首次对功能性球海绵体肌解剖结构（一种新的女性危险器官）进行放射治疗应用，以及对保留器官的可行性进行研究。
A first radiotherapy application of functional bulboclitoris anatomy, a novel female sexual organ-at-risk, and organ-sparing feasibility study.
机构信息
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
Br J Radiol. 2021 Aug 1;94(1124):20201139. doi: 10.1259/bjr.20201139. Epub 2021 Jun 30.
OBJECTIVE
The bulboclitoris (clitoris and vestibular bulbs) is the primary organ responsible for female sexual arousal and orgasm. Effects of radiotherapy on the bulboclitoris are unknown, as its structure/function has yet to be described in radiotherapy, and it overlaps only partially with the external genitalia structure. Our aim was to: describe bulboclitoris structure, function and delineation; compare volume of and dose delivered to the bulboclitoris external genitalia; and, compare bulboclitoris-sparing IMRT (BCS-IMRT) to standard IMRT (S-IMRT) to determine reoptimization feasibility.
METHODS
Our expert team (anatomist, pelvic radiologist, radiation oncologist) reviewed bulboclitoris anatomy and developed contouring guidance for radiotherapy. 20 female patients with anal cancer treated with chemoradiation were analyzed. Sexual organs at risk (OARs) included the external genitalia and the bulboclitoris. Volumes, dice similarity coefficients (DSCs) and dose received using S-IMRT were compared. Plans were reoptimized using BCS-IMRT. Dose-volume histograms (DVHs) for PTVs and all OARs were compared for BCS-IMRT S-IMRT.
RESULTS
Bulboclitoris structure, function and delineation are described herein. The bulboclitoris occupies 20cc (IQR:12-24), largely distinct from the external genitalia (DSC <0.05). BCS-IMRT was superior to S-IMRT in reducing the dose to the bulboclitoris, with the greatest reductions in V30 and V40, with no significant changes in dose to other OARs or PTV 1/V95.
CONCLUSION
The bulboclitoris can be contoured on planning imaging, largely distinct from the external genitalia. Compared with S-IMRT, BCS-IMRT dramatically reduced dose to the bulboclitoris in anal cancer planning. BCS-IMRT might safely reduce sexual toxicity compared with standard approaches.
ADVANCES IN KNOWLEDGE
The structure and function of the bulboclitoris, the critical primary organ responsible for female sexual arousal and orgasm, has yet to be described in the radiotherapy literature. Structure, function and delineation of the bulboclitoris are detailed, delineation and bulboclitoris-sparing IMRT were feasible, and sparing reduces the dose to the bulboclitoris nearly in half in female patients receiving IMRT for anal cancer, warranting further clinical study.
目的
球海绵体（阴蒂和前庭球）是女性性唤起和性高潮的主要器官。放射治疗对球海绵体的影响尚不清楚，因为其结构/功能尚未在放射治疗中描述，并且仅与外阴结构部分重叠。我们的目的是：描述球海绵体的结构、功能和勾画；比较球海绵体和外阴的体积和剂量；并比较球海绵体保护调强放疗（BCS-IMRT）与标准调强放疗（S-IMRT），以确定重新优化的可行性。
方法
我们的专家团队（解剖学家、盆腔放射科医生、放射肿瘤学家）回顾了球海绵体的解剖结构，并制定了放射治疗的勾画指南。对 20 例接受放化疗的肛门癌女性患者进行了分析。包括外阴和球海绵体在内的生殖器官危险器官（OARs）都在研究范围内。比较了 S-IMRT 下的体积、骰子相似系数（DSC）和剂量。使用 BCS-IMRT 对计划进行了重新优化。比较了 BCS-IMRT 和 S-IMRT 下 PTV 和所有 OAR 的剂量-体积直方图（DVH）。
结果
本文描述了球海绵体的结构、功能和勾画。球海绵体体积为 20cc（IQR：12-24），与外阴明显不同（DSC<0.05）。与 S-IMRT 相比，BCS-IMRT 在外阴保留不变的情况下，显著降低了球海绵体的剂量，V30 和 V40 降低幅度最大，对其他 OAR 或 PTV1/V95 的剂量没有显著变化。
结论
球海绵体可以在外照射计划成像上勾画，与外阴明显不同。与 S-IMRT 相比，BCS-IMRT 显著降低了肛门癌计划中的球海绵体剂量。与标准方法相比，BCS-IMRT 可能安全降低女性的性毒性。
知识进展
球海绵体的结构和功能，即女性性唤起和性高潮的主要器官，尚未在放射治疗文献中描述。本文详细描述了球海绵体的结构、功能和勾画，同时表明球海绵体的勾画和保护调强放疗是可行的，并且在外阴保留不变的情况下，显著降低了接受 IMRT 治疗的肛门癌女性患者的球海绵体剂量，接近一半，值得进一步的临床研究。
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