Dosimetry and side effects comparison of prone with Belly board and supine position in intensity modulated radiotherapy for cervical cancer
ZHOU Long TANG Yan LIU Gengchun DONG Ke LIU Yuelong HUANG Baqun
Department of Radiation Oncology, Xiangtan Clinical College of Central South University Xiangtan Central Hospital, Hu′nan Province, Xiangtan 411100, China
Abstract:Objective To explore the optimal position in radiotherapy for cervical cancer, by comparing the dose-volume relationship of the mid-intestinal pouch, bladder, rectum, femoral head and the occurrence of acute radiation enteritis in the prone position + Belly board and the supine position. Methods A total of 40 patients with cervical cancer who underwent intensity modulation radiotherapy in Xiangtan Central Hospital, Hu′nan Province from June 2017 to March 2019 were randomly selected. CT scans were performed in Belly board and Belly position respectively. The target area and organs at risk were mapped under the same conditions and the treatment plan was optimized to compare the dose-volume relationship between the target area and organs at risk in two positions. Then the patients were divided into prone position group (20 cases) and supine position group (20 cases) for treatment by stratified sampling and random number table method according to age and stage, and the occurrence of acute radiation enteritis was observed in the two groups. Results Compared with the supine position group, the volume of intestinal pouch of organs at risk in the prone position group was significantly reduced (P < 0.05), the average volume of bladder and rectum and the average volume of target area showed no statistical significance (P > 0.05), and the comparison of target area fitness index and uniformity index showed no statistical significance (P > 0.05). Compared with the supine group, the volume of intestinal pouch receiving 25-45 Gy dose was significantly reduced in the prone position group (P < 0.01), while the dose-volume relationship of other organs at risk was not statistically significant (P > 0.05). The incidence of acute radiation enteritis in prone position group was significantly lower than that in supine position group, and the severity was reduced, with statistically significant difference (P < 0.05). Conclusion For intensity-modulated radiotherapy of cervical cancer, the Belly board in prone position can significantly reduce the dose of intestinal pouch and reduce the occurrence of intestinal side effects.
周龙 唐滟 刘耿淳 董可 刘跃龙 黄拔群. 宫颈癌调强放疗俯卧位Belly board与仰卧位的剂量学与副反应比较[J]. 中国医药导报, 2020, 17(26): 86-90.
ZHOU Long TANG Yan LIU Gengchun DONG Ke LIU Yuelong HUANG Baqun. Dosimetry and side effects comparison of prone with Belly board and supine position in intensity modulated radiotherapy for cervical cancer. 中国医药导报, 2020, 17(26): 86-90.
[1] Taylor A,Rockall AG,Reznek RH,et al. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy [J]. Int J Radiat Oncol Biol Phys,2005,63(5):1604-1612.
[2] Small W Jr,Mell LK,Anderson P,et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer [J]. Int J Radiat Oncol Biol Phys,2008,71(2):428-434.
[3] Lim K,Small W,Portelance L,et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer [J]. Int J Radiat Oncol Biol Phys,2011,79(2):348-355.
[4] Gay HA,Barthold HJ, O′Meara E,et al. Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas [J]. Int J Radiat Oncol Biol Phys,2012,83(3): e353-362.
[5] 殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2008:1350.
[6] 刘青,张宗恺,王雅棣,等.图像引导对宫颈癌放疗中直肠、膀胱照射剂量的影响[J].中华放射肿瘤学杂志,2018, 27(1):68-73.
[7] 马建萍,夏新舍,潘闻燕,等.膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响[J].中华放射医学与防护杂志,2019,39(9):652-657.
[8] 庞皓文,孙小杨,杨波,等.宫颈癌根治性调强放疗期间膀胱直肠体积与其吸收剂量的关系[J].肿瘤防治研究,2016,43(1):63-66.
[9] 倪晓雷,陈榕钦,柏朋刚,等.图像引导下宫颈癌容积旋转调强放疗中膀胱和直肠实际受照剂量评估[J].中国医学物理学杂志,2019,36(2):142-145.
