直肠癌放疗不同技术和体位对小肠受照体积的比较

陈炜

doi:10.3969/j.issn.1671-038X.2016.12.12

直肠癌放疗不同技术和体位对小肠受照体积的比较

陈炜^,

- 浙江省肿瘤医院放射物理室, 浙江杭州 310022

详细信息

作者简介:
陈炜,男,学士,技师,主要从事肿瘤放射治疗技术方向工作

通讯作者: 陈炜,E-mail:670304754@qq.com

中图分类号: R735.3

收稿日期: 2016-05-30

Influence of modern radiotherapy technique or treatment position on the irradiated volumein small bowel sparing for rectal cancer patients

CHEN Wei^,

- Department of Radiation Physics, Zhejiang Provincial Cancer Hospital, Hangzhou 310022, China

More Information

Corresponding author: CHEN Wei, E-mail: 670304754@qq.com

Received Date: 30 May 2016

摘要

摘要: [目的]探讨仰卧位与俯卧位等体位下实施三维适形(3D-CRT)与调强放射治疗(IMRT)计划对直肠癌患者小肠受照体积的影响。[方法]选择50例直肠癌患者,让其膀胱处于充盈条件下,在仰卧位与俯卧位分别进行CT定位扫描,将扫描图像传输到计划系统。在每一种体位上所得到的CT图像上分别实施3D-CRT与IMRT计划,观察患者在不同技术及体位下小肠受照体积(V₅-₄₅)的差异。[结果]在相同的体位(仰卧位或俯卧位)下,与3D-CRT比较,IMRT治疗下小肠V₄₅显著下降(P＜0.05),小肠V₁₅则两者较为接近。在相同的放疗技术(3D-CRT或IMRT)下,与仰卧位比较,俯卧位治疗小肠V₄₅与V₁₅均显著下降(P＜0.05)。[结论]直肠癌患者在接受体外照射治疗时,治疗体位较放疗技术对患者小肠受照体积的影响更显著。
- 直肠癌 /
- 放疗技术 /
- 治疗体位 /
- 小肠
Abstract: [Objective]To compare the effect of small bowel sparing between modern radiotherapy technique on intensity modulated radiotherapy(IMRT)and prone position with belly-board for rectal cancer radiotherapy.[Methods]50 rectal cancer patients underwent two series of CT scans,prone positioned with a belly board and supine positioned with a flat board,both combined using a full bladder protocol.Supine three dimensional conformal radiotherapy(3D-CRT),supine IMRT and prone 3D-CRT,prone IMRT plans were constructed for each patient.The volume of small bowel receiving doses in 5 Gy increments from(5-45)Gy was calculated using dose-volume histograms for each plan.[Results]Volumes of small bowel receiving dose in 5 Gy increments from(5-45)Gy were calculated,from(35-45)Gy,there was a significantly lower volume of small bowel treated using the IMRT technique in both supine and prone positions.Compared with supine position,a trend was found for lower volume of irradiated small bowel at each dose level between 5 and 45 Gy for prone position,whether using IMRT or not.The differences in small bowel V₁₅(the absolute volume of small bowel receiving at least 15 Gy)and V₄₅(the absolute volume of small bowel receiving at least 45 Gy)[JP]between supine and prone position were significant.The V₄₅ for the small bowel was significantly smaller for IMRT than 3D-CRT,but the V₁₅ was approximately equal for IMRT and 3D-CRT.[Conclusion]Patient position had a greater impact on small bowel sparing than modern radiotherapy technique.
- rectal cancer /
- radiotherapy /
- treatment position /
- small intestine

HTML全文

参考文献(22)

