JP2016032595A - Intraluminal spacer for radiotherapy - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an intraluminal spacer having a simplified configuration enabling easy manufacturing and cleaning while exhibiting excellent function for reducing side effect and excellent therapeutic effect.SOLUTION: During a therapeutic operation in which radiation is externally irradiated or/and intraluminally irradiated to an intraluminal tumor or/and a tumor adjacent to an intraluminal part that is reachable from outside, an intraluminal spacer 1A for radiotherapy is used by inserting from outside into the intraluminal part so as to form a predetermined distance between a portion to be treated and a normal tissue adjacent thereto. The spacer includes an inserting part 120 which is stored between the intraluminal part and a base end part 110 exposed outside of the body at an insertion point, the inserting part 120 having an outer shape and size which can be inserted into and taken out of the intraluminal part from outside while being corresponding or approximate to an inner shape and size in a state where the intraluminal part is inwardly opened, thereby maintaining an open state of the intraluminal part by the insertion.SELECTED DRAWING: Figure 1

Description

  In the treatment of irradiating a predetermined tumor with radiation, the present invention provides a predetermined distance between the treatment site and the normal tissue in order to prevent the radiation from acting excessively on the normal tissue adjacent to the treatment site. The present invention relates to an intraluminal spacer for radiotherapy that is used by being inserted into a cavity so as to ensure.

  In the treatment of externally irradiating a tumor in the body, damage to normal tissue in the site adjacent to the treatment site tends to be a problem, but X-rays commonly used for external irradiation are doses near the body surface. Because the dose decreases as the depth increases from the body surface to the maximum, in order to irradiate the tumor with a dose higher than the predetermined level, the normal tissue up to the treatment site is irradiated with a high dose End up.

  In recent years, with respect to the problem of side effects associated with external irradiation of such radiation, there has been a feature that in recent years, the dose is low at the incident site of radiation, and a high dose is rapidly exhibited at a predetermined depth while almost disappearing at that position. Particle beam therapy has been developed, and is attracting attention as a treatment method capable of irradiating a tumor with a high dose while minimizing side effects on normal tissues.

  In addition, for a body cavity that can be reached from outside the body or a tumor at a position adjacent to the body cavity, intracavitary irradiation in which radiation is irradiated at a pinpoint via a radiation source inserted and arranged in the body cavity may be used in combination. Furthermore, the inventors of the present application have been studying a technique of intra-organization irradiation performed by directly inserting a radiation source from the body cavity into the lesion, and this is used in combination with external irradiation with heavy particle beams and intra-cavity irradiation with gamma rays. We are also working on a new treatment method.

  However, in the treatment by external irradiation including the heavy particle radiotherapy described above, it is difficult to sufficiently avoid the side effects on the normal tissue at the site adjacent to the cancer tissue. For example, as shown in the partial cross-sectional view of the treatment site in cervical cancer in FIG. 15A, when external irradiation is performed on the tumor 40, the radiation irradiation site is generally in a range indicated by a broken line. At some point, the rectum 6 adjacent to this is also included in the irradiation range.

  Therefore, with respect to the tumor cavity 40 existing in a body cavity portion that is relatively easily reachable by insertion from the outside, such as the vagina 5 and the rectum 6, and a tumor 40 existing in the vicinity thereof, a spacer having a predetermined shape is inserted into the cavity. Then, by expanding the cavity from a normally closed state to a moderately open state, a predetermined distance is secured between the normal tissue that is likely to be exposed to a high dose and the tumor, and the external space It is also conceivable to carry out irradiation.

  For example, German Patent No. 4413490 discloses a cylindrical shape formed along a body cavity and exhibits a spacer function and a radiation shielding function for opening the inside of the cavity by being inserted into the body cavity part. An applicator device having an insertion hole through which a catheter for brachytherapy can be inserted along the outer wall portion of the cylinder has been proposed. In Japanese Patent Publication No. 2013-533787, an applicator device is formed on the inner peripheral side of the cylinder. A method is also proposed in which the insertion hole of the catheter is formed by a groove and a columnar member inserted in the center of the cylinder, and the catheter insertion hole can be easily formed and the cleaning and sterilization work after use is facilitated. Has been.

