CAJ | 학술논문

目的探讨宫颈癌患者多次计划CT引导的三维近距离治疗可行性及对危及器官剂量学影响.方法 10例接受根治性放疗的Ⅱb～Ⅲb期宫颈癌患者每次腔内放疗前行CT扫描并勾画高危临床靶体积(HRCTV)及膀胱、直肠、乙状结肠.PLATO14.3计划系统设计,HRCTV采用D90,危及器官采用D2cm3评价.处方剂量A点7Gy单次后进行几何优化,直肠、乙状结肠D2cm3≤5 Gy,膀胱D2cm3≤5.5 Gy.第1次腔内治疗优化计划为标准计划,每次腔内放疗进行CT扫描制定几何优化计划.两组计划参数行独立样本t检验,危及器官体积与参数相关性采用Pearson法相关分析.结果标准计划与优化计划HRCTV的D90相似(t=-0.03～-1.61,P=0.978 ～0.128),膀胱、直肠、乙状结肠D2cm3不同(t=-2.27～-3.35,P=0.049～0.004).膀胱、直肠、乙状结肠体积与各自D2cm3均呈正相关(r =0.314、0.407、0.539,P=0.026、0.003、0.000).结论 CT引导的官颈癌三维近距离治疗中多次计划有必要,危及器官体积对治疗CTV剂量无影响,但体积越大受照最多部位的D2cm3越高.
목적 탐토궁경암환자다차계화CT인도적삼유근거리치료가행성급대위급기관제량학영향.방법 10례접수근치성방료적Ⅱb～Ⅲb기궁경암환자매차강내방료전행CT소묘병구화고위림상파체적(HRCTV)급방광、직장、을상결장.PLATO14.3계화계통설계,HRCTV채용D90,위급기관채용D2cm3평개.처방제량A점7Gy단차후진행궤하우화,직장、을상결장D2cm3≤5 Gy,방광D2cm3≤5.5 Gy.제1차강내치료우화계화위표준계화,매차강내방료진행CT소묘제정궤하우화계화.량조계화삼수행독립양본t검험,위급기관체적여삼수상관성채용Pearson법상관분석.결과 표준계화여우화계화HRCTV적D90상사(t=-0.03～-1.61,P=0.978 ～0.128),방광、직장、을상결장D2cm3불동(t=-2.27～-3.35,P=0.049～0.004).방광、직장、을상결장체적여각자D2cm3균정정상관(r =0.314、0.407、0.539,P=0.026、0.003、0.000).결론 CT인도적관경암삼유근거리치료중다차계화유필요,위급기관체적대치료CTV제량무영향,단체적월대수조최다부위적D2cm3월고.
Objective To evaluate the reproducity of planning and impact of organ at risk in CT image guided three-dimensional high dose rate 192Ir brachytherapy in cervical cancer by dosimetric analysis.Methods Ten patients with FIGO stage Ⅱb or llⅢb of cervical cancer were selected who were treated with CT image guided three-dimensioned high-dose-rate 192Ir brachytherapy.Patients underwent a CT scan in each fraction of brachytherapy and treatment plans were made.Prescription dose to point A with 7 Gy per fraction and graphical optimized with organs at risk (OAR) dose limitations of D2 cm3 ≤5 Gy in rectum and sigmoid and D2cm3 ≤5.5 Gy in bladder.The optimized plan for the first fraction in each patients as the standard planning based on which the optimization planning for the following fractions.The dose volume histogram ((high risk clinical target volume (HRCTV) D90,bladder D2 cm3,rectum D2 cm3 and sigmoid D2 cm3) were evaluated and compared between the two groups of planning.Planning comparison analysis used independent samples t-test and OAR parameters with Pearson correlation analysis.Results HRCTV D90 were not statistically significant difference between the optimization and standard planning (t =-0.03--1.61,P =0.978-0.128).D2 cm3 of bladder,rectum and sigmoid were statistically higher in the standard plans (t =-2.27--3.35,P =0.049-0.004).D2 cm3 of bladder,rectum and sigmoid correlated positively with the absolute volume respectively (r =0.314,0.407,0.539,P =0.026,0.003,0.000).Conclusions It's necessary for the multiple planning for CT image guided brachytherapy in cervical cancer.The bigger volume of OAR,the higher D2 cm3