CAJ | 학술논문

目的：探讨前列腺癌患者全盆腔照射后靶区与正常组织（膀胱和直肠）的体积变化情况。方法选择我科2011年1月~2013年12月全盆腔照射的16例前列腺癌患者，根据其初次定位时的CT图像和全盆腔照射50 Gy以后重新扫描所得到的CT图像，勾画临床靶区（CTV）体积，膀胱和直肠的体积以及计划靶区（PTV）上下各增加5 cm范围内的外轮廓体积，作为评价患者体重变化的指标。分别比较其CTV、膀胱、直肠和外轮廓的体积变化并进行统计学分析。再选择其中5位患者，比较一周之内的膀胱体积变化情况，作出变化曲线。结果与初次定位相比，二次定位时CTV平均体积、直肠平均体积变化显著（P＜0.05），膀胱平均体积、外轮廓平均体积变化不显著（P＞0.05），但个体膀胱体积变化很大，最大为首次定位时的2.5倍。结论患者在治疗过程中有必要进行合理次数的图像引导，以及二次或者两次以上的模拟定位和计划修改。
목적：탐토전렬선암환자전분강조사후파구여정상조직（방광화직장）적체적변화정황。방법선택아과2011년1월~2013년12월전분강조사적16례전렬선암환자，근거기초차정위시적CT도상화전분강조사50 Gy이후중신소묘소득도적CT도상，구화림상파구（CTV）체적，방광화직장적체적이급계화파구（PTV）상하각증가5 cm범위내적외륜곽체적，작위평개환자체중변화적지표。분별비교기CTV、방광、직장화외륜곽적체적변화병진행통계학분석。재선택기중5위환자，비교일주지내적방광체적변화정황，작출변화곡선。결과여초차정위상비，이차정위시CTV평균체적、직장평균체적변화현저（P＜0.05），방광평균체적、외륜곽평균체적변화불현저（P＞0.05），단개체방광체적변화흔대，최대위수차정위시적2.5배。결론환자재치료과정중유필요진행합리차수적도상인도，이급이차혹자량차이상적모의정위화계화수개。
Objective To investigate the changes of clinical target volume and normal tissue volume for patients with prostate cancer in the whole pelvic irradiation.Methods According to the CT images collected from the initial IMRT positioning and the secondary IMRT positioning after the whole pelvic irradiation (50 Gy) of 16 patients with prostate cancer treated from Jan 2011 to Dec 2013 in our hospital, clinical target volume (CTV),bladder volume and rectum volume as well as the external volume which was within the extended scope (the extended distance was 5 cm) of planning target volume (PTV) were delineated to evaluate the body weight changes of the patients. The changes of the above parameters were also compared with the statistical method. Then the changes of rectum volume of 5 patients were compared while the changing curves of rectum volumes were drawed within one week.Results There were signiifcant differences between the initial IMRT positioning and the secondary IMRT positioning on the average CTV volume and the average rectum volume (P<0.05) while there were no signiifcant differences between the initial IMRT positioning and the secondary IMRT positioning on the average bladder volume and the average external volume (P>0.05). However, the maximum bladder volume of one patient in the secondary IMRT positioning was 2.5 times than that in the initial IMRT positioning, which indicated that the individualized changes of bladder volume were signiifcant.Conclusion Image guidance with reasonable frequency, the secondary IMRT positioning and plan modiifcation should be used in the whole pelvic irradiation of patients with prostate cancer.