子宮頸癌放射線治療における直腸࣭ 胱線量と晩期障害

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The relationship between Late Complications and Dose- Volume Parameter of
the Rectum and Bladder in Patients with Cervical Cancer Treated with
High-Dose-Rate Intracavitary Brachytherapy
Takuya TSUGAWA, Keizen SHO, Naoaki KONO, Kiyoshi MURATA
Department of Radiology, Shiga University of Medical Science
Abstract
This study evaluated the efficacy of computed tomography (CT)-based three-dimensional (3D) dose-volume parameters of
the rectum and urinary bladder as predictor for late complication in cervical cancer patients treated with radiotherapy.
Forty-two patients treated with a combination of external radiotherapy and high-dose-rate intracavitary brachytherapy between
January 2002 and December 2008 were retrospectively analyzed. Brachytherapy was prescribed with standard 2D planning.
Patients underwent pelvic CT at every brachytherapy. The external rectal wall and bladder wall were contoured on the CT
images, and the minimum doses delivered to 0.1 cc, 1 cc, 2 cc and 5 cc of the most irradiated rectal and bladder volumes were
calculated with dose-volume histograms. Total dose (external radiotherapy plus brachytherapy) to the rectum and the urinary
bladder was transformed to the biologically equivalent dose in 2 Gy fractions with Ș/ș of 3 Gy (D0.1cc, D1cc, D2cc and
D5cc). The relationships between these dosimetric parameters and the incidence of late rectal complication (LRC) were
analyzed. The values of D0.1cc, D1cc, and D2cc were significantly higher in patients with LRC than in those without (p <
0.05), but the difference in the values of D5cc was not statistically significant (p = 0.092). The rate of LRC is increased
significantly with rectal D1cc higher than 90 GyEQD2 (p = 0.010). This study has suggested that CT-based 3D dose- volume
parameters of the rectum may be effective for predicting LRC.
Keyword Cervical cancer, High-dose-rate intracavitary brachytherapy, 3D image-based brachytherapy
Late rectal complication, Dose-volume histogram
Received:
September 26, 2011
Accepted: November 29, 2011
Correspondence: ⁠㈡་⛉኱Ꮫ ᨺᑕ⥺་Ꮫㅮᗙ ὠᕝ ᣅஓ
ࠛ520-2121 ኱ὠᕷ℩⏣᭶㍯⏫ [email protected]
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࡞࡝ࡢᖹᆒ್ࡢẚ㍑ࡸࠊᬌᮇ㞀ᐖࡢ᭷↓࡛ᒙู໬ࡋࡓ
౑⏝ࡍࡿ⛬ᗘ࡛ᡭᢏࢆ⾜࠺ࡇ࡜ࡀྍ⬟࡛࠶ࡿࠋࢫ࣮࣌
┤ ⭠ 'FF ࡞ ࡝ ࡢ ᖹ ᆒ ್ ࡢ ẚ ㍑ ࡟ ࡣ W ᳨ ᐃ ࢆ ⏝ ࠸ ࡓ ࠋࡑ
ࢧ࣮ඛ➃࡟ࡣⷧ࠸㔠ᒓࣜࣥࢢࢆᇙࡵ㎸ࢇ࡛࠾ࡾࠊ; ⥺
ࡢ ௚ ࠊ 3HDUVRQ ࡢ ✚ ⋡ ┦ 㛵 ಀ ᩘ ࡸ 3HDUVRQ ࡢ Ȯ ஧ ஌ ᳨
෗┿࡛እᏊᐑཱྀࡢ఩⨨ࢆ☜ㄆࡋࡸࡍ࠸ᕤኵࡀ࡞ࡉࢀ࡚
ᐃࡢᡭἲࢆ౑⏝ࡋࠊ᳨ᐃࢆ⾜ࡗ࡚࠸ࡿࠋ
࠸ࡿࠋࡲࡓࠊࢫ࣮࣌ࢧ࣮ࠊ࢜࣎࢖ࢻ࡜ࡶ࡟⥺※࠿ࡽࡢ
㊥ 㞳 ࢆ ⭡ ഃ ࡛ PPࠊ ⫼ ഃ ࡛ PP ࡢ ㊥ 㞳 ࢆ ࡜ ࡗ ࡚ ࠾
ࡾ ࠊ┤ ⭠ ⥺ 㔞 ࢆ ࡼ ࡾ ప ῶ ࡍ ࡿ ࡼ ࠺ ࡟ タ ィ ࡉ ࢀ ࡚ ࠸ ࡿ ᅗ
㸯 ࠋ ⭍ෆ↷ᑕ἞⒪ᐊ࡟࠶ࡿデᐹྎୖ࡛○▼఩ࢆ࡜ࡾࠊᨺ
ᑕ⥺⛉་ࡀᏊᐑෆ⭍ཬࡧ⭐ෆ࡬἞⒪⏝࢔ࣉࣜࢣ࣮ࢱ࣮
ࢆᤄධᚋࠊ࢔ࣉࣜࢣ࣮ࢱ࣮ࢆࢸ࣮ࣉ࡞࡝࡛యᖿ࡟ᅛᐃ
