Radiation Oncology Journal

  • 제22권2호
  • /
  • Pages.130-137
  • /
  • 2004
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지

자궁경부암의 3D-CRT와 IMRT시 소장전위장치의 소장 선량에 대한 영향

Small Bowel Sparing Effect of Small Bowel Displacement System in 3D-CRT and IMRT for Cervix Cancer

  • 강민규 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 허승재 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 한영이 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 박 원 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 주상규 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 김경주 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 이정은 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 박영제 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 남희림 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 임도훈 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 안용찬 (성균관대학교 의과대학 삼성서울병원 방사선종양학과)
  • Kang, Min-Kyu (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung-Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Young-Yih (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ju, Sang-Gyu (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyoung-Ju (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jeung-Eun (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Young-Je (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Hee-Rim (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Do-Hoon (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Yong-Chan (Department of Radiation Oncology, Samsung Medical Center)
  • 발행 : 2004.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 : 자궁경부암의 방사선치료 시 3차원입체조형방사선치료(3D-CRT)와 세기조절방사선치료(IMRT)는 소장의 방사선 조사선량을 감소시킬 수 있으며, 소장전위장치(SBDS)는 골반강 내의 소장 용적을 감소시킬 수 있다고 알려져 있다. 본 연구는 SBDS를 사용한 3D-CRT와 IMRT 계획을 SBDS를 사용하지 않은 계획과 비교하여, SBDS의 소장 조사선량에 대한 영향을 평가하였다 대상 및 방법 : 자궁경부암으로 근치적 방사선치료를 받은 10명의 환자를 대상으로 하였다. 각 환자에 대하여 스티로폼 압박기구와 환자에게 개별적으로 제작되는 고정기구로 구성된 SBDS를 제작하였고, SBDS가 있는 상태와 없는 상태로 복와위에서 전산화단층촬영(CT)을 시행하였다 3D-CRT는 4-field box technique을, IMRT는 15 MV X-선 7 조사문을 이용하여 계획하였으며, 회전중심점에 50 Gy (25회 분할)를 처방하였다. 비교 분석은 SBDS의 사용에 따른 소장 용적의 변화와 네 가지 계획의 소장의 선량체적히스토그람의 차이를 10 Gy 단위로 paired f-test를 이용하여 분석하였다. 결과 : 소장의 용적은 SBDS를 사용하였을 때 평균 522 cm$^{3}$에서 262 cm$^{3}$로 49.8$\%$ 감소되었다. 10 Gy부터 50 Gy까지 10 Gy 간격으로 일정한 조사선량을 받는 소장의 용적은 SBDS를 사용하였을 때 3D-CRT에서65$\~$80$\%$, IMRT에서 54$\~$67$\%$ 감소하였다. 3D-CRT와 IMRT를 서로 비교하면, 20 Gy부터 50 Gy까지 10 Gy간격으로 일정한 조사선량을 받는 소장 용적은 SBDS를 사용하지 않은 경우에는 IMRT가 6$\~$7$\%$ 정도 유의하게 적었으나 SBDS를 사용한 경우에는 1$\%$ 이내로 차이가 없었다. 결론 : 3D-CRT와 IMRT에서 SBDS를 사용할 때 소장의 조사선량을 더 감소시킬 수 있었으므로, SBDS를 치료에 이용하면 소장의 부작용을 더 감소시킬 수 있을 것이다.

Purpose : In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. Materials and Methods : Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and proscribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using palled t-tests. Results : The SBDS significantly reduced the mean SB volume from 522 to 262 cm$^{3}$ (49.8$\%$ reduction). The SB volumes that received a dose of 10$\~$50 Gy were significantly reduced in 3D-CRT (65$\~$80$\%$ reduction) and IMRT plans (54$\~$67$\%$ reduction) using the SBDS. When the SB volumes that received 20$\~$50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6$\~$7$\%$, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1$\%$ when using the SBDS. Conclusion : The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.

