| 程淑霞,张明川,张新慧.宫颈癌引导腔内联合组织间插植近距离放疗阴道模板的临床设计[J].肿瘤学杂志,2019,25(9):808-812. |
| 宫颈癌引导腔内联合组织间插植近距离放疗阴道模板的临床设计 |
| Design of Transvaginal Cylindrical Templet for Combined Interacavitary/Interstitial Brachytherapy Treatment Based on Local Spread Patterns of Cervival Cancer |
| 投稿时间：2018-11-28 |
| DOI：10.11735/j.issn.1671-170X.2019.09.B009 |
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| 中文关键词: 宫颈癌 经阴道插植模板 腔内联合组织间插植 近距离放疗 |
| 英文关键词:cervical cancer transvaginal cylindrical templet combined intracavitary/interstitial brachytherapy |
| 基金项目:河南省医学科技攻关计划项目（201702265） |
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| 中文摘要: |
| 摘 要：［目的］ 分析研究宫颈癌局部转移的精准影像解剖部位，设计制作普遍适用于宫颈癌宫旁远端转移患者的经阴道插植模板，引导腔内联合组织间插植近距离放疗。［方法］ 基于498例ⅡB～ⅣA期宫颈癌患者局部转移部位的影像解剖分析，以及盆腔外照射后肿瘤回缩变化，设计制作经阴道插植模板，应用于20例盆腔外照射后宫旁残留癌肿≥3cm的宫颈癌患者，引导腔内联合组织间插植近距离放疗。［结果］ 498例局部晚期宫颈癌中，98.5%宫旁转移发生在盆隔之上、腹膜之下，在阴道上1/3处贴近阴道侧壁，在宫颈阴道两侧2～4点和8～10点之间，向上：依次沿阴道直肠韧带、骶韧带向侧后方蔓延，沿主韧带向侧前方蔓延，呈扇形逐步远离宫颈阴道侧壁达侧盆壁，发生宫旁远端转移。盆腔外照射后，97.5%宫旁残留癌肿距宫腔管的距离一侧≤3.5cm、另一侧≤2.5cm，上缘在宫颈内口水平，3%为前后极不对称癌肿。基于此解剖，设计一组经阴道圆柱体插植模板，周边8～10个直针孔，6～12点连线上3个宫腔管孔，在两侧壁2点～4点之间和8点～10点之间有1～2排斜孔。该阴道模板引导腔内联合组织间插植近距离放疗，初步应用于20例盆腔外照射后一侧宫旁残留癌肿>3cm或前后极不对称的宫颈癌患者：平均高危临床靶区体积(HR-CTV) （60.4±20.8）cm3；平均剂量 HR-CTV D90 86.7Gy (EQD2 α/β10)，膀胱2cc 76.1Gy (EQD2 α/β 3)，直肠2cc 68.7Gy (EQD2 α/β 3)，乙状结肠2cc 65.9Gy (EQD2 α/β 3)。放疗后3月完全缓解（CR）18例、部分缓解（PR）2例，无3～4级急性期放疗并发症发生。［结论］该阴道插植模板设计合理，引导宫颈癌腔内联合组织间插植近距离放疗，操作简单，损伤小，可重复性好。对于盆腔外照射后宫旁残留癌肿≥3cm者，获得了更好处方剂量的HR-CTV靶区覆盖，较好保护危及器官。 |
| 英文摘要: |
| Abstract：［Objective］ To design a novel transvaginal cylindrical templet for combined interacavitary/interstitial (IC/IS) brachytherapy(BT) based on local spread patterns of cervical cancer. ［Methods］ A transvaginal templet was designed based on local spread patterns of 498 patients with cervical cancer stage ⅡB~ⅣA. The novel templets were used to perform IC/IS BT in 20 cervical cancer patients with insufficient response after external-beam radiotherapy(EBRT). ［Results］ In 498 patients with locally advanced cervical cancer，98.5% parametrial lesions were above the pelvic septum，spreading posterolaterally along rectovaginal ligament and uterosacral ligament，anterolaterally along cardinal ligament. It was fan-shaped away from both sides of cervix and vagina to the lateral pelvic wall. After 45Gy EBRT，residual parametrial tumors of 97.5% cervical cancer patients were ≤3.5 cm in one side and ≤2.5cm in other side，the upper margin at the level of the internal OS of the cervix. There were 3% patients with anteroposterior asymmetrical tumor. Based on the anatomy，the cylindrical templet was designed with peripheral straight holes，oblique needle holes and central tandem holes. In 20 patients treated with the new applicator，the total(EBRT+BT) D90 and the high risk clinical target volume (HR-CTV) were on average 86.7(SD2.4)Gy α/β10 and 60.4(SD20.8)cm3. The average D2ccα/β3 of bladder and rectum and sigmoid were 76.1(SD2.7)Gy and 68.7(SD3.3)Gy and 65.9(SD5.4)Gy，respectively. Among 20 patients there were 18 cases of complete remission and 2 cases of partial remission 3 months after treatment. ［Conclusion］ The transvaginal cylindrical templet guiding IC/IS is feasible in cervical cancer patients with distal parametria residual disease after EBRT，it increases total dose and coverage of HR-CTV without increasing the dose to organs at risk. |
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