ࡍࡿࠋデᐹྎୖ࡛௮⮩఩࡬య఩ኚ᥮ࡋࠊࢫࢺࣞࢵࢳࣕ
࣮࡛᧜ᙳᐊ࡬⛣ືࡍࡿࠋ᧜ᙳᐊ࡟࡚ṇ㠃࠾ࡼࡧഃ㠃ࡢ
; ⥺ ෗ ┿ ᧜ ᙳ ࡜ 㦵 ┙ 㒊 &7 ᧜ ᙳ ࢆ ẖ ᅇ ࡢ ⭍ ෆ ↷ ᑕ ࡈ ࡜ ࡟
⾜ ࠺ ࠋ &7 ᧜ ᙳ ࡣ 㦵 ┙ 㒊 ࢆ PP ཌ ࡢ ࢫ ࣛ ࢖ ࢫ ࡛ ⾜ ࡗ ࡚
ᅗ 68067\SH$SSOLFDWRU
࠸ࡿࠋ⭍ෆ↷ᑕࡢ἞⒪ィ⏬⮬యࡣ㏻ᖖࡢṇ㠃࣭ഃ㠃ࡢ
Ꮚᐑ⭍ෆ࡟ᤄධࡍࡿࢱࣥࢹ࣒࡜⭼⭍ෆ࡟␃⨨ࡍࡿ࢜࣎࢖ࢻࡢ㛫࡟ࢫ࣮࣌ࢧ࣮
; ⥺ ෗ ┿ ࢆ ⏝ ࠸ ࡓ ஧ ḟ ඖ ィ ⏬ ࡛ ⾜ ࠸ ࠊ ㏻ ᖖ $ Ⅼ ⥺ 㔞 ࢆᤄධࡍࡿࡇ࡜࡟ࡼࡾࠊ㏻ᖖࡢ࣐ࣥࢳ࢙ࢫࢱ࣮ἲࡢ࢔ࣉࣜࢣ࣮ࢱ࣮࡛ᚲせ࡞
*\ ࡛ ἞ ⒪ ࢆ ᪋ ⾜ ࡍ ࡿ ࠋ἞ ⒪ ᪋ ⾜ ᚋ ࡟ ┤ ⭠ ࡸ ⭤ ⬔ ࠊ⭘ ⒆
⭐ෆࡢ࣮࢞ࢮ࣭ࣃࢵ࢟ࣥࢢ᧯సࡀ୙せ࡜࡞ࡾᝈ⪅ࡢⱞ③ࡀ㍍ῶࠋࡲࡓࢫ࣮࣌
࡞ ࡝ ࡢ ྛ ᵓ 㐀 ࡢ እ ㍯ 㒌 ࢆ &7 ⏬ ീ ࡟ ධ ຊ ࡋ ࠊ἞ ⒪ ィ ⏬ ࡟
ࢧ࣮࡜ࢱࣥࢹ࣒ࠊࢫ࣮࣌ࢧ࣮࡜࢜࣎࢖ࢻࢆᅛᐃࡍࡿࡇ࡜࡟ࡼࡾయ఩ኚ᥮᫬ࡢ
࡚ స ᡂ ࡋ ࡓ ⥺ 㔞 ศ ᕸ ࡜ &7 ⏬ ീ ࡜ ࢆ 㔜 ࡡ ྜ ࢃ ࡏ ࡿ ࡇ ࡜
࢔ࣉࣜࢣ࣮ࢱ࣮ࡢ⛣ືࢆ㜵ࡄࡇ࡜ࡀྍ⬟ࠋ
࡛ ┤ ⭠ ࡸ ⭤ ⬔ ࡢ '9+ ࢆ స ᡂ ࡍ ࡿ ࠋ ⥺ 㔞 ホ ౯ ࡟ ࡚ ┤ ⭠ ࣭
⭤⬔⥺㔞ࡀ㧗࠸ሙྜ࡟ࡣ⥺※㓄⨨ࡸ↷ᑕ⥺㔞ࢆḟᅇ࡟
ኚ᭦ࡍࡿࠋ
*(&(6752 ࡢ ່ ࿌ > @ ࡟ ᚑ ࠸ ࠊ⭍ ෆ ↷ ᑕ ࡛ ࡢ ┤ ⭠࣭⭤
⾲ 1&,&7&YHUVLRQ
⬔ ࡢ '9+ ࠿ ࡽ ┤ ⭠ ࣭ ⭤ ⬔ ࡢ ᭱ ࡶ ᙉ ࡃ ↷ ᑕ ࡉ ࢀ ࡚ ࠸ ࡿ 㻌
᭷ᐖ஦㇟㻌
FFFFFFFF ࡢ ෆ ࡢ ᭱ ప ⥺ 㔞 'FF'FF
㻳㼞㼍㼐㼑㻌㻜㻌
἞ ⒪ ๓ 䛸ኚ ໬ 䛺䛧㻌
'FF'FFࢆ ⟬ ฟ ࡋ ࠊ ࡑ ࢀ ࡒ ࢀ ࢆ ᅇ *\ ࡢ እ ↷
㻳㼞㼍㼐㼑㻌㻝㻌
䜟䛪䛛䛺ฟ ⾑ 䛒䜚㻌
ᑕ ࡬ ᥮ ⟬ ࡋ ࡓ ➼ ౯ ⥺ 㔞 㸦 1RUPDOL]HG7RWDO'RVH
㻳㼞㼍㼐㼑㻌㻞㻌
㛫 Ḟ ⓗ 䛺ฟ ⾑ 㻌
17'*\ ( 4' 㸧 ࢆ ┤ ⥺ Ѹ ஧ ḟ ᭤ ⥺ ࣔ ࢹ ࣝ /4PRGHO࡟ ᚑ
㻳㼞㼍㼐㼑㻌㻟㻌
ᡭ ⾡ 䜔ෆ ど 㙾 ⓗ ἞ ⒪ 䜢せ 䛩䜛㻌
㻳㼞㼍㼐㼑㻌㻠㻌
ቯ Ṛ 㻛✸ Ꮝ 䞉⒦ Ꮝ ᙧ ᡂ 㻌
ࡗ࡚⟬ฟࡋࡓࠋ
୰ኸ㐽ⶸࡀᤄධࡉࢀࡓᚋࡢእ↷ᑕ࡛ࡣ⭍ෆ↷ᑕ࡛
㧗⥺㔞ࢆཷࡅࡿ┤⭠ࡸ⭤⬔ࡣ㐽ⶸࡉࢀ࡚࠸ࡿࡓࡵࠊ඲
࡚ ࡢ ᨺ ᑕ ⥺ ἞ ⒪ ࡟ ࠾ ࡅ ࡿ ┤ ⭠ ࡸ ⭤ ⬔ ࡢ 'FF'FF
'FF'FF ࡣ ඲ 㦵 ┙ ↷ ᑕ ࡜ ྛ ⭍ ෆ ↷ ᑕ ࡢ ➼ ౯ ⥺ 㔞 ࡢ
2
ᆒ ್ ࡟ ᭷ ព ᕪ ࡀ ㄆ ࡵ ࡽ ࢀ ໬ Ꮫ ⒪ ἲ ↓㸸 ṓ ࠊ᭷ 㸸
⤖ᯝ
ṓ ࠊS ࠊ㧗 㱋 ⪅ ࡛ ࡣ ᨺ ᑕ ⥺ ༢ ⊂ ἞ ⒪ ࡀ 㑅 ᢥ
ࣇ ࢛ ࣟ ࣮ ྍ ⬟ ࡛ ࠶ ࡗ ࡓ ྡ ࡢ ⥲ ⏕ Ꮡ ⋡ ࠾ ࡼ ࡧ ↓ ⑓
ࡉࢀࡓഴྥࡀㄆࡵࡽࢀࡓࠋ
⏕ Ꮡ ⋡ ࢆ .DSODQ0HLHU ἲ ࡛ ᳨ ウ ࡋ ࡓ ࠋ⑕ ౛ ᩘ ࡀ ᑡ ࡞ ࠸
ᖺ ᭶ ࡲ ࡛ ࡟ Ⓨ ⏕ ࡋ ࡓ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡣ ⑕ ౛
ࡓ ࡵ ࠊ ),*2 ࢫ ࢸ ࣮ ࢪ ࡢ $% ⩌ ࡣ ྜ ࢃ ࡏ ࡚ ⩌ ࡜ ࡋ ࡚
ࠊ ⭤ ⬔ ᬌ ᮇ 㞀 ᐖ ࡣ ⑕ ౛ ࡛ ࠶ ࡗ ࡓ ࠋ ┤
ồ ࡵ ࡓ ࠋ ᖺ ⥲ ⏕ Ꮡ ⋡ ࡣ Ϩ ᮇ ࠊ ϩ ᮇ ࠊ
⭠ᬌᮇ㞀ᐖ࡜⭤⬔ᬌᮇ㞀ᐖࡢⓎ⏕ࡋࡓ⑕౛࡟ࡣ㔜」ࡣ
Ϫ ᮇ ࠊ ϫ ᮇ ࡛ ࠶ ࡗ ࡓ ࠋ ᖺ ↓ ⑓ ⏕ Ꮡ ⋡
↓ ࠿ ࡗ ࡓ ࠋ ྡ ࡢ ┤ ⭠ ࠾ ࡼ ࡧ ⭤ ⬔ 'FF'FF'FF
ࡣ Ϩ ᮇ ࠊ ϩ ᮇ ࠊ Ϫ ᮇ ࠊ ϫ ᮇ 'FF17' ࡢ ᭱ ᑠ ್ ࠊ ᭱ ኱ ್ ࠊ ᖹ ᆒ ࠊ ᶆ ‽ ೫ ᕪ ࡣ ࡑ ࢀ
࡛ ࠶ ࡗ ࡓ ࠋ .DSODQ0HLHU ἲ ࡛ ồ ࡵ ࡓ ࢢ ࣛ ࣇ ࢆ ᅗ
ࡒࢀ⾲ ࡢࡼ࠺࡛࠶ࡗࡓࠋ┤⭠⥺㔞ࡼࡾࡶ⭤⬔⥺㔞ࡢ
࡟♧ࡍࠋ
᪉ ࡀ ࠸ ࡎ ࢀ ࡶ 㧗 ್ ࢆ ♧ ࡋ ࡚ ࠾ ࡾ ┤ ⭠ ࡜ ⭤ ⬔ ࡢ 'FF
'FF'FF'FF ࡢ ᖹ ᆒ ್ ࡢ 㛫 ࡟ ࡣ ᭷ ព ᕪ ࡀ Ꮡ ᅾ ࡋ
ࡓ ࡑ ࢀ ࡒ ࢀ S ࠋ ࡇ ࢀ
ࡣ࢔ࣉࣜࢣ࣮ࢱ࣮ࡢタィࡀ⭤⬔ഃࡼࡾࡶ┤⭠ഃ࡟㊥㞳
ࢆ࡜ࡿࡼ࠺࡟࡞ࡗ࡚࠸ࡿᙳ㡪ࡶ࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋ⭤
⬔ᬌᮇ㞀ᐖࡢⓎ⏕ࡀ ౛ࡋ࠿࡞࠿ࡗࡓࡓࡵࠊ┤⭠ᬌᮇ
㞀ᐖ࡟ࡘ࠸࡚ࡢࡳᒙู໬ࡋ᳨࡚ウࢆ⾜ࡗࡓࠋ┤⭠ᬌᮇ
㞀 ᐖ ࡀ Ⓨ ⏕ ࡋ ࡓ ᝈ ⪅ ࡢ ┤ ⭠ 'FF'FF'FF'FF
17' ࠾ ࡼ ࡧ ᬌ ᮇ 㞀 ᐖ ࡢ ⛬ ᗘ ࡣ ⾲ ࡢ ࡼ ࠺ ࡟ ࡞ ࡗ ࡓ ࠋ ⾲ ┤ ⭠ ࣭ ⭤ ⬔ ࡢ D5cc, D2cc, D1cc, D0.1cc (Gy EQD2 )
Rectum D5cc
Rectum D2cc
Rectum D1cc
Rectum D0.1cc
Bladder D5cc
Bladder D2cc
Bladder D1cc
Bladder D0.1cc
WP + point A
Mi nimum
Max imum
Mean
St d. Deviation
46.1
51.7
52.8
56.2
43.2
48.4
51.7
59.7
54.0
89.2
104.8
118.2
181.0
106.1
135.0
160.2
252.4
103.3
66.8
77.0
84.5
106.7
71.1
84.2
93.8
121.8
78.7
9.45
12.63
15.51
27.22
12.53
17.26
21.92
39.32
9.91
WP + point A : ඲ 㦵 ┙ ⥺ 㔞 ࡜ ྛ ⭍ ෆ ↷ ᑕ A Ⅼ ⥺ 㔞 ࡢ N TD ࡢ ࿴
⾲ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ /5&Ⓨ ⏕ ᝈ ⪅ ࡢ ┤ ⭠ ⥺ 㔞 *\ ( 4 ' ᅗ ⥲ ⏕ Ꮡ ⋡ ࡜ ↓ ⑓ ⏕ Ꮡ ⋡ ࡢ ࢢ ࣛ ࣇ Pt .