[10] Okonogi N,Fukahori M,Wakatsuki M,et al. Dose constraints in the rectum and bladder following carbon-ion radiotherapy for uterus carcinoma: a retrospective pooled analysis [J]. Radiat Oncol,2018,13:119.
[11] Maemoto H,Toita T,Ariga T,et al. Predictive factors of uterine movement during definitive radiotherapy for cervical cancer [J]. J Radiat Res,2017,58(3):397-404.
[12] 苗慧,施林心,白海生,等.宫颈癌不同体位调强放疗对周围正常组织的辐射剂量学研究[J].中国辐射卫生,2018,27(4):381-384.
[13] Kundapur V,Cranmer-Sargison G,Vachhrajani H,et al. Evaluating QUANTEC Small Bowel Dose-Volume Guidelines for Rectal Cancer Patients Treated Using a Couch Top Inclined Belly Board [J]. J Med Imaging Radiat Sci,2014,45(3): 218-222.
[14] Wang JF,Li H,Xiong H,et al. Influence of position and radiation technique on organs at risk in radiotherapy of rectal cancer [J]. J Huazhong Univ Sci Technol Med Sci,2016,36(5):741-746.
[15] Rajeev KR,Menon SS,Beena K,et al. A comparative study of set up variations and bowel volumes in supine versus prone positions of patients treated with external beam radiation for carcinoma rectum [J]. J Cancer Res Ther,2014,10(4): 937-941.
[16] White R,Foroudi F,Sia J,et al. Reduced dose to small bowel with the prone position and a belly board versus the supine position in neoadjuvant 3D conformal radiotherapy for rectal adenocarcinoma [J]. J Med Radiat Sci,2017,64(2):120-124.
[17] Estabrook Neil C,Bartlett Gregory K,Compton Julia J,et al. Role of belly board device in the age of intensity modulated radiotherapy for pelvic irradiation [J]. Med Dosim,2016,41(4): 300-304.
[18] Pinkawa M,Gagel B,Demirel C,et al. Dose-volume histogram evaluation of prone and supine patient position in external beam radiotherapy for cervical and endometrial cancer [J]. Radiother Oncol,2003,69(1): 99-105.
[19] Adli M,Mayr NA,Kaiser HS,et al. Does prone positioning reduce small bowel dose in pelvic radiation with intensity-modulated radiotherapy for gynecologic cancer? [J]. Int J Radiat Oncol Biol Phys,2003, 57(1): 230-238.
[20] Martin J,Fitzpatrick K,Horan G,et al. Treatment with a belly-board device significantly reduces the volume of small bowel irradiated and results in low acute toxicity in adjuvant radiotherapy for gynecologic cancer: results of a prospective study [J]. Radiother Oncol,2005,74(3): 267-274.
[21] Ghosh K,Padilla L A,Murray K P,et al. Using a belly board device to reduce the small bowel volume within pelvic radiation fields in women with postoperatively treated cervical carcinoma [J]. Gynecol Oncol,2001,83(2): 271-275.
[22] Anjanappa M,Raghavan RK,James FV,et al. The impact of patient positioning and use of belly board on small bowel toxicity in patients receiving pelvic radiotherapy for gynecological malignancies [J]. J Cancer Res Ther,2017,13(3): 519-523.
[23] Gonzalez VJ,Hullett CR,Burt L,et al. Impact of prone versus supine positioning on small bowel dose with pelvic intensity modulated radiation therapy [J]. Adv Radiat Oncol,2017,2(2): 235-243.
[24] 余建云,李林均,陈萍,等.宫颈癌IMRT治疗中俯卧位Belly-board不同位置对靶区动度和剂量分布的影响[J].肿瘤防治研究,2011,38(4):416-419.
[25] Koelbl O,Vordermark D,Flentje M. The relationship between belly board position and patient anatomy and its influence on dose-volume histogram of small bowel for postoperative radiotherapy of rectal cancer [J]. Radiother Oncol,2003,67(3):345-349.