摘要目的 在保留并移位卵巢的ⅠB1-ⅡA2期根治术后需辅助放疗的年轻宫颈癌患者中,评估移位卵巢剂量学参数与临床不同卵巢功能状态之间相关性.方法 回顾2015-2017年间86例患者疗前和疗后2年内移位卵巢功能和临床相关症状,并评价放疗技术中移位卵巢的剂量学参数以及移位卵巢的功能状态之间的相关性.术后放疗采用不同体外保护移位卵巢,68例IMRT或VMAT,18例二维等中心放疗.结果 卵巢和PTV最近距离与卵巢剂量≥V5Gy呈负相关(P=0.025).V8Gy、Dmean与疗后FSH(为卵巢血清卵泡刺激素,FSH)呈正相关(P=0.011、0.020).即V8 Gy体积越大Dnean越高,疗后FSH越高卵巢功能越差.二维技术中≥V5Gy低于三维技术,剂量降低明显.疗后卵巢功能正常者平均年龄33.4岁,而卵巢功能衰竭者平均年龄39.6岁(P=0.007).不同卵巢状态患者间保留卵巢数目、是否同步化疗均相近,但与疗前FSH、E2(雌二醇)水平相关,即疗前FSH水平越高E2越低,疗后卵巢FSH水平越高E2越低.疗前保留卵巢但功能衰竭者均进行了新辅助化疗且年龄略高.结论 年龄,卵巢V8Gy、Dmean,悬吊卵巢与PTV最近距离,疗前有无新辅助化疗及放疗技术均会影响移位卵巢功能的保护.

abstractsObjective The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the Ⅰ B1-Ⅱ A2 phase of preserved and transposed ovaries.Methods The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed,and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated.Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy.Results The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥ V5 Gy (P=0.025).Vs Gy and D were positively correlated with FSH after treatment (P=0.011,0.020).The larger the volume of Vs Gy and the large D the higher the FSH,the worse the ovarian function.In two-dimensional technology,the ovarian dose ≥ V5 Gy was significantly lower than that in three-dimensional technique.The average age of those with normal ovarian function after treatment was 33.4 years,whereas the average age of women with ovarian failure was 39.6 years (P=0.007).The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status,which were correlated with the levels of FSH and E2 (Estradiol) before treatment,that is,the higher the level of FSH before treatment,the lower the E2 of ovarian FSH after treatment,and the higher the level of FSH after treatment,the lower the level of ovarian E2.Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age.Conclusions Age,V8 Gy and D of the transposed ovary,the shortest distance between transposed ovary and PTV,whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.