CAJ | 학술논문

目的研究前列腺癌IMRT中膀胱不同充盈状态对靶区及OAR的影响.方法选取10例无严重合并症的局限期前列腺癌患者,CT定位时分别在膀胱不同充盈状态(排空、注入生理盐水150 ml及300 ml)进行3次全盆腔CT扫描,将获得的CT图像分别传输至TPS.由同一医生勾画靶区及直肠、膀胱、股骨头后,在同一处方条件下由物理师进行治疗计划设计.将3种膀胱不同充盈状态下获得的靶区及OAR剂量学参数进行分析和配对t检验.结果在定位和实际照射时膀胱充盈状态一致情况下,膀胱不同充盈状态对靶区及股骨头剂量学参数无影响(P=0.077～0.998,0.219 ～0.969),对膀胱剂量学参数影响很大(P=0.000～0.562),对直肠部分剂量学参数会产生影响(P =0.000～0.645),而且膀胱充盈对保护膀胱和直肠有利.如果定位和实际治疗时膀胱充盈状态不一致,则会造成理论计算获得的PTV、膀胱及部分直肠剂量学参数与实际治疗结果存在差异(P =0.000～0.913).结论前列腺癌患者IMRT时建议采用膀胱充盈状态较好且要注意疗程中充盈程度一致性.
목적 연구전렬선암IMRT중방광불동충영상태대파구급OAR적영향.방법 선취10례무엄중합병증적국한기전렬선암환자,CT정위시분별재방광불동충영상태(배공、주입생리염수150 ml급300 ml)진행3차전분강CT소묘,장획득적CT도상분별전수지TPS.유동일의생구화파구급직장、방광、고골두후,재동일처방조건하유물리사진행치료계화설계.장3충방광불동충영상태하획득적파구급OAR제량학삼수진행분석화배대t검험.결과 재정위화실제조사시방광충영상태일치정황하,방광불동충영상태대파구급고골두제량학삼수무영향(P=0.077～0.998,0.219 ～0.969),대방광제량학삼수영향흔대(P=0.000～0.562),대직장부분제량학삼수회산생영향(P =0.000～0.645),이차방광충영대보호방광화직장유리.여과정위화실제치료시방광충영상태불일치,칙회조성이론계산획득적PTV、방광급부분직장제량학삼수여실제치료결과존재차이(P =0.000～0.913).결론 전렬선암환자IMRT시건의채용방광충영상태교호차요주의료정중충영정도일치성.
Objective To study the impacts of bladder filling status on the dosimetric parameters of the target volume and organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) for prostate cancer.Methods Ten localized prostate cancer patients without serious complications treated with IMRT were selected for this study.These patients underwent CT scans of the whole pelvic cavity three times in different bladder filling status (empty and injected with 150 ml and 300 ml of normal saline) to obtain three series of pelvic CT images.The three sets of CT images were transferred to the treatment planning system.The target volume and OAR such as the rectum,bladder,and femoral heads were contoured by the same doctor.The treatment planning was performed and optimized by the physicist.The dosimetric parameters of the target volume and OAR in three bladder filling status were subjected to analysis by paired t-test.Results If the bladder filling status was consistent in orientation and radiation,the bladder filling status was not associated with the dosimetric parameters of the target volume and femoral heads (P =0.077-0.998 ; P =0.219-0.969) ;it had significant impacts on the dosimetric parameters of the bladder (P =0.000-0.562) and some dosimetric parameters of the rectum (P =0.000-0.645),and bladder filling was favorable for the protection of the bladder and rectum.If the bladder filling status was not consistent in orientation and actual radiation,the calculated planning target volume,the dosimetric parameters of the bladder,and some dosimetric parameters of the rectum were different from those in actual treatment (P =0.000-0.913).Conclusions For the prostate cancer patients treated with IMRT,it is recommended to keep the bladder well and consistently filled.