宫颈癌调强放射治疗30例临床分析  

Clinical Analysis of 30 Patients with Cervical Cancer by Intensity-modulated Radiation Therapy

作　　者：姜迎宵[1] 王明臣[1] 马瑞忠[1] 王培合[1] 李勇[1] 

机构地区：[1]潍坊医学院附属潍坊市人民医院放疗科,山东潍坊261041

出　　处：《潍坊医学院学报》2008年第4期335-337,共3页Acta Academiae Medicinae Weifang

摘　　要：目的探讨中晚期宫颈癌患者应用调强放射治疗（IMRT）技术，在提高靶区剂量与减少正常组织受量方面的价值。方法失去手术机会的30例中晚期宫颈癌患者，均给予全程的IMRT，1．8～2．2Gy／次，每周4次外照射和1次内照射，外照射的处方剂量为50～55Gy，中位剂量为53．5Gy，内照射共给6次，每次5Gy。同时拟设计该30例患者2野和4野的放疗计划，拟给予相同的处方剂量，比较危险器官（OAR）直肠、小肠、膀胱和骨髓的受照射剂量和体积。结果30例患者均完成全程的IMRT，放射治疗计划靶区（PTV）的平均剂量为54．5Gy，90％的等剂量曲线（中位剂量53．5Gy）可以覆盖99％以上的肉眼靶区（GTV）体积。IMRT与普通2野和4野放疗组比较，小肠、直肠、膀胱和骨髓的受照射剂量和体积均明显减少（P〈0．05）。急慢性放射反应明显减轻。1，2年生存率比较，差异无统计学意义。结论IMRT放疗技术可以使患者的放疗靶区获得较为理想的剂量分布，邻近危险器官得到很好的保护，从而减小了急慢性放疗反应，毒副反应可以耐受，但未能提高近期生存率。Objective To investigate the application value of intensity-modulated radiation therapy （IMRT） for cervical cancer patients to improve the prescription dose of target volume and with minimizing complication. Methods Thirty cervical cancer patients with missed operation received full course IMRT, 1.8 to 2.0Gy/fraction, four fraction per week, and one fraction per week of inner radiotherapy. The total dose was from 50 to 55Gy, and the median dose was 53.5Gy. Each patient received 6 fraction inner radiotherapy ,5Gy per fraction. Simultaneously conventional 2-field and 4-field plans were designed for the same thirty patients with the same prescription dose. The dose and the volume delivered to the organ at risk（ OAR） was compared. The OAR included rectum,small intestine,bladder and bone marrow. Results All the thirty patients completed the full course of IMRT. The average dose delivered to the planning target volume（ PTV） was 54.5 Gy, and 90% of iso-dose curve（ median dose 53.5Gy ） covered more than 99% gross tumor volume（ GTV）. The dose delivered to small intestine,rectum, bladder, bone marrow was significantly lower than that of conventional 2-field and 4-field plans （ P 〈 0.05 ）. The acute and chronic toxicity of IMRT was significandy decreased. However, the survival rates of 1,2-year were not significantly different. Conclusion IMRT therapy makes better dose distribution, GTV receives radical dose and the adjacent OAR gets better protection. IMRT has statisfying short-term efficacy and tolerable toxicities, but not improve the survival rate of near.

关 键 词：宫颈肿瘤 调强放射疗法 危险器官 

分 类 号：R815[医药卫生—放射医学]