer motion, whereas has large effects on the uterus mostly in the S/I direction. （3） When we use IMRT to treat cevical cancer, we must consider the organ motion and the tumor＇ s regression. The margins of CTV to PTV are unequal.
出处
《肿瘤预防与治疗》
2010年第1期27-31,共5页
Journal of Cancer Control And Treatment
基金
四川省卫生厅2007年重大科研课题(编号:2007026号)
关键词
宫颈癌
调强放射治疗
动度
膀胱
Cervical Cancer
Intensity-Modulated Radiotherapy （IMRT）
Motion
Bladder