  However, since these devices have a simple cylindrical shape, the body cavity portion to be inserted does not necessarily match the internal shape of the open state, and therefore a portion that does not open appropriately in the body cavity portion also occurs. As a side effect reducing function, it must be said that it is insufficient. In the former device, it is technically difficult to form a long catheter insertion hole on the outer wall from the proximal end side to the distal end side, and it takes time and effort for cleaning and disinfection after use. Furthermore, in the latter device, the catheter insertion hole has a shape suitable for cleaning, but it is only parallel to the longitudinal direction of the device or inclined in the central axis direction by the tip, and is appropriate when used for tissue irradiation. It is not easy to guide and hold the catheter at a proper position and angle.

German Patent No. 4413490 Special table 2013-533787 gazette

  The present invention is intended to solve the above-described problems, and has an excellent side-effect reduction function with a simple configuration that enables easy manufacture and cleaning of an intracavity spacer for radiotherapy. It is an object of the present invention to have an excellent therapeutic effect.

  Therefore, the present invention provides a method for treating a tumor in a body cavity that can be inserted from the outside and / or a tumor in a region close to the body cavity by performing external irradiation or / and intra-cavity irradiation. In the spacer used by being inserted from the outside into the body cavity part in order to form a predetermined distance between the site and the normal tissue adjacent thereto, the spacer is a base end part that is exposed outside the body at the insertion position and the intracavity The insertion portion is configured to have an outer shape and size that can be inserted into and removed from the inside of the cavity while matching or approximating the inner surface shape and size of the state where the body cavity portion opens the inner surface side, The inside of the cavity is kept open by insertion.

  In this way, the outer surface shape and size of the normally closed body cavity part is appropriately opened, for example, the penis is inserted into the vaginal cavity and the rectal state during defecation Since the spacer insertion part is formed so as to match or approximate, the space between the treatment site and the normal tissue is moderate within a range that does not excessively expand the cavity so as to cause great pain to the patient even though it is a simple structure. Because it can form a distance, in addition to being able to demonstrate an excellent side effect reducing function as a spacer, side effects can be reduced, so that a higher dose can be given to the treatment site, and an excellent therapeutic effect can also be expected It will be a thing.

  Further, in this intraluminal spacer for radiotherapy, the body cavity portion to be inserted is a vaginal cavity, and the insertion portion has the same outer shape and size as the penis at the time of sexual intercourse. Thus, the vaginal cavity can be opened to an appropriate state without causing excessive pain to the patient during the insertion / withdrawal operation.

  Further, in the above-mentioned intratherapeutic spacer for radiotherapy, a plurality of catheter insertion holes for penetrating a catheter for brachytherapy from the end surface of the proximal end portion to the outer surface on the distal end side of the insertion portion are provided. If the catheter inserted through the catheter insertion hole is guided to the target location and can be fixed at that position, not only the spacer function in external irradiation but also the applicator for brachytherapy The attachment function will be demonstrated.

In this case, the plurality of catheter insertion holes include those in which at least the distal end side portion is inclined in the centrifugal direction with respect to the longitudinal central axis of the insertion portion, and the catheter protruding from the distal end side opening portion is obliquely centrifuged. If it is characterized by guiding and fixing in the direction, for example, when performing intra-organization irradiation, the radiation source can be easily inserted into the tumor in the outer circumferential direction of the spacer.

  Further, the above-mentioned intrathecal spacer for radiotherapy is composed of a plurality of divided bodies that are divided into two or three in the longitudinal direction, and the plurality of divided bodies have a connecting structure on the end portions adjacent to each other. If it is formed by connecting and integrating, and the connecting and separating operations are possible at the connecting position, various spacers can be used to match different intracavity shapes for each patient. It becomes possible to use a combination of divided parts of the shape, and those having a catheter insertion hole, the hole length of the catheter insertion hole of each divided body is shortened, making the manufacturing easier and cleaning work easier. In addition, in brachytherapy including intra-organization irradiation, a catheter can be fixed at an accurate position by combining divided bodies having catheter insertion holes according to the shape and position of the treatment site. The ones that easy to achieve a more effective treatment.

  In this case, if the catheter insertion hole formed in each of the divided bodies is characterized in that at least the proximal opening side is expanded conically, the catheter to be inserted is caught by the opening. In addition to being difficult, the cleaning water can be easily introduced into the catheter insertion hole during the cleaning operation.

