Zhang Xiang, Yu Hua
Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.
J Zhejiang Univ Sci B. 2009 Sep;10(9):683-8. doi: 10.1631/jzus.B0920114.
To evaluate the pelvic lymph node coverage of conventional pelvic fields based on bony landmarks in Chinese patients with cervical cancer by using computed tomography (CT) simulation images to contour pelvic vessels as substitutes for lymph nodes location.
A retrospective review of CT simulation images and conventional pelvic radiation planning data sets was performed in 100 patients with cervical cancer at the International Federation of Gynecology and Obstetrics (FIGO) Stage IIB to IIIB in our hospital. Pelvic arteries were contoured on CT simulation images, and the outlines of conventional pelvic fields were drawn as defined by the gynecologic oncology group (GOG) after hiding the contours. The distances between the following vessel contours and field borders were measured: D(1), the superior border of the anterior/posterior (AP) field and the bifurcation of abdominal aorta; D(2), the ipsilateral border of the AP field and the distal end of external iliac artery; and D(3), the anterior border of the lateral (LAT) field and the distal end of the external iliac artery. The distances were recorded as positive values if the measuring point was within the conventional pelvic fields, or they were recorded as negative values. Lymph nodes coverage was considered adequate when D(1)(0 mm, D(2)(17 mm or D(3)(7 mm.
All patients had at least 1 inadequate margin, 97 patients (97.0%) had 2, and 22 patients (22.0%) had all the 3. On the AP field, 95 patients (95%) had the measuring point, the bifurcation of the abdominal aorta, out of the field (D(1)<0 mm), and all the patients had a distance less than 17.0 mm between the distal end of the external iliac artery and ipsilateral border (D(2)<17.0 mm). On the LAT field, 24 patients (24%) had a distance less than 7.0 mm between the distal end of the external iliac artery and anterior border (D(3)<7.0 mm).
We observed that conventional pelvic fields based on bony landmarks provided inadequate coverage of pelvic lymph nodes in our patients with cervical cancer. CT simulation may be a feasible technique for planning pelvic fields optimally and individually.
通过使用计算机断层扫描（CT）模拟图像勾勒盆腔血管以替代淋巴结位置，评估基于骨性标志的传统盆腔野对中国宫颈癌患者盆腔淋巴结的覆盖情况。
对我院100例国际妇产科联盟（FIGO）IIB至IIIB期宫颈癌患者的CT模拟图像和传统盆腔放射治疗计划数据集进行回顾性分析。在CT模拟图像上勾勒盆腔动脉，隐藏轮廓后按照妇科肿瘤学组（GOG）的定义绘制传统盆腔野的轮廓。测量以下血管轮廓与野边界之间的距离：D(1)，前后（AP）野的上边界与腹主动脉分叉处之间的距离；D(2)，AP野的同侧边界与髂外动脉远端之间的距离；以及D(3)，侧野（LAT）的前边界与髂外动脉远端之间的距离。如果测量点在传统盆腔野内，则距离记录为正值，否则记录为负值。当D(1)≤0 mm、D(2)≤17 mm或D(3)≤7 mm时，认为淋巴结覆盖充分。
所有患者至少有1个边界不充分，97例患者（97.0%）有2个，22例患者（22.0%）3个边界均不充分。在AP野，95例患者（95%）的测量点，即腹主动脉分叉处，不在野内（D(1)<0 mm），并且所有患者髂外动脉远端与同侧边界之间的距离均小于17.0 mm（D(2)<17.0 mm）。在LAT野，24例患者（24%）髂外动脉远端与前边界之间的距离小于7.0 mm（D(3)<7.0 mm）。
我们观察到基于骨性标志的传统盆腔野对我们的宫颈癌患者盆腔淋巴结的覆盖不充分。CT模拟可能是一种优化和个体化盆腔野计划的可行技术。