No.
1
2
3
4
5
6
7
8
ϩᮇᝈ⪅ࡣ௚⑓Ṛࡉࢀࡓ⑕౛ࡶ࠶ࡾࠊ⥲⏕Ꮡ⋡࡛ࡣ
Ϫᮇࡼࡾࡶᝏ࠸ᡂ⦼࡜࡞ࡗࡓࠋϪᮇᝈ⪅ࡣ㐲㝸㌿⛣࡞
࡝ࡢ෌Ⓨ࡛↓⑓⏕Ꮡ⋡ࡣϩᮇࡼࡾࡶᝏ࠸ᡂ⦼ࡔࡀࠊ໬
Ꮫ⒪ἲ࡞࡝ࡢᩆ῭἞⒪ࡢຠᯝࡶ࠶ࡾほᐹᮇ㛫୰࡟Ṛஸ
౛ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋϩᮇ࡜Ϫᮇᝈ⪅ࡢᖹᆒᖺ㱋࡟
ࡣ ᫂ ࡽ ࠿ ࡞ ᕪ ࡣ ㄆ ࡵ ࡽ ࢀ ࡞ ࠿ ࡗ ࡓ ϩ ᮇ 㸸 ṓ ࠊ Ϫ
ᮇ㸸 ṓ ࠊS ࠋ໬ Ꮫ ⒪ ἲ ࡢ ᭷ ↓ ࡛ ࡣ ᖺ 㱋 ࡢ ᖹ
59.4
65.6
66.1
67.3
76.6
75.4
79.3
89.2
3
R ect um
D5cc
Rectum
D2 cc
70.7
78.6
84.1
77.8
87.1
85.8
96.6
104.8
Rectum
D1cc
R ect um
D0.1cc
LR C
(Grade)
79.6
91.2
98.4
84.7
94.7
94.0
108.0
118.2
101.8
130.9
152.5
102.1
116.2
124.8
141.8
181.0
G1
G1
G1
G1
G2
G2
G2
G3
┤ ⭠ 'FF'FF'FF'FF ࡟ ࡘ ࠸ ࡚ ┤ ⭠ ᬌ ᮇ 㞀
ᐖࡢ᭷↓࡛ᒙู໬ࢆ⾜࠸ࠊࡑࢀࡒࢀࡢᖹᆒ್࡟᭷ពᕪ
ࡀ Ꮡ ᅾ ࡍ ࡿ ࠿ ࢆ W ᳨ ᐃ ࡛ ᳨ ウ ࡋ ࡓ ᅗ ࠋ┤ ⭠ 'FF ࡛
ࡣ ᭷ ព ᕪ ࡀ ㄆ ࡵ ࡽ ࢀ ࡞ ࠿ ࡗ ࡓ ࡀ S ࠊ┤ ⭠ 'FF
'FF'FF ࡛ ࡣ ᖹ ᆒ ್ ࡟ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡓ ࡑ ࢀ ࡒ ࢀ
S ࠋ ࡇ ࢀ ࡼ ࡾ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡀ Ⓨ
⏕ ࡋ ࡓ ⑕ ౛ ࡛ ࡣ ┤ ⭠ 'FF'FF'FF ࡢ 17' ࡀ 㧗 ࠸
ഴྥ࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ
⥆ ࠸ ࡚ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡢ ⛬ ᗘ ࢆ 1&,&7&9HUVLRQ
࡟ ᚑ ࠸ *UDGLQJ ࢆ ⾜ ࡗ ࡓ ࠋ⤖ ᯝ ࡣ *UDGH ࡀ ౛ ࠊ*UDGH
ࡀ ౛ ࠊ*UDGH ࡀ ౛ ࡛ ࠶ ࡗ ࡓ ࠋ┤ ⭠ ⥺ 㔞 ࡜ ┤ ⭠ ᬌ
ᮇ㞀ᐖ࡜ࡢ┦㛵ࢆぢࡿࡓࡵ࡟ᬌᮇ㞀ᐖࡢ⛬ᗘࢆຍ࿡ࡋ
ࡓᩓᕸᅗࢆసᡂࡋࡓ⤖ᯝࠊᅗ ࡢࡼ࠺࡟࡞ࡗࡓࠋ┤⭠
'FF ࡜ 'FF'FF'FF ࡟ ࡣ ┦ 㛵 㛵 ಀ ࡀ ♧ ࡉ ࢀ ࠊ
ᅗ 3 . ┤ ⭠ ᬌ ᮇ 㞀 ᐖ (LRC)ࡢ ᭷ ↓ ࡛ ᒙ ู ໬ ࡋ ࡓ ᖹ ᆒ ್
⥺㔞ቑຍ࡜࡜ࡶ࡟┤⭠ᬌᮇ㞀ᐖࡢቑᝏࡀ࠶ࡿྍ⬟ᛶࡀ
♧ ၀ ࡉ ࢀ ࡓ ࠋ ࡇ ࡇ ࡛ ┤ ⭠ 'FF ࡜ ┤ ⭠ 'FF ࡢ ᩓ ᕸ ᅗ ࢆ
సᡂࡋࡓ࡜ࡇࢁᅗ ࡢࡼ࠺࡟୧⪅࡟ࡣ㠀ᖖ࡟ᙉ࠸┦㛵
㛵ಀࡀ࠶ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ
㸦 3HDUVRQ ࡢ ✚ ⋡ ┦ 㛵 ಀ ᩘ
㸧 ⮫ ᗋ ୖ ࠊ⤒ 㐣 ほ ᐹ ࡸ ᢞ ⸆ ἞ ⒪ ࡢ ࡳ ࡛ ㍍ ᛌ ࡍ ࡿ *UDGH
ࡢ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡣ ࡑ ࢀ ࡯ ࡝ ၥ 㢟 ࡜ ࡞ ࡽ ࡞ ࠸ ࡓ ࡵ ࠊ*UDGH
௨ୖࡢ┤⭠ᬌᮇ㞀ᐖࡀⓎ⏕ࡍࡿ⥺㔞࡟ࡘ࠸࡚᭦࡟᳨