  Furthermore, in the above-mentioned intracavity spacer for radiotherapy, a small piece of metal that functions as a marker for position confirmation is embedded in a predetermined position inside the insertion portion. In this case, the operator can perform the operation while recognizing the position of the spacer with the marker by using an X-ray or CT image, and it becomes easy to realize more accurate treatment.

  Furthermore, in the above-mentioned intracavity spacer for radiotherapy, a gap is formed in the inner portion of the insertion portion so that the dose measurement film can be inserted and removed from the outside. If so, the irradiation state of each part of the spacer can be confirmed, and it can be used as an index to exert the maximum therapeutic effect while reducing side effects.

  According to the present invention in which the insertion portion of the spacer is formed so as to approximate the inner surface shape / size in the state where the cavity is open, an excellent side effect reduction function while being a simple configuration that enables easy manufacture and cleaning. It is possible to exhibit an excellent therapeutic effect while having

(A) is a left side view of the intraluminal spacer for radiotherapy according to the first embodiment of the present invention, and (B) is a plan view of (A). It is a fragmentary longitudinal cross-section which shows the state which is using the intraluminal spacer for radiotherapy of FIG. 1 at the time of external irradiation. FIG. 2B is a left side view showing an application example of the radiation therapy intracavity spacer of FIG. 1, and FIG. (A) is a top view which shows the state which decomposed | disassembled the radiotherapy intracavity spacer of FIG. 3 (B), (B) is a left view which shows the state of the cross section side of the upper part of (A). (A) is a left side view of a radiotherapy intracavity spacer according to a second embodiment of the present invention, (B) is a rear view, (C) is a front view, and (D) is an AA of (C). It is line sectional drawing. FIG. 6 is a left side view showing a state in which a brachytherapy catheter is inserted through the radiation therapy intracavity spacer of FIG. 5. (A) is a left side view showing an application example of the radiation therapy intracavity spacer of FIG. 5, (B) is a rear view of (A), (C) is a front view of (A), and (D) is (A) ) Is a right side view. (A) is a left side view showing a state in which a brachytherapy catheter is inserted into the radiation therapy intracavity spacer of FIG. 7, and (B) is an enlarged rear view showing a state of the proximal end side of (A). (C) is a fragmentary longitudinal cross-sectional view which shows the state which uses the intra-cavity spacer for radiotherapy of (A). 7A is a rear view, a left side view, and a front view showing a modification of the radiotherapy intracavity spacer of FIG. 7, and FIG. 7B shows a state in which the radiotherapy intracavity spacer of FIG. 7A is used. (C) is a partial cross-sectional view showing an example of a radiation irradiation situation when a brachytherapy is performed with the intraluminal spacer for radiotherapy in (A). 5A is a rear view, a left side view, and a front view showing an application example of the radiation treatment intracavity spacer in FIG. 5, and FIG. 7B is a rear view and a left side showing an application example of the radiation treatment intracavity spacer in FIG. FIG. 10C is a rear view, a left side view, and a front view showing an application example of the radiation therapy intracavity spacer of FIG. 9. (A) is a left side view of the radiation therapy intracavity spacer according to the third embodiment of the present invention, (B) is a rear view showing the configuration of the base end face of (A), and (C) is a part of (A). It is sectional drawing which follows AA. (A) is a left side view showing a state in which the distal end portion of the radiotherapy intracavity spacer in FIG. 11 is replaced with a replacement split body, and (B) is the distal end portion of the radiotherapy intracavity spacer in (A). (C) is a left side view of another replacement segment to be used, (C) is a left side view of another replacement segment to be used at the distal end of the radiotherapy intracavity spacer in (A), and (D) is It is a left view of the division body for replacement | exchange used for the trunk | drum of the intraluminal spacer for radiotherapy of (A). (A) is a plan view showing an application example of the radiotherapy intracavity spacer of FIGS. 3 and 11 in a divided state, and (B) is a back view showing the configuration of the base end face of the divided body constituting the insertion portion of (A) FIGS. 3C and 3D are rear views showing a modification of FIG. (A) is a plan view showing a modified example of the radiotherapy intracavity spacer in FIG. 13 in a divided state, and (B) is a left side view showing a state before the division in (A). (A) is a partial longitudinal cross-sectional view which shows the irradiation condition of the radiation at the time of external irradiation, (B) is a partial cross-sectional view which shows the irradiation condition of the radiation at the time of intracavity irradiation.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings. In the present invention, intraluminal irradiation is performed by inserting a catheter for brachytherapy into the cavity, or by extending the catheter inserted into the cavity and inserting it directly into the tumor tissue. Irradiation shall be included.

