多模态成像技术引导下组织间徒手插植近距离放射治疗宫颈癌的效果及剂量学分析

Application and dosimetric analysis of brachytherapy with free hand implantation for cervical cancer guided by multimodal imaging technology

目的:探究基于多模态成像技术引导下组织间徒手插植近距离放射治疗(简称放疗)宫颈癌的效果及剂量学分析。方法:选取98例宫颈癌患者为研究对象,分为研究组49例与对照组49例,对照组予以CT图像引导组织间徒手插植近距离放疗,研究组予以实时超声联合CT图像引导组织间徒手插植近距离放疗。比较两组植入特点、疗效及放疗后90%高危临床靶区的受照射剂量(HR-CTVD90)、危及器官累积生物学剂量、并发症发生情况。结果:研究组单根针插植时间短于对照组(P<0.001),放疗后3、6个月疗效优于对照组(P<0.05)。研究组肿瘤直径5~<6 cm、6~<7 cm者HR-CTVD90均高于对照组(P<0.05)。研究组膀胱、乙状结肠、直肠累积生物学剂量均低于对照组(P<0.05),总并发症发生率低于对照组(P=0.036)。结论:多模态成像技术引导下组织间徒手插植近距离放疗对宫颈癌具有较好临床疗效,可有效减少单根针插植时间,减少并发症发生,且具有剂量学优势。

Aim:To explore the application and dosimetry of brachytherapy for cervical cancer with free hand implantation guided by multimodal imaging technology.Methods:A total of 98 patients with cervical cancer were selected,and were allocated into study group(49 cases)and control group(49 cases).The control group was treated with CT image guided brachytherapy with intertissue free hand implantation.The study group conducted real-time ultrasound combined with CT image guided brachytherapy with intertissue free hand implantation.The implantation characteristics,efficacy,90%high risk clinical target volume dose(HR-CTVD 90),cumulative doses of organ at risk and complications between the 2 groups were compared.Results:The time of single needle insertion in the study group was shorter than that in the control group(P<0.001).The efficacy of the study group at 3 and 6 months after brachytherapy was better than that of the control group(P<0.05).Tumor size of 5 to<6 cm HR-CTVD 90 and 6 to<7 cm HR-CTVD 90 in the study group were higher than those in the control group(P<0.05).Bladder,sigmoid and rectal cumulative doses in the study group were lower than those in the control group(P<0.05).The total complication rate of the study group was lower than that of the control group(P=0.036).Conclusion:Brachytherapy guided by multimodal imaging technology has good clinical efficacy,could effectively reduce the time of single needle insertion and the risk of complications and has dosimetry advantages.