키워드

참고문헌

  1. Perez CA, Grigsby PW, Nene SM, et al. Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated with irradiation alone. Cancer 1992;69:2796-2806 https://doi.org/10.1002/1097-0142(19920601)69:11<2796::AID-CNCR2820691127>3.0.CO;2-O
  2. Landoni F, Maneo A, Colombo A, et al. Randomized study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997;350:535-540 https://doi.org/10.1016/S0140-6736(97)02250-2
  3. Perez CA, Breaux S, Bedwinek JM, et al. Radiation therapy alone in the treatment of carcinoma of the uterine cervix. II. Analysis of complications. Cancer 1984;54:235-246
  4. Gallagher MJ, Brereton HD, Rostock RA, et al. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation. Int J Radiat Oncol Biol Phys 1986;12:1565-1573 https://doi.org/10.1016/0360-3016(86)90279-8
  5. Letschert JG, Lebesque JV, Aleman BM, et al. The volume effect in radiation-related late small bowel complications: results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma. Radiother Oncol 1994;32:116-123 https://doi.org/10.1016/0167-8140(94)90097-3
  6. Letschert JG, Lebesque JV, de Boer RW, Hart AA, Bartelink H. Dose-volume correlation in radiation-related late small-bowel complications: a clinical study. Radiother Oncol 1990;18:307-320 https://doi.org/10.1016/0167-8140(90)90111-9
  7. Fu YT, Lam JC, Tze JM. Measurement of irradiated small bowel volume in pelvic irradiation and the effect of a bellyboard. Clin Oncol (R Coll Radiol) 1995;7:188-192 https://doi.org/10.1016/S0936-6555(05)80514-X
  8. 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 posto perative radiotherapy of rectal cancer. Radiother Oncol 2003; 67:345-349 https://doi.org/10.1016/S0167-8140(03)00164-6
  9. Huh SJ, Lim DH, Ahn YC, et al. Effect of customized small bowel displacement system in pelvic irradiation. Int J Radiat Oncol Biol Phys 1998;40:623-627 https://doi.org/10.1016/S0360-3016(97)00764-5
  10. Lim DH, Huh SJ, Ahn YC, et al. Minimization of small bowel volume within treatment fields using customized small bowel displacement system (SBDS). J Korean Soc Ther Radiol Oncol 1997;15:263-268
  11. Kim MK, Kim DY, Ahn YC, et al. Analysis of the interand intra-treatment isocenter deviations in pelvic radiotherapy with small bowel displacement system. J Korean Soc Ther Radiol Oncol 2000;18:114-119
  12. Gerstner N, Wachter S, Knocke TH, Fellner C, Wambersie A, Potter R. The benefit of Beam's eye view based 3D treatment planning for cervical cancer. Radiother Oncol 1999;51:71-78 https://doi.org/10.1016/S0167-8140(99)00038-9
  13. Mundt AJ, Lujan AE, Rotmensch J, et al. Intensitymodulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2002;52:1330-1337 https://doi.org/10.1016/S0360-3016(01)02785-7
  14. Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2003;56:1354-1360 https://doi.org/10.1016/S0360-3016(03)00325-0
  15. Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt AJ. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2000;48:1613-1621 https://doi.org/10.1016/S0360-3016(00)00771-9
  16. Portelance L, Chao KS, Grigsby PW, Bennet H, Low D. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001;51:261-266
  17. 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? Int J Radiat Oncol Biol Phys 2003;57:230-238
  18. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999;73:177-183 https://doi.org/10.1006/gyno.1999.5387
  19. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606-1613 https://doi.org/10.1200/JCO.2000.18.8.1606
  20. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340:1137-1143 https://doi.org/10.1056/NEJM199904153401501
  21. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339-1348 https://doi.org/10.1200/JCO.1999.17.5.1339
  22. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin- based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-1153 https://doi.org/10.1056/NEJM199904153401502
  23. Kavanah MT, Feldman MI, Devereux DF, Kondi ES. New surgical approach to minimize radiation-associated small bowel injury in patients with pelvic malignancies requiring surgery and high-dose irradiation. A preliminary report. Cancer 1985;56:1300-1304 https://doi.org/10.1002/1097-0142(19850915)56:6<1300::AID-CNCR2820560613>3.0.CO;2-4
  24. Herbert SH, Solin LJ, Hoffman JP, et al. Volumetric analysis of small bowel displacement from radiation portals with the use of a pelvic tissue expander. Int J Radiat Oncol Biol Phys 1993;25:885-893 https://doi.org/10.1016/0360-3016(93)90320-U
  25. Roeske JC, Bonta D, Mell LK, Lujan AE, Mundt AJ. A dosimetric analysis of acute gastrointestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiother Oncol 2003;69:201-207 https://doi.org/10.1016/j.radonc.2003.05.001
  26. Huh SJ, Kang MK and Han Y. Small bowel displacement system-assisted intensity-modulated radiotherapy for cervical cancer. Gynecol Oncol 2004;93:400-406 https://doi.org/10.1016/j.ygyno.2004.01.023