ウ ࡋ ࡓ ࠋ*UDGH ௨ ୖ ࡢ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡣ 'FF ࡛ *\ ( 4 '
௨ ୖ ࠊ'FF ࡛ *\ (4 ' ௨ ୖ ࡢ ⥺ 㔞 ࡛ Ⓨ ⏕ ࡋ ࡚ ࠸ ࡿ ࡓ ࡵ ࠊ
'FF*\ (4 ' ௨ ୖ ࡜ ௨ ୗ ࡛ ࣅ ࣥ ศ ๭ ࢆ ⾜ ࡗ ࡓ ࠋ ࡑ ࡢ ሙ
ྜ ࠊ ⾲ ࡢ ศ ᕸ ࡟ ศ ๭ ࡉ ࢀ ࠊ ࡑ ࢀ ࡟ ᑐ ࡋ ࡚ 3HDUVRQ ࡢ
Ȯ ஧ ஌ ᳨ ᐃ ࢆ ⾜ ࡗ ࡓ ࡀ ᭷ ព ᕪ ࢆ ᣢ ࡗ ࡚ ┤ ⭠ 'FF
*\ ( 4 ' ௨ ୖ ࡢ ⥺ 㔞 ࡛ 㧗 ⋡ ࡟ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡀ Ⓨ ⏕ ࡍ ࡿ ࡇ
࡜ ࡀ ♧ ࡉ ࢀ ࡓ S ࠋ ໬Ꮫ⒪ἲࡢ᭷↓࡛┤⭠ᬌᮇ㞀ᐖⓎ⏕࡟ᕪࡀ࠶ࡿ࠿
ࢆ ᳨ ウ ࡋ ࡓ ࡀ ࠊᨺ ᑕ ⥺ ༢ ⊂ ἞ ⒪ ྡ ୰ ⑕ ౛ ࠊ໬ Ꮫ ᨺ
ᑕ ⥺ ἞ ⒪ ౛ ୰ ⑕ ౛ ࡟ ┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡢ Ⓨ ⏕ ࢆ ㄆ ࡵ ࠊ
3HDUVRQ ࡢ Ȯ ஧ ஌ ᳨ ᐃ ࡟ ࡚ ୧ ⪅ ࡢ 㛫 ࡟ ࡣ ᭷ ព ᕪ ࡣ ㄆ ࡵ
࡞ ࠿ ࡗ ࡓ S ࠋ ⾲ 'FF*\ ࡛ ࡢ ࣅ ࣥ ศ ๭ ⾲ ᅗ ┤ ⭠ 'FF ࡜ 'FF㹼 'FF ࡢ ᩓ ᕸ ᅗ Rectum D1cc (Gy EQD2 ) (Binned)
LRC
< 90Gy EQD2
90Gy EQD2 <
NO
25
9
YES
2
6
4
ࡿ㒊఩ࢆࡼࡃ཯ᫎࡋ࡚࠸ࡿࡶࡢ࡜⪃࠼ࡽࢀࡿࠋ
┤ ⭠ 'FF ࡢ ሙ ྜ ࡣ ࠊ ┤ ⭠ ࢞ ࢫ ࡸ ౽ ࡢ ≧ ែ ࡟ ࡼ ࡗ
࡚㧗⥺㔞࡜࡞ࡿ㒊఩࡟ࡤࡽࡘࡁࡀ⏕ࡌࡿࡓࡵࠊ┤⭠ࡢ
㧗⥺㔞࡜࡞ࡿ㒊ศࢆ௦⾲ࡍࡿ್࡛ࡣ࡞࠸ྍ⬟ᛶࡀ࠶ࡿ
࡜⪃࠼ࡽࢀࡓࠋᙜ㝔ࡢ⥺㔞つᐃࡣ┤⭠᭱኱Ⅼ⥺㔞ࢆ౑
ࡗ ࡚ ホ ౯ ࡋ ࡚ ࡁ ࡓ ࡀ ࠊ ┤ ⭠ ᭱ ኱ Ⅼ ⥺ 㔞 ࡣ ┤ ⭠ 'FF
࡜࡯ࡰྠࡌࡼ࠺࡞್࡜࡞ࡗ࡚࠾ࡾࠊ┤⭠᭱኱Ⅼ⥺㔞࡜
┤ ⭠ 'FF ࡣ ࡯ ࡰ ྠ ࡌ ព ࿡ ࢆ ᣢ ࡗ ࡚ ࠸ ࡿ ࡜ ⪃ ࠼ ࡽ ࢀ
ࡿࠋࡇࡢࡇ࡜࠿ࡽ┤⭠ࡢ᭱኱Ⅼ⥺㔞࡛ホ౯ࢆ⾜࠺ࡼࡾ
ࡶ ࠊ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF ࡛ ホ ౯ ࢆ ⾜ ࠺ ᪉ ࡀ ᬌ ᮇ 㞀 ᐖ
ࡢண ࡟᭷ຠ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋ
┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࡢ ᭷ ↓ ࡛ ᒙ ู ໬ ࡋ ࡓ ┤ ⭠ 'FF ࡢ ᖹ ᆒ
್࡟᭷ពᕪࡀㄆࡵࡽࢀ࡞࠿ࡗࡓࡢࡣࠊ༴㝤⮚ჾ࡜ࡋ࡚
ࡢ ┤ ⭠ 9ROXPH ࡢ タ ᐃ ࡟ ၥ 㢟 ࡀ ᭷ ࡿ ࡜ ⪃ ࠼ ࡽ ࢀ ࡿ ࠋ௒ ᅇ
ᙉ ࠸ ┦ 㛵 㛵 ಀ ࡀ Ꮡ ᅾ 㸦 P e ars o n ࡢ ✚ ⋡ ┦ 㛵 ಀ ᩘ = 0.989 㸧
ࡢ◊✲࡛ࡣ┤⭠እ࿘ࡢ㍯㒌ᥥฟࢆ⾜࠸ࠊࡑࡢෆ㒊ࢆ┤
ᅗ ┤ ⭠ 'FF ࡜ 'FF ࡢ ᩓ ᕸ ᅗ ⭠࡜ࡋ࡚ᐜ✚ィ⟬ࢆ⾜ࡗ࡚࠸ࡿࠋࡋ࠿ࡋ┤⭠ᬌᮇ㞀ᐖ
࡟㛵୚ࡋ࡚ࡃࡿࡢࡣᐇ㉁ⓗ࡟ࡣ┤⭠ቨ࡛࠶ࡾࠊ┤⭠ෆ
࡟౽ࡸ࢞ࢫࡀᏑᅾࡋࡓሙྜࡣ┤⭠ቨࡢ⥺㔞ࢆṇ☜࡟ホ
౯ࡋ࡚࠸࡞࠸ྍ⬟ᛶࡀ࠶ࡿࠋࡇࢀ࡟ࡼࡾ┤⭠ᬌᮇ㞀ᐖ
⪃ ᐹ
ࡢ᭷↓࡛ᒙู໬ࡋࡓሙྜ࡟ࡑࢀࡽࡢᖹᆒ್࡟ᕪࡀฟ࡞
),*2 ⑓ ᮇ ู ࡢ ᨺ ᑕ ⥺ ἞ ⒪ ࡟ ࡼ ࡿ ᶆ ‽ ⓗ ࡞ ᖺ ⏕ Ꮡ