  FIG. 1A shows a radiation treatment intracavity spacer 1A according to the present embodiment, and FIG. 1B shows a plan view thereof. The present invention provides a method for treating a tumor in a body cavity that can be reached by inserting a spacer from the outside, and / or a tumor in a site close to the body cavity, by performing external irradiation or / and intra-cavity irradiation. In order to form a predetermined distance between a part and a normal tissue of a part adjacent thereto, it is used by being inserted into a body cavity part, but in the description of the present embodiment, the body cavity part to be inserted is The case where the treatment target is cervical cancer in the vaginal cavity and the radiation to be externally irradiated is a heavy particle beam will be described.

  The intraluminal spacer 1A for radiotherapy according to the present embodiment is formed by molding a synthetic resin into a predetermined shape, and as a material thereof, from the viewpoint of ensuring the same radiation transmissivity as a human tissue, a plurality of times High concentration polyethylene (specific gravity 0.94 to 0.97), polyethylene (specific gravity 0.91 to 0.93), acrylic (specific gravity 1.17 to 1.20) from the viewpoint of ensuring durability that can be sterilized. ) Is preferred.

  The intra-cavity spacer 1A for radiotherapy includes a proximal end portion 110 that is exposed to the outside at the insertion position and is a portion that is grasped and operated by an operator, and an insertion portion 120 that fits in the cavity. The insertion portion 120 has an outer shape and size that can be inserted into and removed from the outside while matching or approximating the inner shape and size of the vaginal cavity with the inner surface open. Is characterized by maintaining a fully open state.

  That is, the present inventors have found that the shape and size of the state in which the vaginal cavity is open on the inner surface side substantially matches the outer surface shape and size of the penis at the time of sexual intercourse. The spacer insertion portion 120 used for maintaining the open state is also configured to have an outer shape / size that matches or approximates this. As shown in FIG. 1 (B), in order to allow the surgeon to grasp the vertical direction of the insertion portion 120 during insertion, the base end portion 110 exposed to the outside is provided with a mark 110a due to a depression. . In addition, since the vaginal wall is a tissue rich in elasticity, the diameter of the insertion portion 120 may be slightly larger than the actual penis from the viewpoint of ensuring a sufficient distance between the treatment site and the adjacent normal tissue. The ratio of the length of the tip side enormous portion to the entire insertion portion may be slightly increased.

  FIG. 2 shows external irradiation with heavy particle beams on a tumor (cervical cancer) 40 on the cervix side of the uterus 4 in a state where the intracavity spacer 1A for radiotherapy according to the present embodiment is inserted into the vaginal cavity 5. It shows the state of doing. As shown in FIG. 15A, when the spacer is not used, the rectal 6 is included in the high-dose region of the radiation indicated by the thick broken line, whereas the intrathecal spacer for radiotherapy according to the present embodiment. In the state where 1A is inserted, the vaginal cavity 5 is sufficiently opened as shown in the figure, and the rectum 6 is moved to a position away from the tumor 40 and maintained outside the high dose range.

  FIG. 3A shows a radiotherapy intracavity spacer 1B as an application example of the aforementioned radiotherapy intracavity spacer 1A, and FIG. 3B shows a plan view thereof. In this application example, the left and right divided bodies 3a and 3b formed by dividing the above-described radiation therapy intracavity spacer 1A into left and right are made connectable and separable as shown in FIG. It can be used in a state where a dosimetry film (Gafchromic film: US registered trademark) for grasping the irradiation state of radiation is sandwiched.

  That is, the intraluminal spacer 1B for radiotherapy is joined to the left and right divided bodies 3a and 3b by bolts 50 and 50 on the base end 111 side, and is divided into left and right by loosening and removing the bolts 50 and 50. The bodies 3a, 3b can be separated. Further, the left and right divided bodies 3a and 3b are respectively formed with recesses 31 and 41 so as to form gaps for sandwiching the dose measuring film between the joint surfaces of the insertion portion 121 in a state where they are joined.

