膀胱和肠道准备情况对前列腺癌放疗精准实施的影响

doi:10.13491/j.issn.1004-714X.2024.02.003

中国辐射卫生

2024, Vol. 33

Issue (2): 123-128 DOI: 10.13491/j.issn.1004-714X.2024.02.003

论著

本期目录 | 过刊浏览 | 高级检索

膀胱和肠道准备情况对前列腺癌放疗精准实施的影响

麻亚茹^1,2,3, 林茂盛^2,3, 陈炯佳^2,3, 丁振华¹

1. 南方医科大学公共卫生学院放射医学系, 广东广州 510515;
2. 中山大学肿瘤防治中心放疗科, 广东广州 510060;
3. 华南恶性肿瘤防治全国重点实验室, 广东广州 510060

The impact of bladder and bowel preparation on the precise implementation of radiotherapy for prostate cancer

MA Yaru^1,2,3, LIN Maosheng^2,3, CHEN Jiongjia^2,3, DING Zhenhua¹

1. Department of Radiology, School of Public Health, Southern Medical University, Guangzhou 510515 China;
2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060 China;
3. State Key Laboratory of Oncology in South China, Guangzhou 510060 China

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (644 KB) HTML ( )
输出: BibTeX | EndNote (RIS)

摘要目的通过锥形束CT（cone beam computed tomography，CBCT）观察每日前列腺癌患者膀胱和肠道的准备情况，分析对前列腺癌放疗精准实施的影响和副反应情况。方法回顾性分析38例行容积调强放射治疗的前列腺癌患者治疗实施过程，处方分次25 ~ 35次/例，患者每日放疗前均行CBCT扫描，25 ~ 40次/例。观察患者准备情况，根据“不脱靶和直肠壁不能进入前列腺高剂量靶区”的临床需求调整摆位误差，有93次显示不能成功治疗，需重新准备后再行CBCT扫描。统计患者每日是否能成功治疗和摆位误差，分析不同膀胱和肠道准备情况下放射治疗师调整误差值的差异，并统计患者的副反应情况。结果 38例患者成功治疗频率为(92.14 ± 5.25)%，有93次准备严重不足，其中48.4%是膀胱充盈过少，30.1%是肠道胀气。副反应与成功治疗频率成负相关（r = -0.393，P = 0.015）。膀胱充盈较多时，肠道准备良好和准备不充分在左右（LR）、头脚（SI）、前后（AP）方向治疗师调整的误差值无统计学差异（P > 0.05）；膀胱充盈适中和较少时，二者在LR、SI、AP方向治疗师调整的误差值均有统计学差异（P < 0.05）。结论膀胱充盈过少和肠道胀气是影响前列腺癌患者成功放疗的主要因素，膀胱充盈稍多时，肠道的准备情况对前列腺体内位置变化无影响。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	麻亚茹
	林茂盛
	陈炯佳
	丁振华

关键词 ：前列腺癌, CBCT, 摆位误差, 膀胱和肠道准备, 放疗副反应

收稿日期: 2023-10-22

PACS:

R816.7

通讯作者: 丁振华,E-mail:dingzh@smu.edu.cn E-mail: dingzh@smu.edu.cn

作者简介: 麻亚茹(1990-),女,河北邢台人,放疗技师,研究方向:放射治疗技术。E-mail:mayaru1121@126.com

引用本文:

麻亚茹, 林茂盛, 陈炯佳, 丁振华. 膀胱和肠道准备情况对前列腺癌放疗精准实施的影响[J]. 中国辐射卫生, 2024, 33(2): 123-128.
MA Yaru, LIN Maosheng, CHEN Jiongjia, DING Zhenhua. The impact of bladder and bowel preparation on the precise implementation of radiotherapy for prostate cancer. Chinese Journal of Radiological Health, 2024, 33(2): 123-128.

链接本文:

http://www.zgfsws.com/CN/10.13491/j.issn.1004-714X.2024.02.003 或 http://www.zgfsws.com/CN/Y2024/V33/I2/123

