结直肠前壁边缘减少的三步图像指导策略 在低分离前列腺放射治疗中
Gao Yan1, Huang Lei1, Zhao Bo2
1Department of Radiotherapy, Peking University First Hospital, Beijing 100034, China.
Practical radiation oncology
|February 4, 2026
概括
一个新的三步图像引导策略通过对准骨,前列腺和直肠前壁来显著降低前列腺放射治疗中的直肠毒性. 这种方法保持了目标覆盖率,同时最大限度地减少了直肠剂量,提供了更安全的治疗选择.
科学领域:
- 辐射瘤学 辐射瘤学
- 医疗成像医学成像
- 图像指导疗法是指导图像的疗法.
背景情况:
- 低分离前列腺放射治疗需要精确的图像指导,以平衡目标覆盖率和风险器官毒性.
- 减少规划目标体积 (PTV) 边缘,特别是后部,是可取的,但由于软组织运动和解剖变异性,这是具有挑战性的.
研究的目的:
- 评估三步图像指导策略 (骨-前列腺-直肠前壁对齐) 以减少前列腺放射治疗中的后部CTV-PTV边缘.
- 通过可变形图像记录 (DIR) 评估对目标覆盖范围,直肠毒性和剂量分配的影响.
主要方法:
- 一个三步调整方案 (骨,前列腺软组织,直肠前壁) 应用于23名接受70 Gy/25分数放射治疗的患者.
- 混合DIR工作流用于可变形剂量积累,并彻底评估DIR不确定性.
- 用莱曼-库切尔-伯曼模型计算了≥2级GI/GU毒性的正常组织并发症概率 (NTCP).
主要成果:
- 与仅前列腺对齐相比,三步策略显著减少了直肠NTCP (7.95%vs13.61%),具有可比的CTV覆盖率.
- 可变形剂量积累证实了足够的内部目标体积 (DIL) 覆盖,除了靠近直肠壁的DIL或有显著的直肠重叠.
- 图像记录质量很高,子相似系数 (DSC) 超过0.8,非物理变形最小.
结论:
- 三步图像引导协议有效地增强了直肠保护,同时在低分离前列腺放射治疗中保持了目标覆盖范围.
- 减少后部PTV边缘是可行的,但需要仔细考虑DIL与直肠的距离.
- 个性化边缘和适应性放射治疗可能是必要的,以确保在特定解剖部位提供足够的DIL覆盖.
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