  Then, after performing radiation therapy while inserting the dose measuring film in the body cavity, the radiation irradiated to each part at the spacer insertion position is taken out by checking the state after taking out the dose measuring film. Since it becomes possible to grasp the amount, it can be used to further reduce side effects while judging the therapeutic effect and the influence on normal tissue.

  In this application example, metal balls 60, 60, 60 made of tungsten, stainless steel, or the like that clearly appear on the image by X-ray photography are embedded as markers in the insertion portion 121. The operation can be performed while confirming the position of the spacer with an X-ray or CT image, and it is easy to realize an excellent therapeutic effect while reducing the influence on the normal tissue.

  FIG. 5A shows a radiotherapy intracavity spacer 1C according to the second embodiment of the present invention, in which FIG. 5B is a rear view thereof, FIG. 5C is a front view thereof, and FIG. The sectional view on the AA line of C) is shown. In this embodiment, the intraluminal spacer 1C for radiotherapy is characterized in that it has an attachment function as an applicator auxiliary tool for brachytherapy in addition to the spacer function.

  That is, as the applicator, the tip end side of the cylindrical insertion portion 122 is formed in a hemispherical shape, and can be widely applied to a body cavity portion having a linear shape from the opening portion. A plurality of catheter insertion holes 71a,..., 71b,... Are provided from the end surface of the base end portion 112 to the distal end surface of the insertion portion 122 for inserting a catheter for brachytherapy. The catheter inserted therein is guided to the target location and held (fixed) at the position and orientation of the insertion hole.

  Since this radiation therapy intracavity spacer 1C has an extremely simple shape as shown in the drawing, it can be easily manufactured at a relatively low cost, and its cleaning and sterilization are also relatively easy. FIG. 6 shows a state in which the brachytherapy catheters 100, 100, 100 are inserted into the radiation therapy intracavity spacer 1C. The radiation source built in each catheter 100 is the position desired by the operator. In addition to the spacer function in external irradiation, an excellent attachment function can be exhibited not only in intracavity irradiation and tissue irradiation used in combination with external irradiation.

  FIG. 7A shows a radiotherapy intracavity spacer 1D as an application example of the radiotherapy intracavity spacer 1C described above, (B) is a rear view, (C) is a front view, and (D). Shows a right side view. In the intra-radiotherapy spacer 1D, a plurality of catheter insertion holes 72a,... For inserting a brachytherapy catheter are provided from the end surface of the base end portion 113 to the distal end surface of the insertion portion 122. In addition, catheter insertion holes 72b, 72b, 72c, and 72c are provided to be inclined with respect to the central axis in the longitudinal direction of the insertion portion 122 from the end surface of the base end portion 113 to the side surface near the distal end of the insertion portion 122. As shown in the figure, the catheter protruding from the opening on the distal end side can be guided and held in an obliquely centrifugal direction.

  Therefore, it is easy to apply the radiation source accurately according to the shape of the vaginal cavity and the position / shape of the tumor which are different for each patient. Further, as shown in FIG. 8 (C), the above-described intrathecal spacer 1C for radiotherapy is sufficient by inserting and projecting the catheters 100, 100 through the catheter insertion holes 72b, 72b protruding in the centrifugal direction. It is also possible to carry out in-tissue irradiation at a position where it was not possible.

  FIG. 9A shows a radiotherapy intracavity spacer 1E as a modification of the above-mentioned radiotherapy intracavity spacer 1D, the center is a left side view, and the left is a rear view showing the configuration of the base end face. The right is a front view showing the configuration of the tip surface. In this modification, the catheter insertion holes 73b and 73b are formed by further inclining the catheter insertion holes provided in the above-mentioned radiation therapy intracavity spacer 1D so as to be inclined in the centrifugal direction and opening them further on the outer peripheral surface closer to the proximal end side. , 73c, 73c.

  By adopting such a configuration, the catheter 100 can be protruded by being further inclined in the centrifugal direction at a position away from the distal end position toward the proximal end, thereby greatly increasing the degree of freedom of the radiation source arrangement. It has become a thing. And even in the tissue irradiation performed by directly inserting the radiation source into the tissue, the range of applicable tumors is further expanded, so that more accurate treatment can be easily performed.

