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目的观察锎-252中子内照射治疗宫颈癌时直肠和膀胱受量与晚期放射性并发症(直肠炎和膀胱炎)的相关性。方法选取2007年1月至2010年8月采取锎-252中子内照射治疗的286例宫颈癌患者作为研究对象。给予A点剂量10 Gy/f×4f,总量为40 Gy,分别确定直肠前壁和膀胱后壁的最大受量,测量直肠和膀胱最大受量参考点与宫腔施源器中心点之间的距离。以记录的4次内照射时直肠和膀胱最大受量值的平均值高低为标准把患者分为高、中、低剂量组;观察严重(≥G2级)晚期放射性直肠炎和膀胱炎的发生率。结果直肠最大受量点和宫腔施源器中心的距离是随着放疗时治疗次数的增加而增加,呈正相关关系(r=0.990,P<0.05),而直肠受量是随着放疗时治疗次数的增加而降低,呈负相关关系(r=-0.959,P<0.05);膀胱最大受量点和宫腔施源器中心的距离以及膀胱受量与放疗时治疗次数没有相关关系。直肠高、中、低剂量组严重晚期放射性直肠炎发生率分别为13.2%(12/91)、2.0%(2/100)和1.1%(1/95),3组间比较差异均有统计学意义(P<0.01),膀胱高、中、低剂量组晚期放射性膀胱炎发生率分别为4.2%(6/143)、2.6%(2/77)和4.5%(3/66),3组间比较差异无统计学意义(P=0.270)。结论通过监测锎-252中子内照射时直肠和膀胱受量的高低,可预测晚期放射性直肠炎和膀胱炎的发生情况。
Objective To observe the relativity between rectum and bladder volume and advanced radioactive complication (proctitis and cystitis) when 锎 -252 neutron irradiation is applied to treat cervical cancer. Methods A total of 286 cervical cancer patients treated with 锎 -252 neutron irradiation from January 2007 to August 2010 were selected as the study subjects. A point dose of 10 Gy / f × 4f, a total of 40 Gy, respectively, to determine the anterior rectum and bladder posterior wall of the maximum amount of measurement of rectal and bladder maximum dose reference point and the uterine source device between the center point distance. The patients were divided into high, medium and low dose groups according to the average value of maximum rectum and bladder in the record of 4 internal irradiation. The incidence of severe radiological proctitis and cystitis . Results The distance between the maximal receiving point of the rectum and the center of the uterine applicator increased with the increase of the number of radiotherapy, which was positively correlated with r = 0.990, P <0.05. (R = -0.959, P <0.05). There was no correlation between the maximum dose point of the bladder and the center of the uterine-style applicator and the amount of the urinary bladder and the number of treatments during radiotherapy. The incidences of severe late proctitis in the high, middle and low dose rectal groups were 13.2% (12/91), 2.0% (2/100) and 1.1% (1/95), respectively. The differences among the three groups were statistically significant (P <0.01). The incidence of late-stage radiation cystitis in high, medium and low-dose bladder was 4.2% (6/143), 2.6% (2/77) and 4.5% The difference was not statistically significant (P = 0.270). Conclusion The incidence of late proctitis and cystitis can be predicted by monitoring the amount of rectum and bladder received during 锎 -252 neutron irradiation.