࠿ࡗࡓྍ⬟ᛶࡶ⪃࠼ࡽࢀࡿࠋᙜ㝔࡛౑⏝ࡋ࡚࠸ࡿィ⏬
⋡ ࡣ , ᮇ ࠥ ,, ᮇ ࠥ ,,, ᮇ ࠥ ,9$ ᮇ ࠥ ࡜ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ
>@
⿦⨨࡛ࡣ┤⭠ቨ⮬యࢆ㍯㒌ᥥฟࡍࡿࡇ࡜ࡣ࡛ࡁ࡞࠸ࡀࠊ
ࠋᙜ㝔࡛ࡢ἞⒪
἞⒪ィ⏬⿦⨨ࡀ᭦᪂ࡉࢀࡓ࡜ࡁ࡟┤⭠ቨࢆ㍯㒌ᥥฟࡋ
ᡂ⦼ࡣ௚᪋タࡢ἞⒪ᡂ⦼࡜ẚ㍑ࡋ࡚ྠ➼௨ୖ࡜⪃࠼ࡿࠋ
᳨࡚ドࡋࡓ࠸࡜⪃࠼࡚࠸ࡿࠋ
἞⒪⥺㔞࡟ࡘ࠸࡚ࡶᶆ‽ⓗ἞⒪⥺㔞࡜ྠ➼࠿ࡑࢀ௨ୖ
Ꮚᐑ㢁⒴ࡢ୕ḟඖᨺᑕ⥺἞⒪ィ⏬࡟౑⏝࡛ࡁࡿ⏬
࡜⪃࠼ࡽࢀࠊᏊᐑ㢕⒴⑓ኚ࡟㧗⥺㔞ࢆᢞ୚ࡋࡼ࠺࡜⪃
ീ ࡜ ࡋ ࡚ ࡣ &7 ௨ እ ࡟ 05, ࡶ Ꮡ ᅾ ࡍ ࡿ ࠋ05, ࡣ ⤌ ⧊ 㛫 ࢥ
࠼ࡽࢀࡓᙜ㝔ࡢ⥺㔞つᐃ࡟ࡼࡾ἞⒪ᡂ⦼ࢆྥୖࡉࡏࡓ
ࣥࢺࣛࢫࢺࡀࡼ࠸ࡓࡵᏊᐑ㢕⒴⑓ኚࡢ㍯㒌ᥥฟ࡛ࡣ
ྍ ⬟ ᛶ ࡀ ⪃ ࠼ ࡽ ࢀ ࡿ ࠋ ࡲ ࡓ *UDGH ௨ ୖ ࡢ ฟ ⾑ ᛶ ┤ ⭠
&7 ࡼ ࡾ ࡶ ṇ ☜ ࡟ ⾜ ࠺ ࡇ ࡜ ࡀ ฟ ᮶ ࡿ ࡀ ࠊ⭤ ⬔ ࡸ ┤ ⭠ ࿘ ᅖ
⅖ ࠊ ฟ ⾑ ᛶ ⭤ ⬔ ⅖ ࡢ 㢖 ᗘ ࡣ ࡑ ࢀ ࡒ ࢀ ࠥ ࠊ ௨ ୗ
࡟ ࡣ ⬡ ⫫ ⤌ ⧊ ࡀ Ꮡ ᅾ ࡍ ࡿ ࡓ ࡵ &7 ࡜ 05, ࡛ ࡣ 2$5 ࡢ ㍯ 㒌
࡜ࡉࢀ࡚࠾ࡾ
> @
ᥥ ฟ ࡟ ࡘ ࠸ ࡚ ᕪ ࡣ ࡞ ࠸ ࡜ ࡉ ࢀ ࡚ ࠾ ࡾ > @ ࠊ2$5 ࡢ タ ᐃ ⮬
ࠊᬌ ᮇ 㞀 ᐖ ࡢ 㢖 ᗘ ࡣ ௚ ᪋ タ ࡢ ᡂ ⦼ ࡼ ࡾ
ࡶ ప ࠸ ྍ ⬟ ᛶ ࡀ ࠶ ࡿ ࠋྛ ⭍ ෆ ↷ ᑕ ᫬ ࡟ &7 ࢆ ᧜ ᙳ ࡋ ࠊ'9+
య࡟ၥ㢟ࡣ࡞࠿ࡗࡓ࡜⪃࠼ࡿࠋ
࡟࡚⥺㔞ホ౯ࢆ⾜࠸ࠊ⥺※㓄⨨ࡸ↷ᑕ⥺㔞ࢆᕤኵࡍࡿ
௒ ᅇ ࠊ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF ࡀ 㧗 ⥺ 㔞 ࡟ ࡞ ࡗ ࡚ ࠸ ࡿ
ࡇ࡜࡛ᬌᮇ㞀ᐖࡢⓎ⏕ࢆᢚไฟ᮶ࡓ࡜⪃࠼ࡿࠋ
ࡶࡢࡢ┤⭠ᬌᮇ㞀ᐖࡀⓎ⏕ࡋ࡚࠸࡞࠸⑕౛ࡀᏑᅾࡍࡿ
௒ᅇࡢ᳨ウ࡛㧗㱋⪅ࡣᨺᑕ⥺༢⊂἞⒪ࢆ㑅ᢥࡉࢀ
ࡀࠊࡇࢀࡣྛ⭍ෆ↷ᑕࡢ⥺㔞ホ౯࡟ࡼࡗ࡚┤⭠⥺㔞ࡀ
࡚࠸ࡿഴྥࡀࡳࡽࢀࡓࡀࠊ᭱㏆ࡣ㧗㱋⪅࡛ࡶ໬Ꮫᨺᑕ
᫂ࡽ࠿࡟㧗࠸ሙྜࡣࠊ἞⒪ẖ࡟⥺※ࡢ㓄⨨ࡸ࢙࢘࢖ࢺ
⥺἞⒪ࡀ㑅ᢥࡉࢀࡿ⑕౛ࡀቑຍࡋ࡚࠾ࡾࠊ἞⒪ᡂ⦼ࡢ
ࡢኚ᭦ࢆ⾜࠺ࡇ࡜࡛ྠ୍㒊఩ࡀ㧗⥺㔞࡟࡞ࡽ࡞࠸ࡼ࠺
ྥୖࡀᮇᚅࡉࢀࡿࠋ
࡟ᕤኵࡋ࡚࠸ࡿᙳ㡪ࡢྍ⬟ᛶࡀ࠶ࡿࠋࡇࡢࡼ࠺࡞⑕౛
┤⭠⥺㔞ࡢቑຍ࡟ᚑࡗ࡚┤⭠ᬌᮇ㞀ᐖࡢ⛬ᗘ࡟ቑ
>@
࡛ ࡣ ࠊྛ ἞ ⒪ ࡛ ࡢ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF ࡣ 㧗 ࠸ ࡓ ࡵ 17'
ྠᵝ࡟┤⭠ᬌᮇ㞀
ࡀ㧗ࡃホ౯ࡉࢀ࡚ࡋࡲ࠺ࡀࠊ␗࡞ࡿ఩⨨࡛⥺㔞ࡀ㧗ࡃ
ᐖ࡜┤⭠⥺㔞࡟ࡣ┦㛵㛵ಀࡀ࠶ࡿࡇ࡜ࡀ௒ᅇࡢ᳨ウ࡛
࡞ࡗ࡚࠸ࡿࡔࡅ࡛ࠊᬌᮇ㞀ᐖ࡟ᑐࡍࡿᙳ㡪࡜ࡋ࡚ࡣప
ࡶ ♧ ࡉ ࢀ ࡓ ࠋࡲ ࡓ ௒ ᅇ ࡢ ᳨ ウ ࡛ ࡣ ┤ ⭠ 'FF ࡜ ┤ ⭠ 'FF
ῶ࡛ࡁ࡚࠸ࡿ࡜⪃࠼ࡿࠋࡋ࠿ࡋ௒ᚋࠊࡉࡽ࡟⤒㐣ほᐹ
ࡢ㛫࡟ࡣᙉ࠸┦㛵㛵ಀࡀ࠶ࡿࡇ࡜ࡀ♧ࡉࢀࠊࡇࢀࡣ┤
ࢆ ⾜ ࡗ ࡚ ࠸ ࡃ ୰ ࡛ ࠊ 'FF ࡸ 'FF ࡀ 㧗 ⥺ 㔞 ࢆ ♧ ࡋ ࡓ ᝈ
⭠ ᬌ ᮇ 㞀 ᐖ ࢆ ண ࡍ ࡿ ᣦ ᶆ ࡜ ࡋ ࡚ ┤ ⭠ 'FF ࡸ ┤ ⭠
⪅࡛┤⭠ᬌᮇ㞀ᐖࡀⓎ⏕ࡋ࡚ࡃࡿྍ⬟ᛶࡣྰᐃ࡛ࡁ࡞
ᝏഴྥࡀㄆࡵࡽࢀࠊㅖᐙࡢሗ࿌
'FF ࡀ ᭷ ⏝ ࡛ ࠶ ࡿ ࡜ ࡍ ࡿ ሗ ࿌
>@
ࢆᨭᣢࡍࡿ⤖ᯝ࡜
࠸ࠋ
⪃࠼ࡿࠋ⭍ෆ↷ᑕ࡛㧗⥺㔞࡜࡞ࡿ┤⭠ࡢ㒊ศࢆ⥺※㓄