  For example, in cervical cancer, since the initial lesion is usually in the cervix, it can be dealt with on the tip side of the attachment, but in the advanced state, as shown in FIG. In a normal attachment, a high dose can be irradiated only within the range of the thick broken line. On the other hand, when this intraluminal spacer 1E for radiotherapy is used, as shown by a thick broken line in FIG. 9C, a high dose is irradiated also at 4 o'clock and 8 o'clock without spreading to the bladder or rectum side. Therefore, it is easy to minimize side effects while accurately dealing with advanced cervical cancer.

  FIG. 10 shows a rear view, a left side view, and a front view when an enormous portion is formed at the tip of the above-described columnar embodiment, and FIG. 10A shows an application example of the intrathecal spacer 1C for radiotherapy. (B) is an application example of the radiotherapy intracavity spacer 1D, and (C) is an application example of the radiotherapy intracavity spacer 1E. Thus, by forming the enormous portion on the distal end side, for example, in the vaginal cavity, the cavity near the uterus can be expanded more than the straight shape, and it is easier to avoid damage to adjacent normal tissue. In addition, in a catheter that is inclined and protruded, a larger inclination angle can be secured while protruding in the centrifugal direction.

  FIG. 11A shows a radiation therapy intracavity spacer 1I according to the third embodiment of the present invention, FIG. 11B is a rear view showing the configuration of the base end face of FIG. It is sectional drawing which follows AA of (A). In this embodiment, the proximal end portion 112 of the above-mentioned radiotherapy intracavity spacer 1C is a proximal end portion 118 whose diameter is increased so as to be easily grasped by an operator, and the insertion portion 122 is a proximal end portion. It is characterized in that the insertion portion 128 is separable from the insertion portion 128 and can be further separated into the body portion 128a and the distal end portion 128b.

  In other words, this intraluminal spacer 1I for radiotherapy is composed of a plurality of divided bodies that are divided into three in the longitudinal direction, and as shown in FIG. Each has a connecting structure and is connected and integrated at this portion, and the connecting / separating operation can be performed at the connecting position. For this reason, conventionally, it has been technically difficult to form a thin catheter insertion hole over the entire length of the spacer, and the cleaning operation has been troublesome. Was shortened to about one-half to one-third of the conventional length, so that drilling was easy and cleaning was easy.

  In addition, if each divided body is prepared with various outer shapes and arrangements of catheter insertion holes according to the patient's situation, it can be combined with the outer shape according to the intracavity shape of the patient as a spacer, As an attachment for the radiation source treatment, a combination of a catheter insertion hole that matches the intracavity shape of the patient and the shape / position of the tumor can be easily realized at the treatment site.

  Further, when the intraluminal spacer 1I for radiotherapy is inserted into the vaginal cavity, it is used with a condom in order to ensure lubricity during insertion and not damage the lumen surface. There are many cases, but a feature is that the base end portion 112 is formed with a depression 118c having a chevron structure so that the base end side of the condom does not move.

  In addition, the proximal end side opening portions of the catheter insertion holes 76a and 76b of each divided body are expanded in a conical shape (funnel shape), and the distal end side of the catheter 100 to be inserted is less likely to be caught by each opening portion. At the same time, it is easy to introduce cleaning water into the catheter insertion holes 78a and 78b during the cleaning operation. In addition, it is preferable that the shape of the joint surface is an ellipse or a concavo-convex structure that fits in the correct orientation is provided so that the orientations of the respective divided bodies can be accurately aligned at the time of connection.

  FIG. 12 (A) is a radiotherapy intracavity spacer 1J in which the distal end portion 128b of the above-mentioned radiotherapy intracavity spacer 1I is replaced with a distal end portion 128J as a replacement split body constituting the enormous portion. B) is a distal end portion 128k as a replacement divided body having a catheter insertion hole 77b whose distal end side is inclined in the centrifugal direction, and (C) is a catheter insertion hole 78b whose distal end side is further inclined in the centrifugal direction while forming a huge portion. A distal end portion 128L as a replacement divided body provided with a body part as a replacement divided body provided with a catheter insertion hole 79b that is inclined in the centrifugal direction at an intermediate portion in the longitudinal direction and opened to the outer peripheral surface. 128 m. Thus, various aspects are assumed in each divided body, and diversity of the combination can be realized.

