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目的:研究宫颈癌调强放疗计划设计中膀胱壁与膀胱受照剂量的差别,从而在计划设计中正确设置和评价膀胱的限制剂量。方法:随机选取19例宫颈癌病例,为其设计调强计划。为了便于比较,分别给19例患者设计第一程全盆照射计划,处方剂量50 Gy/25次,利用DVH图分别评价膀胱和膀胱壁的受量。结果:调强计划中膀胱、膀胱壁的最小剂量、最大剂量差异均无统计学意义。膀胱平均剂量、D70、D50、D40和D30分别为38.45、30.07、38.68、43.90和47.54 Gy,膀胱壁平均剂量、D70、D50、D40和D30分别为40.97、32.80、45.83、49.16和50.24 Gy。用膀胱所受剂量评价膀胱壁剂量,膀胱壁平均剂量、D70、D50、D40和D30分别被低估6.55%、9.08%、18.49%、11.98%和5.68%。结论:在宫颈癌调强计划设计中,简单的用整个膀胱受量评价膀胱壁受量,将会低估膀胱壁的真正受量,从而加大膀胱并发症的概率,对膀胱造成不必要的损伤。
OBJECTIVE: To study the difference of the doses of bladder wall and bladder in the design of IMRT planning for cervical cancer so as to correctly set and evaluate the limiting dose of bladder in the planning design. Methods: Nineteen cases of cervical cancer were randomly selected to design an intensification plan. In order to facilitate comparison, 19 patients were designed for the first round of the whole basin irradiation plan, the prescription dose of 50 Gy / 25 times, the use of DVH maps were evaluated bladder and bladder wall by the amount. Results: There was no significant difference between the minimum dose and the maximum dose of bladder and bladder wall in the intensity adjustment program. The mean bladder dose, D70, D50, D40 and D30 were 38.45, 30.07, 38.68, 43.90 and 47.54 Gy, respectively. The mean bladder wall dose, D70, D50, D40 and D30 were 40.97, 32.80, 45.83, 49.16 and 50.24 Gy, respectively. The dose of bladder was used to evaluate the dose of bladder wall. The average bladder wall dose, D70, D50, D40 and D30 were underestimated by 6.55%, 9.08%, 18.49%, 11.98% and 5.68%, respectively. Conclusions: In the design of cervical cancer IMRT, the assessment of the bladder wall simply by the amount of the whole bladder will underestimate the true amount of the bladder wall, thereby increasing the probability of bladder complications and causing unnecessary damage to the bladder .