⭤⬔ᬌᮇ㞀ᐖࡣ௒ᅇࡢほᐹᮇ㛫୰࡟ ⑕౛ࡋ࠿ほᐹ
⨨ࡸ࢙࢘࢖ࢺࡢ᮲௳ࢆྠ୍࡟ࡋ࡚⏬ീⓗ࡟ྛ⑕౛᳨࡛
ࡉ ࢀ ࡞ ࠿ ࡗ ࡓ ࠋ ⭤ ⬔ ᬌ ᮇ 㞀 ᐖ ࡀ ฟ ࡓ ⑕ ౛ ࡢ ⭤ ⬔ 'FF
ウ ࢆ ࠾ ࡇ ࡞ ࠺ ࡜ ࠊ㧗 ⥺ 㔞 㒊 ࡢ ఩ ⨨ ࡣ ẖ ᅇ ࡢ &7 ࡛ ࡯ ࡰ ྠ
'FF'FF'FF ࡣ ࠸ ࡎ ࢀ ࡶ ᖹ ᆒ ್ ࡟ ㏆ ࠸ ್ ࡛ ࠶ ࡗ
୍ ࡛ ࠶ ࡾ ࠊ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF ࡣ ┤ ⭠ ࡀ 㧗 ⥺ 㔞 ࡜ ࡞
ࡓࠋࡑࡢࡓࡵࠊ⭤⬔⥺㔞࡜⭤⬔ᬌᮇ㞀ᐖࡢ㛵ಀ࡟ࡘ࠸
5
࡚ࡣ᳨ウ࡛ࡁ࡞࠿ࡗࡓࠋ⭤⬔⥺㔞ࡀ┤⭠⥺㔞ࡼࡾࡶ㧗
⭠ 'FF ࡜ ࠸ ࡗ ࡓ '9+ ࢆ ⏝ ࠸ ࡓ ⥺ 㔞 ホ ౯ ࡢ ᪉ ࡀ ┤ ⭠ ᬌ ᮇ
್࡛࠶ࡾ࡞ࡀࡽ㞀ᐖⓎ⏕ᩘࡀᑡ࡞࠿ࡗࡓࡢࡣࠊ⭤⬔ࡢ
㞀ᐖࡢண ࡟ࡣ㐺ࡋ࡚࠸ࡿ࡜⪃࠼ࡽࢀࠊᙜ㝔ࡢ⥺㔞つ
⪏ᐜ⥺㔞ࡀ┤⭠ࡼࡾࡶ㧗࠸ࡇ࡜ࡶᙳ㡪ࡋ࡚࠸ࡿ࡜⪃࠼
ᐃ࡟ྲྀࡾධࢀ࡞ࡅࢀࡤ࡞ࡽ࡞࠸࡜⪃࠼ࡿࠋ
ࡽࢀࡿࠋࡋ࠿ࡋ࡞ࡀࡽ⭤⬔ᬌᮇ㞀ᐖࡣ┤⭠ᬌᮇ㞀ᐖࡼ
⭤⬔ࡢ㐜Ⓨᛶᨺᑕ⥺㞀ᐖ࡟ࡘ࠸࡚ࡣⓎ⏕ᩘࡀᑡ࡞
ࡾ㐜ࢀ࡚Ⓨ⏕ࡍࡿഴྥ࡟᭷ࡾࠊ௒ᅇࡢ⑕౛ࡢᖹᆒほᐹ
ࡃ᳨ウࢆ⾜࠺ࡇ࡜ࡀฟ᮶࡞࠿ࡗࡓࡀࠊほᐹᮇ㛫ࡢ▷࠸
ᮇ 㛫 ࡛ ࠶ ࡿ ࣨ ᭶ ࡛ ࡣ ⭤ ⬔ ᬌ ᮇ 㞀 ᐖ ࢆ ほ ᐹ ࡍ ࡿ ࡟ ࡣ
⑕౛ࡀከࡃࠊ㞀ᐖࡀⓎ⏕ࡍࡿ᫬ᮇࡲ࡛⤒㐣ほᐹࡀ⾜࠼
୙༑ศ࡛࠶ࡗࡓྍ⬟ᛶࡀ࠶ࡿࠋ௒ᚋࠊ⭤⬔ᬌᮇ㞀ᐖࡀ
࡚࠸࡞࠸ྍ⬟ᛶࡀ⪃࠼ࡽࢀࡓࠋࡲࡓ㈋⾑ࡢ᭷↓ࡸ᪤ ほᐹࡉࢀࡿྍ⬟ᛶࡣ༑ศ᭷ࡿ࡜⪃࠼࡚࠸ࡿࠋ
Ṕࠊෆ᭹⸆࡞࡝࡟ࡘ࠸࡚ࡣ௒ᅇ᳨ウฟ᮶࡚࠾ࡽࡎࠊࡑ
ࡢ௚ࡢᅉᏊࡶຍ࠼࡚ࡢ᳨ウࡀࡉࡽ࡟ᚲせ࡛࠶ࡿ࡜⪃࠼
໬Ꮫ⒪ἲࡢ᭷↓࡜ᬌᮇ㞀ᐖࡢ㛫࡟ࡣ᫂ࡽ࠿࡞┦㛵
ࡿࠋ
ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋࡋ࠿ࡋᨺᑕ⥺༢⊂⑕౛ࡣ໬Ꮫᨺ
ᑕ⥺἞⒪౛࡟ẚࡋ࡚᫂ࡽ࠿࡟㧗㱋⪅ࡀከࡃࠊᖺ㱋ࢆ࣐
ࡉ ࡽ ࡟ Ꮚ ᐑ 㢕 ⒴ ⑓ ኚ ࡢ '9+ ࡜ ᒁ ᡤ ไ ᚚ ⋡ ࡢ 㛵 ಀ ࢆ ྵ
ࢵࢳࣥࢢࡋ࡚ࡢ᳨ウࡀᚲせ࡟࡞ࡿ࡜⪃࠼ࡽࢀࡿࠋ௒ᅇ
ࡵࡓ᳨ウࢆ௒ᚋ⾜࠺ࡇ࡜࡛ࠊࡼࡾ᭷ຠ࡛๪స⏝ࡢᑡ࡞
ࡢ᳨ウ࡛ࡣ㈋⾑ࡢ᭷↓ࡸ⢾ᒀ⑓࡞࡝ࡢ᪤ ⑕ࠊ࣮࣡ࣇ
࠸⥺㔞つᐃࢆసᡂࡋࡓ࠸࡜⪃࠼࡚࠸ࡿࠋ
࢓ࣜࣥ࡞࡝ࡢෆ᭹⸆࡟ࡘ࠸࡚ࡣ᳨ウ࡛ࡁ࡚࠸࡞࠸ࡀࠊ
ᩥ⊩
ࡇࡢࡼ࠺࡞ᅉᏊࡶᬌᮇ㞀ᐖࡢⓎ⏕࡟ᙳ㡪ࢆཬࡰࡋ࡚࠸
ࡿྍ⬟ᛶࡶ⪃࠼ࡽࢀࡿࠋ௚㝔ࡼࡾ⤂௓࠸ࡓࡔࡃ⑕౛ࡀ
1. Eifel PJ, Levenback C, Wharton JT, Oswald MJ. Time
ከ࠸ᙳ㡪࠿ࠊ᪤ Ṕࡸෆ᭹⸆࡟㛵ࡍࡿ᝟ሗྲྀᚓࡀ୙㊊
course and incidence of late complications in patients
ࡋ࡚࠸ࡓ࡜཯┬ࡉࡏࡽࢀࡿⅬ࡛࠶ࡾࠊ௒ᚋࡢ⮫ᗋ࡟࠾
treated
࠸࡚ᨵၿࡋ࡚࠸ࡁࡓ࠸ࠋ
carcinoma of the uterine cervix. Int J Radiat Oncol Biol
௒ ᅇ ࠊ Ꮚ ᐑ 㢁 ⒴ ཎ Ⓨ ᕢ ࡟ ᑐ ࡍ ࡿ ↷ ᑕ ⥺ 㔞 ࡢ '9+ ࡜ ἞
*(&(6752 ࡢ ່ ࿌
radiation
therapy
for
FIGO
stage
IB
Phys, 32:1289-300, 1995
⒪ᡂ⦼࡟ࡘ࠸࡚ࡢ᳨ウࡣ⾜࠼࡞࠿ࡗࡓࠋࡇࢀࡣ
>@
with
2. Nakano T, Kato S, Ohno T, Tsujii H, Sato S, Fukuhisa
ࡀฟࡿࡼࡾࡶ๓࠿ࡽࡢ⑕౛ࡶྵ
K,
Arai
T.
