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目的:分析膀胱不同容量对宫颈癌大体肿瘤体积(GTV)、中心点及体表参考点位置的影响,为勾画靶区提供参考。方法:选取IIB~IIIB期宫颈癌患者17例,分别在膀胱充盈及排空状态下行模拟定位CT扫描,由同一位医生勾画膀胱不同容量下肿瘤GTV,比较充盈状态下(GTVF)与排空状态下(GTVE)肿瘤体积大小、中心点三维坐标及体表参考点三维坐标的差异,分析参考点位置变化与膀胱容量的相关性。结果:宫颈肿瘤GTVF与GTVE的体积分别为(70.42±30.29)cm3、(71.66±30.15)cm3,两者比较差异无统计学意义(P=0.236)。膀胱充盈与排空状态下,GTV中心点X轴坐标分别为-6.00±12.37、-6.34±11.94(P=0.21),Y轴分别为-423.37±142.27、-427.40±139.13(P=0.01),Z轴分别为-52.82±14.05、-51.46±12.04(P=0.35)。膀胱充盈与排空状态下体表参考点X轴的坐标分别为-12.02±18.43、-11.96±18.40(P=0.86),Y轴的坐标分别为-377.49±136.76、-378.28±135.84(P=0.43),Z轴坐标分别为74.60±20.10、68.55±19.75(P=0.02)。参考点在Z轴方向的位移与膀胱容量呈正相关(P=0.001)。结论:膀胱充盈状态对宫颈肿瘤GTV大小无明显影响,对宫颈肿瘤中心点及体表参考点位置均有影响。膀胱不同容量下宫颈肿瘤GTV的位移以头足方向为著,而体表参考点的位移在前后方向更明显。
OBJECTIVE: To analyze the effect of different bladder volume on gross tumor volume (GTV), center point and body surface reference position of cervical cancer, and to provide a reference for delineating the target area. Methods: Twenty-seven patients with stage IIB to IIIB cervical cancer were selected and underwent simulated CT scanning in the state of bladder filling and emptying respectively. The same doctor outlined GTV tumor with different volume of bladder, compared with emptying state (GTVE) tumor volume size, the center of the three-dimensional coordinates and body surface reference point three-dimensional coordinates of the difference between the reference point position changes and bladder capacity correlation. Results: The volumes of GTVF and GTVE in cervical cancer were (70.42 ± 30.29) cm3 and (71.66 ± 30.15) cm3, respectively. There was no significant difference between the two groups (P = 0.236). Under the conditions of bladder filling and emptying, the X-axis coordinates of the GTV central point were -6.00 ± 12.37 and -6.34 ± 11.94, respectively (P = 0.21) and -423.37 ± 142.27 and -427.40 ± 139.13 (P = 0.01) Z-axis respectively -52.82 ± 14.05, -51.46 ± 12.04 (P = 0.35). The coordinates of the X-axis of the reference point of the body surface under filling and emptying of the bladder were -12.02 ± 18.43 and -11.96 ± 18.40 respectively (P = 0.86), and the coordinates of the Y-axis were -377.49 ± 136.76 and -378.28 ± 135.84 respectively (P = 0.43 ), The Z-axis coordinates were 74.60 ± 20.10,68.55 ± 19.75 (P = 0.02). The displacement of the reference point in the Z axis was positively correlated with bladder volume (P = 0.001). Conclusion: The state of bladder filling had no significant effect on the size of GTV in cervical tumors, but had an influence on the location of cervical tumor center and reference point. The displacement of GTV in cervical tumor with different volume of bladder is in the direction of head and foot, while the displacement of body surface reference point is more obvious in anteroposterior direction.