调强放疗治疗宫颈癌术后并发无症状盆腔淋巴囊肿的靶区勾画

摘要

Objective:To explore the feasibility of pelvic lymphocyst (PL) all included in clinical target volume (CTV) in patients after radical operation with asymptomatic PL who were given intensity-modulated radiotherapy (IMRT).Methods:From January 2015 to February 2016,90 cervical cancer patients after radical operation with indications of radiotherapy were collected,46 of which were detected asymptomatic PL on the simulation computed tomography (CT) and enrolled in this study.CTV was all sketched twice per patient,and 46 cases were divided into the experimental group (46 cases,PL included completely in CTV) and the control group (46 cases,PL not included completely in CTV) according to whether PL included completely in CTV.The influence of two CTV sketched ways on irradiation dose and volume of organ at risk (OAR) was compared by means of dose volume histogram (DVH).Results:The volume of CTV in the experimental group was significantly greater than that in the control group,the differences between two groups were statistically significant (P<0.05).In IMRT,irradiation dose and volume of small intestine,rectum,bladder in the experimental group were all more than that in the control group,but the differences between two groups were not statistically significant (P>0.05).Conclusion:PL included completely in CTV in IMRT was feasible with not significantly increased irradiation dose and volume of OAR in cervical cancer patients after radical operation in the presence of asymptomatic PL.%目的:探讨宫颈癌根治术后并发无症状盆腔淋巴囊肿(pelvic lymphocyst,PL)给予调强放疗(intensity-modulated radiotherapy,IMRT)时勾画临床靶区(clinical target volume,CTV)将PL包括完全的可行性.方法:2015年1月至2016年2月我科收治的宫颈癌根治术后具有放疗指征的患者共90例,模拟定位计算机断层扫描(computed tomography,CT)时发现并发无症状PL的46例患者纳入本研究.每例患者均进行两次CTV勾画,根据CTV是否将淋巴囊肿包括完全分为实验组(46例,将淋巴囊肿包括完全)和对照组(46例,未将淋巴囊肿包括完全),两组均采用同样的IMRT技术制定治疗计划,通过剂量体积直方图(dose volume histogram,DVH)比较两种CTV勾画方式对周围危及器官(organ at risk,OAR)受照剂量体积的影响.结果:实验组CTV体积明显大于对照组,差异具有统计学意义(P<0.05).在IMRT放疗方式中,实验组的小肠、直肠、膀胱受照剂量和体积均高于对照组,但上述差异均不具有统计学意义(P>0.05).结论:宫颈癌根治术后并发无症状PL进行IMRT时,CTV勾画可以将PL全部包括在内,OAR的受照剂量体积并未明显增加.