在制定膀胱扫描方案以协助接受放射治疗的前列腺癌患者保持膀胱充盈一致性方面采用前瞻性队列研究。
Use of a prospective cohort study in the development of a bladder scanning protocol to assist in bladder filling consistency for prostate cancer patients receiving radiation therapy.
作者信息
Cramp Leah, Connors Vanessa, Wood Maree, Westhuyzen Justin, McKay Michael, Greenham Stuart
机构信息
Department of Radiation Oncology North Coast Cancer Institute Coffs Harbour Health Campus Coffs Harbour New South Wales Australia.
North Coast Cancer Institute Lismore Health Campus Lismore New South Wales Australia.
出版信息
J Med Radiat Sci. 2016 Sep;63(3):179-85. doi: 10.1002/jmrs.162. Epub 2016 Feb 23.
INTRODUCTION
Evidence of variations in bladder filling effecting prostate stability and therefore treatment and side-effects is well established with intensity modulated radiation therapy (IMRT). This study aimed to increase bladder volume reproducibility for prostate radiation therapy by implementing a bladder scanning (BS) protocol that could assist patients' bladder filling at computed tomography (CT) simulation and treatment.
METHODS
Based on a retrospective review of 524 prostate cancer patients, a bladder volume of 250-350 mL was adopted as 'ideal' for achieving planning dose constraints. A prospective cohort study was conducted to assess the clinical utility of measuring patients' bladder volumes at CT simulation using an ultrasound bladder scanner (Verathon 9400 BladderScan(®)). A revised bladder preparation protocol was utilised by a bladder scan group (BS) and a non-BS group followed the standard departmental bladder preparation protocol. Time and volume data for the BS group (n = 17) were compared with the non-BS group (n = 17).
RESULTS
The BS cohort had a CT bladder volume range of 221-588 mL; mean 379 mL, SD 125 mL. The non-BS group had a larger range: 184-757 mL; mean 373 mL, SD 160 mL (P = 0.9171). There was a positive correlation between CT volume and BS volume in the BS group (r = 0.797; P = 0.0002) although BS volumes were smaller: range 160-420 mL; mean 251 mL; SD 91 mL; P < 0.0001). The maximum bladder volume receiving 50 Gy (V50) from the BS group was 46.4%, mean 24.5%. The maximum bladder V50 from the non-BS group was 50.9%, mean 27.3% (P = 0.5178). Treatment data from weekly cone beam CT scans were also compared over 6 weeks. They were assessed as being a pass if bladder and bowel requirements were acceptable. The BS group proceeded to treatment on the basis of a pass 92.7% of the time, whereas the pass rate for non-BS group was 75%; difference 17.7% (P < 0.0001).
CONCLUSION
The BS is a useful tool for achieving consistent, appropriately sized bladder volumes in prostate cancer patients.
引言
调强放射治疗（IMRT）中，膀胱充盈变化影响前列腺稳定性进而影响治疗及副作用的证据已得到充分证实。本研究旨在通过实施膀胱扫描（BS）方案来提高前列腺放射治疗中膀胱体积的可重复性，该方案可在计算机断层扫描（CT）模拟和治疗时辅助患者膀胱充盈。
方法
基于对524例前列腺癌患者的回顾性研究，采用250 - 350 mL的膀胱体积作为实现计划剂量限制的“理想”体积。进行了一项前瞻性队列研究，以评估使用超声膀胱扫描仪（Verathon 9400 BladderScan®）在CT模拟时测量患者膀胱体积的临床效用。膀胱扫描组（BS）采用修订后的膀胱准备方案，非BS组遵循标准的科室膀胱准备方案。将BS组（n = 17）的时间和体积数据与非BS组（n = 17）进行比较。
结果
BS队列的CT膀胱体积范围为221 - 588 mL；平均379 mL，标准差125 mL。非BS组范围更大：184 - 757 mL；平均373 mL，标准差160 mL（P = 0.9171）。BS组中CT体积与BS体积呈正相关（r = 0.797；P = 0.0002），尽管BS体积较小：范围160 - 420 mL；平均251 mL；标准差91 mL；P < 0.0001）。BS组接受50 Gy（V50）的最大膀胱体积为46.4%，平均24.5%。非BS组的最大膀胱V5（此处原文可能有误，推测为V50）为50.9%，平均27.3%（P = 0.5178）。还比较了6周内每周锥形束CT扫描的治疗数据。如果膀胱和肠道条件可接受，则评估为通过。BS组92.7%的时间基于通过情况进行治疗，而非BS组的通过率为75%；差异为17.7%（P < 0.0001）。
结论
BS是在前列腺癌患者中实现一致、大小合适的膀胱体积的有用工具。
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