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婦女腹股淋巴結之放射治療技術

Inguinal Lymph Node Radiotherapy Technique for Female Patients

摘要


前言:晚期的會陰部腫瘤常會合併有腹股淋巴結的轉移,因此腹股淋巴結的治療對處理晚期的會陰部腫瘤佔有非常重要的角色。若放射治療給予腹股淋巴結足夠的輻射劑量及深度,控制率幾乎會和手術有一樣的效果且副作用較小。但治療太深以致於腹股溝的劑量太高時卻又有增加股關節骨折的危險。因此如何拿捏治療效用(therapeutic ratio),是用放射線來治療腹股溝淋巴結的重要課題。我們做了婦女腹股淋巴結深度的分析,並探討可能較好的治療方式。 材料及方法:我們隨機抽驗65位在放射腫瘤科接受放射治瘴的婦癌患者,檢視其四條股血管的深度來代表腹股淋巴結的可能深度。另外我們使用電腦計劃系統來計算不同能量的光子射線、電子射線及不等比重之光子、電子之組合所得之劑量分布情況。 結果:經過測量,65位女病人的腹股淋巴結可能的深度,從1至6.5公分,平均是2.49公分。中間值為3.75公分。最深處從2.5至8.8公分,平均是4.46公分,中間值是5.65公分。在治療3公分以下的深度,電子射線或許是不錯的選擇。要治療5公分的厚度以上時,使用10-12 MeV電子射線合併6 MV光子射線,可以在5公分後,劑量便下降了20%以上的能量,而能使股關節的輻射劑量不會太高。 結論:腹股溝淋巴結的放射治療需要做個別的考量,因不同的厚度做不同方式的治療,以期達到最佳的治療效果,同時能有最小的副作用。

並列摘要


Purpose: irradiation to inguinal lymph node had a very important role to treat advanced stage perineal tumor for it had high incideoce of inguinal lymph node metastasis. It needs great caution to irradiate the ingoinal area. To irradiate with inadequate depth will cause poor control rate but too deep will lead risk of femoral head or neck fracture. We evaluate the depth of inguinal lymph nodes and propose the possible better irradiation method. Material and Methods: We reviewed the CT films of sixty-five gynecological cancer patients who received radiotherapy to find the possible depth of inguinal nodes - the depth of four femoral vessels. We also calculated the irradiation dose distribotion by using different energy of photon beam, electron beam and various combination of photon and electron beams. Results: The most superficial depth of inguinal lymph node ranged from 1 cm to 6.5 cm; the median was 3.75 and the mean was 2.49 cm. The most deep depth of inguinal lymph node ranged from 2.5 to 8.8 cm; the median was 5.65 cm and the mean was 4.46 cm. Using the photon beam to treat the inguinal will cause too much radiation dose to femoral head area. High energy electron was a good choice to treat the lesion with 3 cm depth without too much hot spot. To treat the depth of 5 cm, using the combination of 6 MV photon beam and high energy electron beam can get much homogenous dose distribution but also can reduce more than 20 % of dose to the femoral head area. Conclusion: It needs individual treatment plan according to the different depth to irradiate the inguinal lymph node area. To treat with appropriate depth with proper radiation modality not only can get good control but also to reduce the complication as much as possible.

並列關鍵字

Inguinal lymph node Radiotherapy

延伸閱讀