College of Clinical Medicine for Oncology, Fujian Medical University, Fujian, China.
Department of Oncology, Second Hospital of Sanming City, Sanming, Fujian, China.
Radiat Oncol. 2024 Sep 27;19(1):131. doi: 10.1186/s13014-024-02522-6.
To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method.
All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans.
In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB.
The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors.
通过采用舒适的体位方法，尽量减少妇科肿瘤患者在接受治疗过程中小肠（SB）的辐射暴露。
本研究纳入了 76 名接受调强放疗（IMRT）的女性患者。患者仰卧位，使用真空袋和热塑成型体固定。在试验组（n=36）中，患者抬高臀部，在固定前在骶尾部放置一个实心泡沫垫。对照组（n=40）接受标准仰卧位治疗。在 CT 扫描中，从耻骨联合到总髂分叉勾画 SB。
试验组盆腔内 SB 体积明显减少（平均 399.17±158.7 cc），对照组（平均 547.48±166.9 cc），p 值小于 0.001。试验组在每个剂量下照射的 SB 绝对体积均有统计学意义的减少，从低剂量（10 Gy）到高剂量（45 Gy）。对照组中，SB 与膀胱体积之间存在负相关（R=-0.411，P=0.008），而试验组相关性较弱（R=-0.286，P=0.091），膀胱体积与 SB 之间无显著关系。
高位仰卧位可有效减少 SB 辐射暴露，而无需膀胱扩张。这种体位方法有望减少各种盆腔肿瘤的 SB 照射。
