Zunino S, Rosato O, Lucino S, Jauregui E, Rossi L, Venencia D
Instituto de Radioterapia-Fundación Marie Curie, Cordoba, Argentina.
Int J Radiat Oncol Biol Phys. 1999 Apr 1;44(1):53-9. doi: 10.1016/s0360-3016(98)00538-0.
To review the radiation therapy "box" technique for cancer of the cervix by means of magnetic resonance imaging (MRI), lymphangiography, and anatomic studies on cadavers.
From 1993 to 1996, the anatomic borders of the "box" technique used at our Radiation Oncology Department-the superior border of the AP-PA fields at the inferior edge of L4; the inferior border at the inferior edge of the ischium; the lateral borders placed 2.5 cm outside of the bony pelvis rim; the anterior border of the lateral fields over the anterior edge of the pubic symphysis; and the posterior at the S2-S3 interspace-were reviewed in 35 sagittal MRI and 10 lymphangiographies of patients with FIGO IB (6), IIA (6), IIB (19), IIIB (3), and IVA (1). An anatomic revision was conducted on 30 cadavers to identify aortic bifurcation, lymphatic nodes, and uterus flexion.
In 50% of the patients with FIGO IB, the posterior border of the lateral field was inadequate to encompass the planning target volume (PTV), and in 67% with Stage IIA. In IIB, the anterior border was inadequate in 1 patient, and the posterior in 8 (42%). In IIB and IVA patients, the PTV was not encompassed. When correlating the anterior and posterior borders of the lateral field and the treatment volume in the 35 sagittal MRIs, the posterior border of the lateral field was inadequate in 49%, and the anterior border in 9% of the cases. According to the lymphangiography, the portals encompassed the external iliac nodes. Dissected female pelvises revealed that the aortic bifurcation occurred at the level of the inferior L4 edge in 80% of the cadavers. There was no correlation between uterus flexion in MRIs and in cadavers.
The design of the lateral fields of the four-field technique for the irradiation of the uterine cervix based on anatomic bone references failed to encompass the planning-target volume in a significant number of patients.
通过磁共振成像（MRI）、淋巴管造影以及尸体解剖研究，回顾子宫颈癌放射治疗的“盒式”技术。
1993年至1996年，在我们放射肿瘤学部门使用的“盒式”技术的解剖边界——前后野的上边界位于L4下缘；下边界位于坐骨下缘；侧边界位于骨盆骨缘外侧2.5厘米处；侧野的前边界位于耻骨联合前缘上方；后边界位于S2 - S3间隙——在35例矢状面MRI以及10例国际妇产科联盟（FIGO）IB期（6例）、IIA期（6例）、IIB期（19例）、IIIB期（3例）和IVA期（1例）患者的淋巴管造影中进行了回顾。对30具尸体进行解剖修正，以确定主动脉分叉、淋巴结和子宫弯曲情况。
在FIGO IB期患者中，50%的侧野后边界不足以覆盖计划靶体积（PTV），IIA期患者中这一比例为67%。在IIB期，1例患者的前边界不足，8例（42%）患者的后边界不足。在IIB期和IVA期患者中，PTV未被覆盖。在35例矢状面MRI中，将侧野的前后边界与治疗体积相关联时，49%的病例侧野后边界不足，9%的病例前边界不足。根据淋巴管造影，射野覆盖了髂外淋巴结。解剖女性骨盆显示，80%的尸体主动脉分叉位于L4下缘水平。MRI和尸体中的子宫弯曲情况之间无相关性。
基于解剖学骨标志的子宫颈照射四野技术的侧野设计，在相当数量的患者中未能覆盖计划靶体积。