Long-term
results
of
high-dose
rate
ࡵ࡚ࡢ᳨ウ࡜ࡋࡓࡓࡵࠊᏊᐑ㢁⒴⑓ᕢࡢ㍯㒌ᥥฟ࡟ࡘ
intracavitary brachytherapy for squamous cell carcinoma
࠸࡚ࡢᐃ⩏࡛ࡤࡽࡘࡁࡀ⏕ࡌ࡚࠸ࡿࡓࡵホ౯ࡀᅔ㞴࡛
of the uterine cervix. Cancer, 103:92-101, 2005
࠶ ࡗ ࡓ ࡇ ࡜ ࡀ ཎ ᅉ ࡛ ࠶ ࡿ ࠋ ࡲ ࡓ ࠊ Ꮚ ᐑ 㢁 ⒴ ⑓ ኚ ࡣ &7
3.
ࡢ ࡳ ࡛ ㍯ 㒌 ᥥ ฟ ࢆ ⾜ ࡗ ࡓ ሙ ྜ ࠊ 05, ࢆ ౑ ࡗ ࡚ ㍯ 㒌 ᥥ ฟ
Haie-Meder C, Briot E, Dumas I, Van Limbergen E, De
ࢆࡍࡿࡼࡾࡶࠊ≉࡟ഃ᪉ࡢᏊᐑഐ⤌⧊ࡲ࡛ྵࡵ࡚㍯㒌
Brabandere M, Nulens A, Erickson B, Rownd J, Petrow P.
ᥥฟࡍࡿഴྥࡀぢࡽࢀࠊ኱ࡁࡃホ౯ࡋ࡚ࡋࡲ࠺ࡿሗ࿌
Recommendations
ࡉࢀ࡚࠾ࡾ
>@
ࠊࡑ ࡢ Ⅼ ࡶ ⪃ ៖ ࡋ ࡚ ⥺ 㔞 ホ ౯ ࢆ ⾜ ࡗ ࡚ ࠸
Potter
R,
Dimopoulos
for
J,
Kirisits
image-based
C,
Lang
S,
intracavitary
brachytherapy of cervix cancer: the GYN GEC ESTRO
࠿࡞ࡅࢀࡤ࡞ࡽ࡞࠸࡜⪃࠼ࡿࠋ
Working Group point of view: in regard to Nag et al. (Int
⭍ ෆ ↷ ᑕ ࢆ 㸯 ᅇ ⾜ ࡗ ࡓ ᫬ Ⅼ ࡛ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF
J Radiat Oncol Biol Phys 2004;60:1160-1172). Int J
ࡢ ್ ࢆ ࠶ ࡿ ⛬ ᗘ ண ࡍ ࡿ ࡇ ࡜ ࡀ ྍ ⬟ ࡞ ࡢ ࡛ ࠊ'FF ࡀ Radiat Oncol Biol Phys, 62:293-5; author reply 5-6, 2005
*\ ( 4 ' ࢆ ㉸ ࠼ ࡿ ࡇ ࡜ ࡀ ண ࡉ ࢀ ࡿ ሙ ྜ ࡣ ⥺ ※ 㓄 ⨨ ࡸ ࢘
4. Haie-Meder C, Potter R, Van Limbergen E, Briot E, De
࢙࢖ࢺࢆኚ᭦ࡍࡿࡇ࡜ࡸሙྜ࡟ࡼࡗ࡚ࡣ $ Ⅼ⥺㔞ࢆ࠾
Brabandere M, Dimopoulos J, Dumas I, Hellebust TP,
࡜ࡋ࡚⭍ෆ↷ᑕࢆ⥆ࡅ࡚࠸ࡃࡇ࡜ࡀ┤⭠ᬌᮇ㞀ᐖࡢప
Kirisits C, Lang S, Muschitz S, Nevinson J, Nulens A,
ῶ࡟᭷ຠ࡛࠶ࡿ࡜⪃࠼ࡿࠋ
Petrow P, Wachter-Gerstner N, Gynaecological GECEWG.
Recommendations
⤖ㄒ
from
Gynaecological
(GYN)
GEC-ESTRO Working Group (I): concepts and terms in
ᙜ㝔࡛౑⏝ࡋ࡚ࡁࡓ⥺㔞つᐃ࡟ࡼࡿ἞⒪ᡂ⦼ࡣⰋ
3D image based 3D treatment planning in cervix cancer
ዲ࡛ࠊᬌᮇ㞀ᐖࡢ㢖ᗘࡶチᐜෆ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡓࠋ
brachytherapy with emphasis on MRI assessment of GTV
௒ ᚋ ࡣ ᙜ 㝔 ࡛ ౑ ⏝ ࡋ ࡚ ࠸ ࡿ ⥺ 㔞 つ ᐃ ࢆ *(&(6752 ࠿ ࡽ
and CTV. Radiother Oncol, 74:235-45, 2005
່ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ ࠊ '9+ ࢆ ฼ ⏝ ࡋ ࡓ ⥺ 㔞 ᣦ ᶆ ࡬ ኚ ᥮ ࡍ ࡿ
5. Wachter-Gerstner N, Wachter S, Reinstadler E, Fellner
ࡇ࡜ࡀ㔜せ࡜⪃࠼ࡿࠋ
C, Knocke TH, Wambersie A, Potter R. Bladder and
௒ᅇࡢ᳨ウ࡛ࡣ┤⭠ᬌᮇ㞀ᐖࡢண ᅉᏊ࡜ࡋ࡚┤
rectum dose defined from MRI based treatment planning
⭠ 'FF ࡸ ┤ ⭠ 'FF ࡀ ࡼ ࠸ ᣦ ᶆ ࡛ ࠶ ࡿ ࡜ ⪃ ࠼ ࡽ ࢀ ࡓ ࠋ
for
≉ ࡟ ┤ ⭠ 'FF ࡀ *\ ( 4 ' ௨ ୖ ࡢ ᫬ ࡟ 㧗 ⋡ ࡟ *UDGH
dose-volume histograms for organ contours and organ
௨ୖࡢ㞀ᐖࡀ㉳ࡇࡿ༴㝤ᛶࡀ♧၀ࡉࢀࡓࠋ┤⭠ࡢ᭱኱
wall, comparison with ICRU rectum and bladder reference
Ⅼ ⥺ 㔞 ࡛ ┤ ⭠ ⥺ 㔞 ࡢ ホ ౯ ࢆ ⾜ ࠺ ࡼ ࡾ ࡶ ࠊ┤ ⭠ 'FF ࡸ ┤
point. Radiother Oncol, 68:269-76, 2003
6
cervix
cancer
brachytherapy:
comparison
of
6. Hyun Kim T, Choi J, Park SY, Lee SH, Lee KC, Yang
࿴ᩥ ᢒ㘓
DS, Shin KH, Cho KH, Lim HS, Kim JY. Dosimetric
parameters that predict late rectal complications after
ᙜ㝔࡛⾜ࢃࢀࡓᏊᐑ㢕⒴ᨺᑕ⥺἞⒪࡟࠾ࡅࡿ┤
curative radiotherapy in patients with uterine cervical
⭠࣭⭤ ⬔ ⥺ 㔞 ࡜ ᬌ ᮇ 㞀 ᐖ ࡢ 㛵 ಀ ࡟ ࡘ ࠸ ࡚ ᖺ ᭶ ࠿
carcinoma. Cancer, 104:1304-11, 2005
ࡽ ᖺ ᭶ ࡟ Ꮚ ᐑ 㢕 ⒴ ࡟ ᑐ ࡍ ࡿ ᰿ ἞ ⓗ ᨺ ᑕ ⥺ ἞ ⒪
7.
Kirisits
C,
Potter
R,
N,
Georg
Wachter-Gerstner
parameters
for
Lang
S,
D.