[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660
[2] Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 70(1): 67-74. DOI: 10.1016/j.ijrobp.2007.06.054
[3] Yao LH, Shou JZ, Wang SL, et al. Long-term outcomes of moderately hypofractionated radiotherapy (67.5 Gy in 25 fractions) for prostate cancer confined to the pelvis: a single center retrospective analysis[J]. Radiat Oncol, 2020, 15(1): 231. DOI: 10.1186/s13014-020-01679-0
[4] 王慧, 谢瑞霖, 秦庆伟, 等. T1b-4N0-1M0期前列腺癌高剂量及常规剂量放疗疗效及安全性对比Meta分析[J]. 中华放射肿瘤学杂志,2019,28(7):514-517. DOI: 10.3760/cma.j.issn.1004-4221.2019.07.008
Wang H, Xie RL, Qin QW, et al. Efficacy and safety of high-dose versus conventional-dose conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer: a meta-analysis[J]. Chin J Radiat Oncol, 2019, 28(7): 514-517. DOI: 10.3760/cma.j.issn.1004-4221.2019.07.008
[5] 林玉菊, 陈建鑫, 袁岩成, 等. 基于DRR图像的膀胱径线与体积相关性研究[J]. 医疗装备,2018,31(1):1-2. DOI: 10.3969/j.issn.1002-2376.2018.01.001
Lin YJ, Chen JX, Yuan YC, et al. Investigate the correlation of volume and radial direction distance of bladder for cervical cancer in digitally reconstructed radiography[J]. Med Equip, 2018, 31(1): 1-2. DOI: 10.3969/j.issn.1002-2376.2018.01.001
[6] Chang JS, Yoon HI, Cha HJ, et al. Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients: early experience of bladder volume assessment using ultrasound scanner[J]. Radiat Oncol J, 2013, 31(1): 41-47. DOI: 10.3857/roj.2013.31.1.41
[7] 姜晓勃, 钟庆初, 黄群峰, 等. 盆腔肿瘤放疗中膀胱充盈一致性初步研究[J]. 中华放射肿瘤学杂志,2016,25(6):598-601. DOI: 10.3760/cma.j.issn.1004-4221.2016.06.012
Jiang XB, Zhong QC, Huang QF, et al. Consistency of bladder filling during radiotherapy for pelvic tumor: a preliminary study[J]. Chin J Radiat Oncol, 2016, 25(6): 598-601. DOI: 10.3760/cma.j.issn.1004-4221.2016.06.012
[8] 中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国前列腺癌放射治疗指南(2020年版)[J]. 中华肿瘤防治杂志,2021,28(5):323-337. DOI: 10.16073/j.cnki.cjcpt.2021.05.01
Radiooncologist Branch of Chinese Medical Doctor Association, Radiation Oncology Therapy Branch of the Chinese Medical Society, Cancer Radiotherapy Professional Committee of China Anti-Cancer Association. Radiotherapy guidelines for prostate cancer in China (2020ed)[J]. Chin J Radiat Oncol, 2021, 28(5): 323-337. DOI: 10.16073/j.cnki.cjcpt.2021.05.01
[9] 应文敏, 廖绍光, 傅志超, 等. 前列腺癌调强放疗中直肠充盈状态对靶区及危及器官的影响[J]. 临床肿瘤学杂志,2016,21(9):810-813
Ying WM, Liao SG, Fu ZC, et al. Impacts of rectum filling status on dosimetric parameters of target volume and organ at risk in intensity-modulated radiotherapy for prostate cancer[J]. Chin Clin Oncol, 2016, 21(9): 810-813
[10] 李明, 林海磊, 修霞, 等. 膀胱直肠管理对前列腺癌靶区及OAR剂量影响[J]. 中华放射肿瘤学杂志,2015,24(6):644-648. DOI: 10.3760/cma.j.issn.1004-4221.2015.06.009
Li M, Lin HL, Xiu X, et al. Effects of bladder and rectum management on dose distributions of target and organs at risk in intensity-modulated radiotherapy for prostate cancer[J]. Chin J Radiat Oncol, 2015, 24(6): 644-648. DOI: 10.3760/cma.j.issn.1004-4221.2015.06.009
[11] 李克新, 鞠永健, 曹丽媛, 等. 前列腺癌患者定位与调强放疗时膀胱充盈程度不一致对剂量学参数的影响[J]. 中华放射医学与防护杂志,2019,39(3):192-196. DOI: 10.3760/cma.j.issn.0254-5098.2019.03.006
Li KX, Ju YJ, Cao LY, et al. The dosimetric effect of inconsistency of bladder filling states between CT simulation and IMRT treatment for prostate cancer patients[J]. Chin J Radiol Med Prot, 2019, 39(3): 192-196. DOI: 10.3760/cma.j.issn.0254-5098.2019.03.006
[12] Heng SP, Low SH, Sivamany K. The influence of the bowel and bladder preparation protocol for radiotherapy of prostate cancer using kilo-voltage cone beam CT: our experience[J]. Indian J Cancer, 2015, 52(4): 639-644. DOI: 10.4103/0019-509X.178386
