CAJ | 학술논문

目的比较调强放疗( IMRT)、三维适形放疗(3D-CRT)在子宫颈癌放疗中危及器官( OAR)的剂量学差异.方法对36例子宫颈癌患者均同时制定IMRT放疗计划和3D-CRT放疗计划,临床靶区(CTV)包括子宫、子宫颈、阴道等原发肿瘤区域及其以下的淋巴结引流区域.淋巴结引流区的勾画主要以盆腔伴行血管外放1.0 cm得到,闭孔淋巴结从骨盆内缘内外扩1.8 cm,CTV不包括骨盆组织.比较计划靶区(PTV)在45 Gy和50 Gy情况下各敏感组织的受照剂量-体积情况.PTV由CTV边界在三维头脚方向外放1.0 cm,其他方向外放0.7 cm得到.结果通过剂量体积直方图比较两组计划敏感组织的受照体积变化,在处方剂量45 Gy剂量时,30、40、45 Gy的敏感组织剂量体积IMRT计划均优于3D-CRT计划.在盆壁淋巴结引流区剂量达到50 Gy时,IMRT计划敏感组织受量亦优于45 Gy时3D-CRT计划.结论子宫颈癌IMRT可以使周围OAR得到较好的保护,具备临床应用的剂量学优势.
목적 비교조강방료( IMRT)、삼유괄형방료(3D-CRT)재자궁경암방료중위급기관( OAR)적제량학차이.방법 대36례자궁경암환자균동시제정IMRT방료계화화3D-CRT방료계화,림상파구(CTV)포괄자궁、자궁경、음도등원발종류구역급기이하적림파결인류구역.림파결인류구적구화주요이분강반행혈관외방1.0 cm득도,폐공림파결종골분내연내외확1.8 cm,CTV불포괄골분조직.비교계화파구(PTV)재45 Gy화50 Gy정황하각민감조직적수조제량-체적정황.PTV유CTV변계재삼유두각방향외방1.0 cm,기타방향외방0.7 cm득도.결과 통과제량체적직방도비교량조계화민감조직적수조체적변화,재처방제량45 Gy제량시,30、40、45 Gy적민감조직제량체적IMRT계화균우우3D-CRT계화.재분벽림파결인류구제량체도50 Gy시,IMRT계화민감조직수량역우우45 Gy시3D-CRT계화.결론 자궁경암IMRT가이사주위OAR득도교호적보호,구비림상응용적제량학우세.
Objective To compare the dosimetric difference on organ at risk (OAR) in intensitymodulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3D-CRT) in treatment with cervical carcinoma. Methods 36 cases of cervical cancer patients accepted radiotherapy both on IMRT and 3D-CRT in the same time,clinical target volume (CTV) focused on primary tumor and its lymphatic drainage area.Lymphatic drainage area was determined as follows:1.0 cm extension were added to the margin of pelvic vessels,the obturator lymph nodes region was extended by 1.8 cm from the pelvis inner margin.CTV does not include pelvic tissue. Data of dose distribution and irradiation volume of OAR on the basis of distributing on 45 Gy and 50 Gy were analyzed individually. The margins of planning target volume (PTV) was obtained based on CTV margins by which added 1.0 cm extension in inferior and superior directions,0.7 cm were added in all other directions. Results With the comparison of variety on irradiation volume of organs at risk (OAR) by DVH in both groups,underlying the treatment dose 45 Gy,the individual volume of D30,D40 and D45 were all lesser in IMRT plan than that of 3D-CRT plan. Even on the dose 50 Gy at pelvic wall lymph nodes regions,the volume of OAR was lesser than that in 3D-CRT plan.Conclusion In the radiotherapy of cervical cancer,IMRT should have improved protections for tumor surrounding OAR which has domestic superiority in clinical application.