MRI-based
J,
ࢆ⾜ࡗࡓ⑕౛࡛⭍ෆ↷ᑕ᫬࡟࢔ࣉࣜࢣ࣮ࢱ࣮ᤄධᚋࠊ
volume
ẖ ᅇ &7 ࢆ ᧜ ᙳ ࡋ ⥺ 㔞 ホ ౯ ࢆ ⾜ ࡗ ࡓ ౛ ࡢ ࠺ ࡕ ⤒ 㐣 ほ
Dimopoulos
Dose
and
treatment
planning
ᐹ ࡍ ࡿ ࡇ ࡜ ࡀ ࡛ ࡁ ࡓ ౛ ࡛ ᳨ ウ ࡋ ࡓ ࠋ in
⑓⌮⤌⧊ᙧࡣ඲౛࡜ࡶᡥᖹୖ⓶⒴࡛࠶ࡗࡓࠋᖺ㱋ࡣ
intracavitary brachytherapy for cervical cancer. Int J
Radiat Oncol Biol Phys, 62:901-11, 2005
ṓ ࠿ ࡽ ṓ 㸦 ᖹ ᆒ ṓ 㸧ࠊ Ꮚ ᐑ 㢕 ⒴ ࡢ ࢫ ࢸ ࣮ ࢪ
8. Koom WS, Sohn DK, Kim JY, Kim JW, Shin KH, Yoon
ࡣ ),*2 ศ 㢮 ࡛ Ϩ % ᮇ ౛ ࠊ ϩ $ ᮇ ౛ ࠊ ϩ % ᮇ ౛ ࠊ
SM, Kim DY, Yoon M, Shin D, Park SY, Cho KH.
Ϫ $ ᮇ ౛ ࠊϪ % ᮇ ౛ ࠊϫ $ ᮇ ౛ ࠊϫ % ᮇ ౛ ࡛ ࠶
Computed tomography-based high-dose-rate intracavitary
ࡗ ࡓ ࠋ እ ↷ ᑕ ࡣ *\㹼 *\㸦 ୰ ኸ ್ *\㸧ࠊ
brachytherapy for uterine cervical cancer: preliminary
඲ 㦵 ┙ ↷ ᑕ *\㹼 *\୰ ኸ ್ *\ࠊ ୰ ኸ
demonstration
dose-volume
㐽 ⶸ *\㹼 *\୰ ኸ ್ *\ࠊ ⭍ ෆ ↷ ᑕ ࡣ $
parameters and rectal mucosal changes observed by
Ⅼ ⥺ 㔞 *\ ᅇ 㹼 *\ ᅇ ࠊ ほ ᐹ ᮇ 㛫 ࡢ ୰ ኸ
flexible sigmoidoscopy. Int J Radiat Oncol Biol Phys,
್ ࡣ ࣨ ᭶ ࡛ ࠶ ࡗ ࡓ ࠋ ໬ Ꮫ ⒪ ἲ ࢆ ే ⏝ ࡉ ࢀ ࡓ ࡢ ࡣ 68:1446-54, 2007
⑕ ౛ ࡛ ࠊ ᨺ ᑕ ⥺ ἞ ⒪ ༢ ⊂ ࡣ ⑕ ౛ ࡛ ࠶ ࡗ ࡓ ࠋ of
correlation
between
ྛ ⭍ ෆ ↷ ᑕ ἞ ⒪ ࡟ ࡼ ࡿ ⭤ ⬔ ࣭ ┤ ⭠ ࡢ 'FFࠥ 'FF ࢆ
9. Kato S, Tran DN, Ohno T, Nakano T, Kiyohara H,
dose-volume
'9+ ࡼ ࡾ ⟬ ฟ ࡋ ࠊ ඲ 㦵 ┙ ↷ ᑕ ⥺ 㔞 ࡜ ྜ ィ ࡋ ᅇ *\ ࡢ
parameter of the rectum and late rectal complication in
እ↷ᑕ⥺㔞࡬᥮⟬ࡋࡓࡶࡢ࡜⭤⬔࣭┤⭠ᬌᮇ㞀ᐖࡢ⛬
patients with cervical cancer treated with high-dose-rate
ᗘࢆẚ㍑ࡋࡓࠋ┤⭠ᬌᮇ㞀ᐖࡢ᭷↓࡛⩌ศࡅࡍࡿ࡜ࠊ
intracavitary
୧ ⪅ ࡢ 㛫 ࡛ ࡣ ┤ ⭠ 'FFࠥ 'FF ࡢ ᖹ ᆒ ್ ࡟ ᭷ ព ᕪ ࡀ
Ohkubo
Y,
Kamada
T.
CT-based
brachytherapy.
J
3D
Radiat
Res
(Tokyo),
Ꮡᅾࡋࡓࠋࡉࡽ࡟┤⭠ᬌᮇ㞀ᐖࡢࢢ࣮ࣞࢻ࡛⩌ศࡅࢆ
51:215-21, 2010
10. Georg P, Lang S, Dimopoulos JC, Dorr W, Sturdza
⾜࠸┤⭠⥺㔞࡜ࡢ㛵ಀࢆぢࡿ࡜ࠊ┤⭠⥺㔞ࡢቑຍ࡜࡜
AE,
ࡶ࡟ᬌᮇ㞀ᐖࡢࢢ࣮ࣞࢻࡀୖ᪼ࡍࡿഴྥࡀㄆࡵࡽࢀࡓࠋ
Berger
D,
Georg
D,
Kirisits
C,
Potter
R.
Dose-volume histogram parameters and late side effects
┤ ⭠ 'FF ࡀ *\ ( 4' ௨ ୖ ࡢ ⑕ ౛ ࡛ ࡣ ᭷ ព ᕪ ࢆ ࡶ ࡗ ࡚
in magnetic resonance image-guided adaptive cervical
┤⭠ᬌᮇ㞀ᐖࡢ☜⋡ࡀୖ᪼ࡋࡓࠋ
௒ᅇࡢ᳨ウ࡛ࡣ┤⭠ࡢ㐜Ⓨᛶᨺᑕ⥺㞀ᐖࡢண ᅉ
cancer brachytherapy. Int J Radiat Oncol Biol Phys,
79:356-62, 2011
Ꮚ ࡜ ࡋ ࡚ ࠊ ┤ ⭠ 'FF ࡸ ┤ ⭠ 'FF ࡀ ࡼ ࠸ ᣦ ᶆ ࡛ ࠶ ࡿ ࡜
11. Suyama S, Nakaguchi T, Kawakami K, Shou K,
⪃ ࠼ ࡽ ࢀ ࡓ ࠋ≉ ࡟ ┤ ⭠ 'FF ࡀ *\ ௨ ୖ ࡢ ᫬ ࡟ 㧗 ⋡ ࡟
Fushiki M, Taneike M, Matsui A, Takahashi M, Morita R.
JUDGH ௨ ୖ ࡢ 㞀 ᐖ ࡀ ㉳ ࡇ ࡿ ༴ 㝤 ᛶ ࡀ ♧ ၀ ࡉ ࢀ ࡓ ࠋ Computed tomography analysis of causes of local failure
in
࿴ᩥ࣮࣮࢟࣡ࢻ
radiotherapy
for
cervical
carcinoma.
Cancer,
83:1956-65, 1998
Ꮚᐑ㢕⒴ࠊ㧗⥺㔞⋡⭍ෆ↷ᑕࠊ ḟඖィ⏬ᑠ⥺※἞⒪
ᡞ ᯈ Ꮥ ᩥ ᨺ ᑕ ⥺ ἞ ⒪ ࢞ ࢖ ࢻ ࣛ ࢖ ࣥ ࣭ ᪥ ᮏ ᨺ
┤ ⭠ ᬌ ᮇ 㞀 ᐖ ࠊ 'RVHYROXPHKLVWRJUDP
ᑕ⥺ᑓ㛛་఍࣭་఍㸪᪥ᮏᨺᑕ⥺⭘⒆Ꮫ఍㸪᪥ᮏ་Ꮫ
ᨺ ᑕ ⥺ Ꮫ ఍ ⦅ 㞟 ᮾ ி 13. Viswanathan AN, Dimopoulos J, Kirisits C, Berger D,
Potter
R.
Computed
tomography
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magnetic
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7