CAJ | 학술논문

目的：比较不同放疗技术及膀胱充盈状态对宫颈癌术后放疗靶区剂量的分布及正常组织受照体积的影响，探讨宫颈癌术后放疗的理想模式。方法：选择10例宫颈癌术后患者，分别进行膀胱充盈状态及排空状态下模拟CT扫描，处方剂量50 Gy，分别制定双弧快速旋转调强计划（RapidArc）及7野调强适形计划（IMRT）。计划的实施均为Varian公司的TrueBeam直线加速器。利用每个计划的剂量一体积直方图（DVH）进行数据分析。结果：膀胱充盈状态下IMRT及RapidArc的靶区均匀性指数分别为1.05及1.04（P>0.05），膀胱排空状态下IMRT及RapidArc的靶区均匀性指数均为1.04（P>0.05）。膀胱充盈状态下，IMRT及Rapi-dArc的靶区适形度指数分别为0.71及0.73（P>0.05）。膀胱排空状态下，IMRT及RapidArc的靶区适形度指数分别为0.71及0.73（P>0.05）。小肠及膀胱接受30 Gy及40 Gy剂量的体积，膀胱充盈状态下优于膀胱排空状态，两种技术间无显著性差异。直肠及膀胱接受30 Gy剂量的体积IMRT优于RapidArc。RapidArc在治疗时间及机器跳数上明显优于IMRT。结论：7f-IMRT及双弧RapidArc在靶区适形度及均匀性方面无显著性差异；无论何种技术，膀胱充盈状态对小肠及膀胱的保护均优于膀胱排空状态；IMRT在直肠及膀胱的保护方面均优于RapidArc，RapidArc在机器跳数及治疗时间上优于IMRT。
목적：비교불동방료기술급방광충영상태대궁경암술후방료파구제량적분포급정상조직수조체적적영향，탐토궁경암술후방료적이상모식。방법：선택10례궁경암술후환자，분별진행방광충영상태급배공상태하모의CT소묘，처방제량50 Gy，분별제정쌍호쾌속선전조강계화（RapidArc）급7야조강괄형계화（IMRT）。계화적실시균위Varian공사적TrueBeam직선가속기。이용매개계화적제량일체적직방도（DVH）진행수거분석。결과：방광충영상태하IMRT급RapidArc적파구균균성지수분별위1.05급1.04（P>0.05），방광배공상태하IMRT급RapidArc적파구균균성지수균위1.04（P>0.05）。방광충영상태하，IMRT급Rapi-dArc적파구괄형도지수분별위0.71급0.73（P>0.05）。방광배공상태하，IMRT급RapidArc적파구괄형도지수분별위0.71급0.73（P>0.05）。소장급방광접수30 Gy급40 Gy제량적체적，방광충영상태하우우방광배공상태，량충기술간무현저성차이。직장급방광접수30 Gy제량적체적IMRT우우RapidArc。RapidArc재치료시간급궤기도수상명현우우IMRT。결론：7f-IMRT급쌍호RapidArc재파구괄형도급균균성방면무현저성차이；무론하충기술，방광충영상태대소장급방광적보호균우우방광배공상태；IMRT재직장급방광적보호방면균우우RapidArc，RapidArc재궤기도수급치료시간상우우IMRT。
Objective:To evaluate the performance of RapidArc technique on cervical cancer patients with various filling status of the bladder. Methods: Conventional fixed field intensity modulation radiated therapy (IMRT) is used as the benchmark. In 10 fe-males suffering from cervical cancer, two CT scans were performed for treatment planning:one with an empty bladder and the other with filled bladder. The prescribed dose was 50 Gy. The images of that with an evacuated bladder and that with filled bladder were planned in the dual-arc RapidArc and the 7-field IMRT, respectively. The implementor of the plan was the Varian TrueBeam linear ac-celerator. Dose-volume histogram was used to evaluate the data from each plan. Results:When the bladder was filled, IMRT and Rapi-dArc homogeneity were 1.05 and 1.04 (P>0.05), respectively. When the bladder was emptied, the homogeneity was 1.04 for both plans (P>0.05). With or without bladder filling, the conformity index was 0.71 and 0.73 for IMRT and RapidArc (P>0.05), respectively. The effect of V30 and V40 (volume for receiving doses of 30 and 40 Gy) on the intestine and the bladder was more favorable in a full than in an empty bladder. No significant difference between the two plans was observed. IMRT exhibited improved V30 on the rectum and on the bladder. RapidArc was much better in terms of monitor unit (MU) and deliver time. Conclusion:No significant differences in the homogeneity and conformity index between dual-arc RapidArc and 7-field IMRT were observed. Filled bladder is better than empty bladder in intestine and bladder protection in both RapidArc and IMRT. IMRT is better on V30 of the rectum and the bladder, whereas RapidArc improved MU and deliver time.