  FIG. 13 (A) shows a state in which the radiation therapy intracavity spacer 1K, which is an application example of the radiation therapy intracavity spacers 1B and 1I, is divided, and FIG. 13 (B) constitutes the insertion portion 129 of (A). The rear view which shows the structure of the base end surface of the division body to perform, (C), (D) is a rear view which shows the modification of (B). This application example is characterized in that a dose measuring film for grasping the radiation irradiation state is inserted into the interior from the joint surface of the divided body so that the interior can be installed.

  As shown in FIG. 13B, the gap 129b serving as a space for inserting the dose measuring film has a linear shape as shown in FIG. 13B, a cross shape as shown in FIG. 13C, and as shown in FIG. It is possible to implement a shape in which a film can be inserted in accordance with the shape, such as a circular shape. Further, as shown in FIG. 14 (A), if the intra-radiotherapy spacer 1L that can be divided into three is used, as shown in FIG. It is possible to form a gap 129c in which a film having a shape that cannot be inserted can be incorporated.

  As described above, the intraluminal spacer for radiotherapy can exhibit an excellent therapeutic effect while having an excellent side effect reduction function while having a simple configuration that facilitates manufacture and cleaning according to the present invention. became.

  1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, Intracavity spacer for radiation therapy, 3a, 3b Left and right divided bodies, 5 Vaginal cavity, 6 Rectum, 31, 41 Concavity, 60 Metal sphere, 40 Tumor, 71a, 71b, 72a, 72b, 72c, 73a, 73b, 73c, 76a, 76b, 77b, 78b, 79b Catheter insertion hole, 100 Catheter, 110, 111, 112, 113, 114, 118 , 119 Base end portion, 120, 121, 122, 123, 124, 128, 129 Insertion portion, 128a, 128m, 128o trunk portion, 128b, 128j, 128k, 128l, 128n Tip portion

Claims (8)

  When a treatment is performed by externally irradiating or / and intracavitally irradiating a tumor in the body cavity that can be inserted from the outside and / or a tumor in the vicinity of the body cavity, and adjacent to the treatment site In the spacer used by being inserted into the body cavity part from the outside in order to form a predetermined distance between the normal tissue, the spacer is composed of a proximal end part which is exposed outside the body at the insertion position and an insertion part which fits in the cavity. The insertion portion has an outer shape and size that can be inserted into and removed from the inside of the cavity while matching or approximating the inner shape and size of the body cavity portion with the inner surface open. An intracavity spacer for radiotherapy characterized by maintaining an open state.   The intracavity spacer for radiotherapy according to claim 1, wherein the body cavity part is a vaginal cavity, and the insertion part has the same outer shape and size as a penis during sexual intercourse.   A plurality of catheter insertion holes through which the catheter for brachytherapy is inserted from the end surface of the base end portion to the outer surface on the distal end side of the insertion portion are provided, and the catheter inserted through the catheter insertion hole is a target location. The intraluminal spacer for radiotherapy according to claim 1, wherein the spacer is capable of being guided and fixed at the position.   The plurality of catheter insertion holes include those in which at least the distal end side portion is inclined in the centrifugal direction with respect to the longitudinal central axis of the insertion portion, and the catheter protruding from the distal end side opening portion is obliquely centrifuged The intraluminal spacer for radiotherapy according to claim 3, wherein the spacer is guided and fixed.   Consists of a plurality of divided bodies that are divided into two or three in the longitudinal direction, and the plurality of divided bodies are connected and integrated with a connecting structure on the side of adjacent ends. The intraluminal spacer for radiotherapy according to claim 1, 2, 3, or 4, characterized in that connection / separation operation is possible at a position.   6. The intrathecal spacer for radiotherapy according to claim 5, wherein at least a proximal end side opening portion side of the catheter insertion hole formed in each divided body is expanded in a conical shape.   The metal small piece which functions as a marker for position confirmation is embed | buried under the inner part predetermined position of the said insertion part, The 1, 2, 3, 4, 5 or 6 characterized by the above-mentioned. Intracavity spacer for radiation therapy.   A gap is formed in the inner portion of the insertion portion for internally installing the dose measuring film in a state where it can be inserted and removed from the outside. The intraluminal spacer for radiotherapy as described in 6 or 7.

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