调强放射治疗在宫颈癌术后治疗中的临床研究  

Clinical study of intensity modulated radiation therapy for patients with cervical cancer after radical hysterectomy

作　　者：陈真云[1] 盛修贵[1] 李慧芹[1] 李庆水[1] 李大鹏[1] 马志芳[1] 马悦冰[1] 李庆菊[1] 

机构地区：[1]山东省肿瘤医院妇科,山东济南250117

出　　处：《中国实用妇科与产科杂志》2007年第7期539-542,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的 探讨调强放射治疗（IMRT）用于宫颈癌术后提高靶区受照射剂量,减少并发症的价值。方法 对2002年6月至2006年6月山东省肿瘤医院20例宫颈癌术后患者放疗前均给予2-3个周期化疗,并行全程IMRT,每日1次,每次1.8-2.2Gy,每周5次,给予处方剂量50-60Gy,中位剂量54.5Gy;同时拟设计该20例患者的普通2野放疗计划,拟给予相同的处方剂量,比较危险器官（OAR）受照射剂量;选取同期23例接受普通放疗的完整病例,比较调强放疗和普通放疗急、慢性毒副反应及近期存活率。结果 20例患者均完成全程IMRT,放射治疗计划靶区（planning target volume,PTV）内的平均剂量为56.2Gy,90%的等剂量曲线（中位剂量54.5Gy）可以覆盖99%以上的肉眼靶区（gross target volume,GTV）体积。IMRT与拟行普通2野放疗计划比较,小肠、直肠、膀胱的受照射剂量均明显减小,P均〈0.01;IMRT与普通放疗比较,急慢性毒副反应明显降低,但1、2、3年存活率比较差异无显著性意义,P〉0.05。结论 IMRT技术使宫颈癌术后患者的靶区获得理想的剂量分布,邻近危险器官得到很好的保护,毒副反应可以耐受,但未能提高患者近期存活率。Objective To investigate the application value of IMRT for patients with cervical cancer after radical hysterectomy to improve the prescription dose of target volume and reduce complications. Methods All 20 patients received full course IMRT after 2 to 3 cycles of chemotherapy, 1.8 to 2. 2Gy/fraction/day, 5 fractions/week, the prescription dose range was 50. 0 - 60. 0Gy, the median dose being 54. 5Gy. Simultaneously conventional 2-field plans were designed for the same 20 patients, same prescription dose was given, and the dose of organs at risk was compared. Twenty-three cases who received conventional radiotherapy with cervical cancer after radical hysterectomy were chosen to compare toxicity and short-term survival rate with the 20 IMRT cases. Results The average dose delivered to the PIN was 56. 2Gy, 90% of iso-dose curve covering more than 99% GTV（54. 5Gy）. The dose of small intestine, bladder and rectum was significantly lower than that of conventional 2-field plans, P 〈 0. 01. Compared with conventional radiotherapy, the acute and chronic toxicity of IMRT was significantly decreased. However, the survival rates of 1, 2 ,3-year were not significantly different, P 〉 0. 05. Conclusions IMRT therapy makes better dose distribution and acceptable toxicity than traditional radiotherapy for cervical cancer after radical hysterectomy. The adjacent organs at risk are well protected, but the shortterm survival rate is not enhanced.

关 键 词：子宫颈癌 根治性子宫切除 放射治疗 调强放射治疗 

分 类 号：R71[医药卫生—妇产科学]