河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (10): 1210-1214.doi: 10.3969/j.issn.1007-3205.2021.10.019

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宫颈癌术后保护骨髓调强放疗的剂量学优势

  

  1. 河北医科大学第二医院放疗科，河北 石家庄 050000
  • 出版日期:2021-10-25 发布日期:2021-10-28
  • 作者简介:田磊（1988-），男，河北南宫人，河北医科大学第二医院主治医师，医学硕士，从事肿瘤精确放射治疗研究。
  • 基金资助:
    河北省医学科学研究课题（20200931）

Dosimetric advantages of bonemarrow-sparing intensity modulated radiotherapy for cervical cancer after hysterectomy

  1. Department of Radiotherapy, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Online:2021-10-25 Published:2021-10-28

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摘要： 目的 对比分析保护骨髓调强放疗（bone marrow sparing-intensity modulated radiation therapy，BMS-IMRT）与普通调强放疗（intensity modulated radiation therapy，IMRT）在宫颈癌术后患者中的剂量学参数，为BMS-IMRT的临床应用提供一定理论依据。
方法 10例宫颈癌术后患者纳入研究，针对每例患者分别制作BMS-IMRT与IMRT两种计划，收集计划靶区（planning target volume，PTV）与危及器官（organs at risk，OARs）的相关剂量学指标进行统计学分析。
结果 BMS-IMRT计划PTV的平均Dmax与Dmean均高于IMRT计划，且HI劣于IMRT计划（P＜0.05），BMS-IMRT计划中平均的骨髓V10、V20、V30、V40均低于IMRT计划，股骨头Dmax低于IMRT计划（P＜0.05），两种计划中直肠、膀胱的受照剂量比较差异均无统计学意义（P＞0.05）。
结论 对于宫颈癌术后患者，BMS-IMRT相较于普通IMRT在保证治疗靶区覆盖的同时可降低骨髓的受照剂量，并不增加直肠与膀胱的受照剂量，理论上可降低血液学毒性的发生。


关键词: 宫颈癌, 保护骨髓, 放射治疗, 剂量学

Abstract: Objective The dosimetric parameters of bone marrow sparing-intensity modulated radiation therapy(BMS-IMRT) and conventional intensity modulated radiation therapy(IMRT) in patients with cervical cancer after hysterectomy were compared and analyzed, providing a theoretical basis for the clinical application of BMS-IMRT. 
Methods Ten patients with cervical cancer undergoing hysterectomy were selected to design BMS-IMRT and IMRT plans respectively, and the dosimetric indexes of the planning target volume(PTV) and organs at risk(OARs) were statistically analyzed. 
Results The mean value of Dmax and Dmean in BMS-IMRT group were higher than those in IMRT group and the homogeneity index(HI) of PTV in the BMS-IMRT group was inferior to that in IMRT group(P＜0.05). The mean V10, V20, V30, V40 of bone marrow in BMS-IMRT group were lower than those in IMRT group, and the Dmax of femoral heads was also lower in the BMS-IMRT group than in IMRT group(P＜0.05). The radiation dose of rectum and bladder in the two plans was not statistically significant(P＞0.05). 
Conclusion BMS-IMRT can reduce the radiation dose of bone marrow while ensuring the coverage of PTV compared with the conventional IMRT in postoperative patients with cervical cancer and dose not increase the radiation dose of the rectum and bladder, theoretically reducing the occurrence of hematological toxicity.


Key words: Cervical cancer, bone marrow sparing, radiation therapy, dosimetry

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