膀胱体积差异对宫颈癌放射治疗的影响

王延花; 靳晓伟; 温林春; 徐璐; 黄栎有

doi:10.13898/j.cnki.issn.2097-5252.2025.02.018

膀胱体积差异对宫颈癌放射治疗的影响

Effect of the bladder volume difference on radiotherapy for cervical cancer

摘要

摘要:
目的探讨宫颈癌术后病人在放射治疗中膀胱体积差异对剂量学参数和摆位误差的影响。
方法回顾性分析接受宫颈癌术后放射治疗的病人71例。分别获取病人首次定位和复位的CT图像, 将2次CT图像配准, 获得摆位误差。根据复位时膀胱体积的变化率, 将病人分为A组、B组和C组。借助Eclipse计划系统, 研究不同分组的组内病人2次定位的膀胱体积差异对剂量学参数的影响, 以及膀胱体积差异对摆位误差的影响。
结果 A组病人复位与首次定位比较, 膀胱体积明显增大, 靶区的HI变大(P < 0.05), 膀胱的V₃₀、V₃₅和V₄₀减小(P < 0.05~P < 0.01);B组病人复位与首次定位比较, 膀胱体积基本保持一致, 除了靶区的HI变大(P < 0.01)外, 其他剂量学参数差异均无统计学意义(P>0.05);C组病人复位与首次定位比较, 膀胱体积明显减小, 靶区的D_max、D_mean、HI以及膀胱的V₃₀和V₃₅均变大(P < 0.05), CI减小(P < 0.05)。A、B和C组病人膀胱体积差异对X方向、Y方向和Z方向摆位误差均无统计学意义(P>0.05)。
结论宫颈癌术后调强放疗病人在首次定位时保持适宜的膀胱体积, 且分次放疗时保证病人膀胱体积变化率在-1/3~1/3, 对剂量学参数影响较小, 膀胱体积的差异对摆位误差无影响。

Abstract:
Objective To investigate the effects of bladder volume difference on dosimetric parameters and positional errors in patients with cervical cancer after radiotherapy.
Methods The clinical data of 71 cervical cancer patients treated with postoperative radiotherapy were retrospectively analyzed.The first positioning and reduction CT images of patients were obtained, respectively, and the two CT images were registered to obtain the positional error.The patients were divided into the group A, group B, and group C according to the change rate of in bladder volume at reduction.The Eclipse planning system was used to study the influence of bladder volume difference of two-time positional on dosimetric parameters and positional error of patients in different groups.
Results In group A, the bladder volume at reduction significantly increased, the difference of PTV HI enlarged(P < 0.05), and the bladder V₃₀, V₃₅, and V₄₀ statistically decreased compared with the first postioning(P < 0.05).In group B, the bladder volume at reduction were essentially the same with the first positioning except the HI of PTV, the differences of the rest dosimetric parameters were not statistically significant(P>0.05).In group C, the bladder volume and CI at reduction significantly decreased, and the D_max, D_mean, and HI of PTV and V₃₀ and V₃₅ of bladder statistically increased compared with the first positioning(P < 0.05).There was no statistical significance in the bladder volume in X direction, Y direction and Z direction among group A, group B and group C(P>0.05).
Conclusions Maintaining appropriate bladder volume at first positioning in intensity-modulated radiation therapy for postoperative cervical cancer is important.When the change rate of bladder volume is -1/3 to 1/3, its effects on dosimetric parameters is less.The bladder volume differences have no effect on positional errors.

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