[1]	PETTERSSON D,CEDERMARK B,HOLM T,et al.Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer[J].BRIT J SURG,2010,97:580-587.
[2]	LATKAUSKAS T,PAUZAS H,GINEIKIENE I,et al.Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy,both with delayed surgery[J].Colorectal Dis,2012,14:294-298.
[3]	PHANG P T,MCGAHAN C E,MCGREGOR G,et al.Effects of change in rectal cancer management on outcomes in British Columbia[J].Can J Surg,2010,53:225.
[4]	ENGELS B,DE RIDDER M,TOURNEL K,et al.Preoperative helical tomotherapy and megavoltage computed tomography for rectal cancer:Impact on the irradiated volume of small bowel[J].Int J Radiat Oncol Biol Phys,2009,74:1476-1480.
[5]	PEETERS K C,VAN DE VELDE C J,LEER J W,et al.Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer:Increased bowel dysfunction in irradiated patients-a Dutch colorectal cancer group study[J].J Clin Oncol,2005,23:6199-6206.
[6]	STACEY R,GREEN J T.Radiation-induced small bowel disease:Latest developments and clinical guidance[J].Ther Adv Chronic Dis,2014,5:15-29.
[7]	CHUNG Y,YOON H I,KEUM K C,et al.Effect of belly board with bladder compression device on small bowel displacement from the radiotherapy field forrectal cancer[J].Onkologie,2013,365:241-246.
[8]	WIESENDANGER-WITTMER E M,SIJTSEMA N M,MUIJS C T,et al.Systematic review of the role of a belly board device in radiotherapy delivery in patients with pelvic malignancies[J].Radiother Oncol,2012,102:325-334.
[9]	MAAS M,NELEMANS P J,VALENTINI V,et al.Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer:apooled analysis of individual patient data[J].Lancet Oncol,2010,11:835-844.
[10]	DAS P,SKIBBER J M,RODRIGUEZ-BIGAS M A,et al.Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer[J].Cancer,2007,109:1750-1755.
[11]	VUONG T,DEVIC S,PODGORSAK E.High dose rate endorectal brachytherapy as a neoadjuvant treatment for patients with resectable rectal cancer[J].Clin Oncol(R Coll Radiol),2007,19:701-705.
[12]	CALLENDER G G,DAS P,RODRIGUEZBIGAS M A,et al.Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3rectal cancer[J].Ann Surg Oncol,2010,17:441-447.
[13]	PEREZ R O,HABR-GAMA A,LYNN P B,et al.Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates[J].Dis Colon Rectum,2011,54:545-551.
[14]	BELLUCO C,DE PAOLI A,CANZONIERI V,et al.Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3rectal cancer:implications for local excision surgical strategies[J].Ann Surg Oncol,2011,18:3686-3693.
[15]	BORSCHITZ T,WACHTLIN D,MHLER M,et al.Neoadjuvant chemoradiation and local excision for T2-3rectal cancer[J].Ann Surg Oncol,2008,15:712-720.
[16]	TAYLOR F G,QUIRKE P,HEALD R J,et al.Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I,II,and III rectal cancer best managed by surgery alone:aprospective,multicenter,European study[J].Ann Surg,2011,253:711-719.
[17]	LOMBARDI R,CUICCHI D,PINTO C,et al.Clinically-staged T3 N0rectal cancer:is preoperative chemoradiotherapy the optimal treatment?[J].Ann Surg Oncol,2010,17:838-845.
[18]	RODEL C,ARNOLD D,BECKER H,et al.Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer[J].Strahlenther Onkol,2010,186:658-664.
[19]	BEETS G L.Critical appraisal of the‘wait and see’approach in rectal cancer for clinical complete responders after chemoradiation[J].Br J Surg,2012,99:897-909.
[20]	WEST N.The surgical significance of residual mucosal abnormalities in rectal cancer following neoadjuvant chemoradiotherapy[J].Br J Surg,2012,99:993-1001.
[21]	GUERRERO URBANO M T,HENRYS A J,ADAMS E J.Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels[J].Int J Radiat Oncol Biol Phys,2006,65:907-916.
[22]	KIM T H,KIM D Y,CHO K H,et al.Comparative analysis of the effects of belly board and bladder distension in postoperative radiotherapy of rectal cancer patients[J].Strahlenther Onkol,2005,181:601-605.