[13] Rowe LS, Mandia JJ, Salerno KE, et al. Bowel and bladder reproducibility in image guided radiation therapy for prostate cancer: results of a patterns of practice survey[J]. Adv Radiat Oncol, 2022, 7(5): 100902. DOI: 10.1016/j.adro.2022.100902
[14] 伍嘉颖, 陆世培, 李存啸, 等. 盆腔肿瘤放疗执行前膀胱充盈一致性研究[J]. 中华放射肿瘤学杂志,2021,30(1):61-65. DOI: 10.3760/cma.j.cn113030-20190624-00245
Wu JY, Lu SP, Li CX, et al. Study on the bladder filling consistency of pelvic tumors prior to the radiotherapy[J]. Chin J Radiat Oncol, 2021, 30(1): 61-65. DOI: 10.3760/cma.j.cn113030-20190624-00245
[15] 钟嘉健, 丘敏敏, 邓永锦, 等. 两种膀胱充盈方式在宫颈癌术后调强放疗中的对比[J]. 中华肿瘤防治杂志,2021,28(12):944-948. DOI: 10.16073/j.cnki.cjcpt.2021.12.11
Zhong JJ, Qiu MM, Deng YJ, et al. Comparison of two methods of bladder filling in postoperative IMRT for cervical cancer[J]. Chin J Cancer Prev Treat, 2021, 28(12): 944-948. DOI: 10.16073/j.cnki.cjcpt.2021.12.11
[16] 杨烨, 侯彦杰, 薛少军, 等. 前列腺癌放疗患者植入水凝胶后对直肠保护作用的Meta分析[J]. 中华放射医学与防护杂志,2021,41(6):436-443. DOI: 10.3760/cma.j.issn.0254-5098.2021.06.007
Yang Y, Hou YJ, Xue SJ, et al. The protective effects of hydrogel implantation in prostate cancer patients for radiotherapy: a Meta-analysis[J]. Chin J Radiol Med Prot, 2021, 41(6): 436-443. DOI: 10.3760/cma.j.issn.0254-5098.2021.06.007
[17] Yahya S, Zarkar A, Southgate E, et al. Which bowel preparation is best? Comparison of a high-fibre diet leaflet, daily microenema and no preparation in prostate cancer patients treated with radical radiotherapy to assess the effect on planned target volume shifts due to rectal distension[J]. Br J Radiol, 2013, 86(1031): 20130457. DOI: 10.1259/bjr.20130457
[18] Jotwani A, Surendran J, Chilukuri S, et al. Rectum and bladder dose variations during prostate IGRT: an evaluation of bowel and bladder preparation protocol[J]. Int J Radiat Oncol Biol Phys, 2012, 84(3S): S395. DOI: 10.1016/j.ijrobp.2012.07.1042
[19] 李婷, 郭雨军, 杨鑫, 等. 肠道膀胱准备下前列腺癌精准放疗膀胱直肠变化分析[J]. 中华放射肿瘤学杂志,2023,32(2):124-130. DOI: 10.3760/cma.j.cn113030-20220701-00229
Li T, Guo YJ, Yang X, et al. Analysis of the rectum and bladder changes in prostate precise radiotherapy under the bowel and bladder preparation[J]. Chin J Radiat Oncol, 2023, 32(2): 124-130. DOI: 10.3760/cma.j.cn113030-20220701-00229
[20] Linney H, Barrett S. Stereotactic body radiation therapy for patients with early-stage prostate cancer[J]. Anticancer Res, 2018, 38(3): 1231-1240. DOI: 10.21873/anticanres.12344
[21] 曾自力, 林锋, 谭勇. 摆位误差对直肠癌术后调强放射治疗剂量学影响的研究[J]. 中国辐射卫生,2021,30(4):517-523,528. DOI: 10.13491/j.issn.1004-714X.2021.04.025
Zeng ZL, Lin F, Tan Y. Dosimetric effects study of set-up error in postoperative intensity modulated radiotherapy of rectal cancer[J]. Chin J Radiol Health, 2021, 30(4): 517-523,528. DOI: 10.13491/j.issn.1004-714X.2021.04.025
[22] 董晓庆, 胡杰, 陆春花, 等. 前列腺癌图像引导放射治疗精准度评估[J]. 中国医学物理学杂志,2016,33(7):658-663. DOI: 10.3969/j.issn.1005-202X.2016.07.003
Dong XQ, Hu J, Lu CH, et al. Accuracy assessment of image-guided radiotherapy for prostate cancer[J]. Chin J Med Phys, 2016, 33(7): 658-663. DOI: 10.3969/j.issn.1005-202X.2016.07.003
[23] 刘豪佳, 王慧涛, 徐红卫, 等. X射线容积成像系统配准方式对中下段食管癌放疗体位验证的影响[J]. 中国辐射卫生,2023,32(1):52-57. DOI: 10.13491/j.issn.1004-714X.2023.01.011
Liu HJ, Wang HT, Xu HW, et al. Effects of X-ray volume imaging registration methods on position verification for radiotherapy in treatment of middle/lower-segment esophageal cancer[J]. Chin J Radiol Health, 2023, 32(1): 52-57. DOI: 10.13491/j.issn.1004-714X.2023.01.011