基于磁共振成像（MRI）的局部晚期宫颈癌腔内/组织间近距离放射治疗新模板的开发与临床应用：从基于计算机断层扫描（CT）的MUPIT到MRI兼容的贝尼多姆模板。十年经验
Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience.
作者信息
Rodríguez Villalba Silvia, Richart Sancho Jose, Otal Palacín Antonio, Perez-Calatayud Jose, Santos Ortega Manuel
机构信息
Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante.
Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante; Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
出版信息
J Contemp Brachytherapy. 2016 Oct;8(5):404-414. doi: 10.5114/jcb.2016.63187. Epub 2016 Oct 25.
PURPOSE
To study outcome and toxicity in 59 patients with locally advanced cervix carcinoma treated with computed tomography (CT)-based Martinez universal perineal interstitial template (MUPIT) and the new magnetic resonance imaging (MRI)-compatible template Benidorm (TB).
MATERIAL AND METHODS
From December 2005 to October 2015, we retrospectively analyzed 34 patients treated with MUPIT and 25 treated with the TB. Six 4 Gy fractions were prescribed to the clinical target volume (CTV) combined with external beam radiotherapy (EBRT). The organs at risk (OARs) and the CTV were delineated by CT scan in the MUPIT implants and by MRI in the TB implants. Dosimetry was CT-based for MUPIT and exclusively MRI-based for TB. Dose values were biologically normalized to equivalent doses in 2 Gy fractions (EQD).
RESULTS
Median CTV volumes were 163.5 cm for CT-based MUPIT (range 81.8-329.4 cm) and 91.9 cm for MRI-based TB (range 26.2-161 cm). Median D CTV (EBRT + BT) was 75.8 Gy for CT-based MUPIT (range 69-82 Gy) and 78.6 Gy for MRI-based TB (range 62.5-84.2 Gy). Median D for the rectum was 75.3 Gy for CT-based MUPIT (range 69.8-132.1 Gy) and 69.9 Gy for MRI-based TB (range 58.3-83.7 Gy). Median D for the bladder was 79.8 Gy for CT-based MUPIT (range 71.2-121.1 Gy) and 77.1 Gy for MRI-based TB (range 60.5-90.8 Gy). Local control (LC) was 88%. Overall survival (OS), disease free survival (DFS), and LC were not statistically significant in either group. Patients treated with CT-based MUPIT had a significantly higher percentage of rectal bleeding G3 ( = 0.040) than those treated with MRI-based TB, 13% vs. 2%.
CONCLUSIONS
Template Benidorm treatment using MRI-based dosimetry provides advantages of MRI volume definition, and allows definition of smaller volumes that result in statistically significant decreased rectal toxicity compared to that seen with CT-based MUPIT treatment.
目的
研究59例局部晚期宫颈癌患者采用基于计算机断层扫描（CT）的马丁内斯通用会阴间质模板（MUPIT）和新型磁共振成像（MRI）兼容模板贝尼多姆模板（TB）治疗的疗效和毒性。
材料与方法
2005年12月至2015年10月，我们回顾性分析了34例采用MUPIT治疗的患者和25例采用TB治疗的患者。临床靶体积（CTV）给予6个4Gy分割剂量，并联合外照射放疗（EBRT）。在MUPIT植入时通过CT扫描勾画危及器官（OARs）和CTV，在TB植入时通过MRI勾画。MUPIT的剂量测定基于CT，TB则完全基于MRI。剂量值经生物学归一化至2Gy分割剂量的等效剂量（EQD）。
结果
基于CT的MUPIT的CTV中位体积为163.5cm³（范围81.8 - 329.4cm³），基于MRI的TB为91.9cm³（范围26.2 - 161cm³）。基于CT的MUPIT的CTV中位D（EBRT + BT）为75.8Gy（范围69 - 82Gy），基于MRI的TB为78.6Gy（范围62.5 - 84.2Gy）。基于CT的MUPIT的直肠中位D为75.3Gy（范围69.8 - 132.1Gy），基于MRI的TB为69.9Gy（范围58.3 - 83.7Gy）。基于CT的MUPIT的膀胱中位D为79.8Gy（范围71.2 - 121.1Gy），基于MRI的TB为77.1Gy（范围60.5 - 90.8Gy）。局部控制率（LC）为88%。两组的总生存期（OS）、无病生存期（DFS）和LC均无统计学差异。基于CT的MUPIT治疗的患者直肠出血G3的百分比显著高于基于MRI的TB治疗的患者（P = 0.040），分别为13%和2%。
结论
采用基于MRI剂量测定的贝尼多姆模板治疗具有MRI体积定义的优势，与基于CT的MUPIT治疗相比，可定义更小的体积，从而使直肠毒性显著降低。
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