Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Efficacy of the Change in Belly Board Aperture Location by the Addition of Bladder Compression Device for Radiotherapy of Rectal Cancer

직장암 환자의 골반 방사선치료에서 벨리보드 하위 경계 위치 변화의 영향

  • Yoon, Hong-In (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Chung, Yoon-Sun (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Kim, Joo-Ho (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Park, Hyo-Kuk (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Lee, Sang-Kyu (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Kim, Young-Suk (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Choi, Yun-Seon (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Kim, Mi-Sun (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Lee, Ha-Yoon (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Chang, Jee-Suk (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Cha, Hye-Jung (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Seong, Jin-Sil (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Keum, Ki-Chang (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Koom, Woong-Sub (Department of Radiation Oncology, Yonsei University College of Medicine)
  • 윤홍인 (연세대학교 의과대학 방사선종양학교실) ;
  • 정윤선 (연세대학교 의과대학 방사선종양학교실) ;
  • 김주호 (연세대학교 의과대학 방사선종양학교실) ;
  • 박효국 (연세대학교 의과대학 방사선종양학교실) ;
  • 이상규 (연세대학교 의과대학 방사선종양학교실) ;
  • 김영석 (연세대학교 의과대학 방사선종양학교실) ;
  • 최윤선 (연세대학교 의과대학 방사선종양학교실) ;
  • 김미선 (연세대학교 의과대학 방사선종양학교실) ;
  • 이하윤 (연세대학교 의과대학 방사선종양학교실) ;
  • 장지석 (연세대학교 의과대학 방사선종양학교실) ;
  • 차혜정 (연세대학교 의과대학 방사선종양학교실) ;
  • 성진실 (연세대학교 의과대학 방사선종양학교실) ;
  • 금기창 (연세대학교 의과대학 방사선종양학교실) ;
  • 금웅섭 (연세대학교 의과대학 방사선종양학교실)
  • Received : 2010.10.12
  • Accepted : 2010.10.27
  • Published : 2010.12.31
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Abstract

Purpose: We investigated the effect of location changes in the inferior border of the belly board (BB) aperture by adding a bladder compression device (BCD). Materials and Methods: We respectively reviewed data from 10 rectal cancer patients with a median age 64 years (range, 45~75) and who underwent computed tomography (CT) simulation with the use of BB to receive pelvic radiotherapy between May and September 2010. A CT simulation was again performed with the addition of BCD since small bowel (SB) within the irradiated volume limited boost irradiation of 5.4 Gy using the cone down technique after 45 Gy. The addition of BCD made the inferior border of BB move from symphysis pubis to the lumbosacral junction (LSJ). Results: Following the addition of BCD, the irradiated volumes of SB and the abdominopelvic cavity (APC) significantly decreased ($174.3{\pm}89.5mL$ vs. $373.3{\pm}145.0mL$, p=0.001, $1282.6{\pm}218.7mL$ vs. $1,571.9{\pm}158mL$, p<0.001, respectively). Bladder volume within the treated volume increased with BCD ($222.9{\pm}117.9mL$ vs. $153.7{\pm}95.5mL$, p<0.001). The ratio of irradiated bladder volume to APC volume with BCD ($33.5{\pm}14.7%$) increased considerably compared to patients without a BCD ($27.5{\pm}13.1%$) (p<0.001), and the ratio of irradiated SB to APC volume decreased significantly with BCD ($13.9{\pm}7.6%$ vs. $24.2{\pm}10.2%$, p<0.001). The ratios of the irradiated SB volume and irradiated bladder volume to APC volume negatively correlated (p=0.001). Conclusion: This study demonstrated that the addition of BCD, which made the inferior border of BB move up to the LSJ, increased the ratio of the bladder to APC volume and as a result, decreased the irradiated volume of SB.

목적: 방광압박도구(bladder compression device) 추가에 따른 벨리보드(belly board) 하위 경계의 위치 변화에 따라 조사체적 (irradiated volume) 내의 각 장기의 체적 차이 및 선량체적히스토그람을 분석하여 벨리보드의 하위 경계의 위치가 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 2010년 5월부터 2010년 9월까지 직장암으로 수술 전이나 후에 방사선치료를 위해 벨리보드만 사용하여 전산화 단층촬영을 시행한 경우와 방광압박도구를 추가하여 전산화 단층촬영을 재 시행한 10명을 대상으로 후향적으로 분석하였다. 환자의 중앙나이는 64세(범위, 45~75세)로 조직학적으로 선암 진단을 받고, 수술 전 혹은 후에 동시항암화학방사선요법을 시행받았다. 방광압박도구 사용 전후 각 체적과 조사체적비의 평균비교 및 복강과 골반강의 조사체적의 합과 소장의 체적비와 방광의 체적비 간의 상관관계를 분석하였다. 결과: 방광압박도구 추가 후 벨리보드 하위 경계는 치골결합 부위에서 허리엉치관절 부위 상방으로 올라갔다. 방광압박도구 사용 후 소장의 조사체적은 $174.3{\pm}89.5mL$로 사용 전 조사체적 $373.3{\pm}145.0mL$ 보다 유의하게 감소하였고(p=0.001), 복부골반강(abdominopelvic cavity)의 조사체적도 사용 전보다 유의하게 감소하였다($1,282.6{\pm}218.7mL$ vs, $1,571.9{\pm}158mL$, p<0.001). 방광압박도구 사용 전과 후의 치료체적 안의 방광 체적은 사용 후가 전보다 유의하게 증가하였다($222.9{\pm}117.9mL$ vs. $153.7{\pm}95.5mL$, p<0.001) 방광압박도구 사용 후 복부골반강대 방광의 조사체적비는 $33.5{\pm}14.7%$로 사용 전 조사체적비인 $27.5{\pm}13.1%$보다 유의하게 증가하였고(<0.001), 복부골반강대 소장의 조사체적비는 방광압박도구 사용 후 유의하게 감소하였다($13.9{\pm}7.6%$ vs. $24.2{\pm}10.2%$, p<0.001). 결론: 방광압박도구를 추가함으로 인해 벨리보드의 하위 경계를 허리영치관절 부위 상방으로 올리는 것이 복부골반강 내 방광의 체적을 증가시켜 소장의 조사체적을 감소시킬 수 있음을 확인할 수 있었다.

Keywords

References

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