CAJ | 학술논문

目的研究宫颈癌术后盆腔三维适形放疗(3DCRT)和调强放疗(IMRT)技术建立方法,进行三维剂量学研究,找出适合临床应用的最佳方案.方法选择宫颈癌根治性全子宫切除术及盆腔淋巴结清扫术后具有术后盆腔放疗指征的10例患者行下列研究:(1)放疗最佳体位(俯卧位或仰卧位)比较;(2)放疗时膀胱充盈状况与正常组织受照体积相关性研究;(3)放疗射野移动误差测定和靶区勾画;(4)3DCRT及IMRT计划设计及优化比较.结果采用俯卧位固定方式患者治疗中心点的摆位误差在前后、头脚及左右方向的误差均在5 mm以内,而采用仰卧位误差均>5mm,两者差异有统计学意义.俯卧位、膀胱充盈状态时膀胱受照体积百分比较之膀胱处于排空状态时为小,且小肠和结肠受照体积百分比较之膀胱处于排空状态时为小.俯卧位、膀胱充盈状态时射野片显示放疗过程中射野移动的总误差为(7.4±1.6)mm.采用95%可信区间,CTV至PTV的外放边界可定为1cm.3DCRT 3、4、5和6个射野下PTV适形指数分别为0.46、0.67、0.68和0.68,4个以上射野数目的增加不再显著改善靶区分布和减少正常组织受照体积百分比.IMRT 5、7、9、11和13个射野下PTV适形指数分别为0.75、0.83、0.84、0.85和0.85,9个以上增加射野数目不再显著改善靶区分布和减少正常组织受照体积百分比.结论宫颈痛术后盆腔放疗者俯卧位固定方式因摆位误差小而优于仰卧位固定方式,膀胱处于充盈状态因可使膀胱及肠道受照体积百分比减少而优于膀胱排空状态.对宫颈癌术后盆腔3DCRT和IMRT计划的三维剂量学研究表明,3DCRT以4个射野数计划为优,IMRT以9个射野数计划为优.
목적 연구궁경암술후분강삼유괄형방료(3DCRT)화조강방료(IMRT)기술건립방법,진행삼유제량학연구,조출괄합림상응용적최가방안.방법 선택궁경암근치성전자궁절제술급분강림파결청소술후구유술후분강방료지정적10례환자행하렬연구:(1)방료최가체위(부와위혹앙와위)비교;(2)방료시방광충영상황여정상조직수조체적상관성연구;(3)방료사야이동오차측정화파구구화;(4)3DCRT급IMRT계화설계급우화비교.결과 채용부와위고정방식환자치료중심점적파위오차재전후、두각급좌우방향적오차균재5 mm이내,이채용앙와위오차균>5mm,량자차이유통계학의의.부와위、방광충영상태시방광수조체적백분비교지방광처우배공상태시위소,차소장화결장수조체적백분비교지방광처우배공상태시위소.부와위、방광충영상태시사야편현시방료과정중사야이동적총오차위(7.4±1.6)mm.채용95%가신구간,CTV지PTV적외방변계가정위1cm.3DCRT 3、4、5화6개사야하PTV괄형지수분별위0.46、0.67、0.68화0.68,4개이상사야수목적증가불재현저개선파구분포화감소정상조직수조체적백분비.IMRT 5、7、9、11화13개사야하PTV괄형지수분별위0.75、0.83、0.84、0.85화0.85,9개이상증가사야수목불재현저개선파구분포화감소정상조직수조체적백분비.결론 궁경통술후분강방료자부와위고정방식인파위오차소이우우앙와위고정방식,방광처우충영상태인가사방광급장도수조체적백분비감소이우우방광배공상태.대궁경암술후분강3DCRT화IMRT계화적삼유제량학연구표명,3DCRT이4개사야수계화위우,IMRT이9개사야수계화위우.
Objective To establish the methods of three-dimensional eonformal(3DCRT) and intensity-modulated radiotherapy(IMRT) for whole pelvic irradiation in post-hysterectomy cervical carcinoma, And to optimize the methods for clinical practice. Methods Between 2004 and 2005,10 patients with cervical carcinoma who underwent hysterectomy with high risk of recurrence were selected for this study. The following observations and measurements were used for the study: Set-up errors with supine or prone position were measured to determine appropriate immobilization position. Influence of full and empty bladder on irradiated normal tissue volume was measured. Treatment errors were detected and CTV/PTV were then delineated. 3DCRT and IMRT planning and comparison were applied. Results The set-up error was within 5 mm of three dimensions in prone position and more than 5 mm in supine position, the difference of which was statistically significant. The percentage of irradiated volume of the bladder and bowel was smaller when the bladder was full comparing with empty bladder. In prone position and with full bladder,portal films showed the movement of isocenter in three directions. The total uncertainty was [7.4±1.6]mm. For 95% confidence interval,the margin from CTV to PTV was 1 cm. CIPTV for 3,4,5,and 6 fields 3DCRT was 0.46,O. 67, O. 68, and O. 68, respectively. When beyond 4 fields, the advantage of adding fields was not significant.Four fields planning was feasible for clinical practice. CI for 5,7,9,11 ,and 13 fidds IMRT was 0.75,0.83, 0.84,0.85 ,and 0.85 ,respectively. When beyond 9 fields,the advantage of adding fields was not significant. Nine fields planning was feasible for clinical practice. Conclusions For whole pelvic radiotherapy for post-hysterectomy cervical carcinoma,prone position was better than supine position for immobilization due to smaller set-up errors. The full bladder is recommended during radiotherapy, planning,For clinical practice,4 fields planning is feasible in 3DCRT while 9 fields planning is feasible in IMRT.