CAJ | 학술논문

目的探讨局限期前列腺癌精囊临床靶区(CTV)的勾画范围.方法 114例接受根治性放疗的局限期中、高危前列腺癌患者行定位CT扫描,对比欧美指南共同参考的精囊亚临床灶范围的病理结果,得到精囊长轴距起点1.0 cm和2.0 cm处的精囊截面,确定精囊近端1.0 cm和2.0cm的解剖范围,然后测量两个截面距精囊起始平面的最大垂直距离(D10H、D20H)和最小垂直距离(D10L、D20L),并与欧美指南规定的勾画范围对比,进一步指导高剂量区精囊CTV的勾画范围.结果D10H、D10L、D20H、D20L平均值分别为(10.6±1.8)、(2.1±2.0)、(17.2±2.9)和(8.8±2.7)mm,包括95％病例的D10H和D20H分别为13.5和21.5 mm,多因素分析显示,D10H和D20H与精囊倾斜角度和横断面最大径相关(R2=0.64和0.77,P＜0.01).对比欧美指南规定的精囊靶区勾画方法,即自精囊起始平面开始沿人体长轴方向垂直向上勾画1.0 cm或2.0 cm作为CTV时,分别有65.8％(75/114)及17.5％(20/114)的病例无法完全包含根部1.0 cm或2.0 cm的精囊.结论局限期中、高危前列腺癌勾画高剂量区精囊CTV时,按照现行欧美指南的画法存在部分亚临床病灶漏照风险.若要包含1.0 cm近端精囊,推荐前内侧部垂直向上勾画1.4 cm、后外侧部垂直向上勾画0.5 cm可包含95％病例的亚临床病灶;若要包含2.0 cm近端精囊,前内侧部垂直向上勾画2.2 cm即可,后外侧部可适当降低,但不低于1.4 cm.
목적탐토국한기전렬선암정낭림상파구(CTV)적구화범위.방법 114례접수근치성방료적국한기중、고위전렬선암환자행정위CT소묘,대비구미지남공동삼고적정낭아림상조범위적병리결과,득도정낭장축거기점1.0 cm화2.0 cm처적정낭절면,학정정낭근단1.0 cm화2.0cm적해부범위,연후측량량개절면거정낭기시평면적최대수직거리(D10H、D20H)화최소수직거리(D10L、D20L),병여구미지남규정적구화범위대비,진일보지도고제량구정낭CTV적구화범위.결과D10H、D10L、D20H、D20L평균치분별위(10.6±1.8)、(2.1±2.0)、(17.2±2.9)화(8.8±2.7)mm,포괄95％병례적D10H화D20H분별위13.5화21.5 mm,다인소분석현시,D10H화D20H여정낭경사각도화횡단면최대경상관(R2=0.64화0.77,P＜0.01).대비구미지남규정적정낭파구구화방법,즉자정낭기시평면개시연인체장축방향수직향상구화1.0 cm혹2.0 cm작위CTV시,분별유65.8％(75/114)급17.5％(20/114)적병례무법완전포함근부1.0 cm혹2.0 cm적정낭.결론 국한기중、고위전렬선암구화고제량구정낭CTV시,안조현행구미지남적화법존재부분아림상병조루조풍험.약요포함1.0 cm근단정낭,추천전내측부수직향상구화1.4 cm、후외측부수직향상구화0.5 cm가포함95％병례적아림상병조;약요포함2.0 cm근단정낭,전내측부수직향상구화2.2 cm즉가,후외측부가괄당강저,단불저우1.4 cm.
Objective To discuss the clinical target volume (CTV) for the seminal vesicle (SV)in localized prostate cancer radiotherapy.Methods Radiotherapy planning CT images from 114 patients with intermediate-or high-risk prostate cancer were collected and reconstructed at a thickness of 1 mm.Cross sections of the SV,1.0 and 2.0 cm from the starting point,were located.Then,the maximum (D10H,D20H) and minimum (D10L,D20L) distance from these two cross sections to the initial plane of the SV were measured the proximal SV included in the high-dose CTV based on EORTC prostate cancer radiotherapy guideline and the current RTOG 0815 protocol guideline and the anatomic volume of proximal 1 and 2 cm SV were compared.Results The distance of D10H,D10L,D20HandD20Lwere (10.6 ± 1.8),(2.1 ± 2.0),(17.2 ± 2.9) and (8.8 ± 2.7)mm,D10HandD20H that can include 95％ of the patients were 13.5 mm and 21.4 mm respectively.A smaller SV tilt angle (α and β) and a larger diameter of the cross section (R10/20) were associated with a longer D10H (R2 =0.64,P ＜ 0.01) or D20H (R2 =0.77,P ＜0.01) When it was defined 1.0 cm vertically upward from the initial plane as the upper limit of the CTV,the proximal 1.0 cm of the SV could not been entirely encompassed in 65.8％ (75/114) of the enrolled cases.The proximal 2.0 cm of the SV could not been entirely encompassed in 17.5％ (20/114) of our cases when 2.0 cm as the upper limit were used.Conclusions In order to contouring anatomic 1.0 cm/2.0 cm SV,the high-dose CTV need to extend 1.4 cm/2.2 cm upward for the anteromedial portion of the SV,and 0.5 cm/1.4 cm for the posterolateral SV.