子宫颈癌调强放射治疗临床分析  

Clinical analysis of cervical cancer treated with intensified radiation therapy

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

机构地区：[1]山东省潍坊市人民医院放疗科,潍坊261041

出　　处：《中国肿瘤临床与康复》2010年第2期118-121,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨中晚期宫颈癌患者应用调强放射治疗(IMRT),在提高靶区剂量与减少正常组织受量方面的价值。方法62例中晚期宫颈癌患者,随机分成IMRT组和普放组。IMRT组30例患者给予全程IMRT和6～7次腔内照射,外照射与内照射同步进行,外照射每周4次,内照射1次/周,IMRT的PTV总处方剂量为50 Gy,2.0 Gy/次;腔内照射5 Gy/次,共30～35 Gy(A点剂量)。同时虚拟设计普通放疗计划,按相同的处方剂量计算,自身比较靶区以及直肠、小肠、膀胱和骨髓等危险器官的受照剂量和体积。普放组32例患者接受普通外照射和腔内照射,外照射24 Gy时开始内照射,腔内照射A点剂量35Gy左右,外照射的剂量和分割方式同IMRT组。比较两组的肿瘤缓解率和1,2年生存率,急慢性放射反应和并发症发生率以及疗程长短。结果IMRT较普放计划的靶区剂量明显提高(P<0.01),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);IMRT组肿瘤缓解率较高(P<0.05),部分急、慢性放射反应明显减少(P<0.05),1,2年生存率比较差异无显著性(P>0.05)。结论IMRT技术可提高宫颈癌的靶区剂量,并获得理想的剂量分布,邻近危险器官得到很好的保护,从而减少了急慢性放疗反应的发生,但未能提高近期生存率。Objective To study the application value of intensified radiation therapy（IMRT） for treatment of middle/late stage cervical cancer with improving the prescription dose for target while decreasing dose for normal tissue.Methods Sixty-two cervical cancer patients who missed operation were randomly divided into two groups,IMRT and conventional radiotherapy（CRT） groups.Patients in IMRT group received full course of IMRT and six/seven times of internal radiotherapy,four fractions of external radiotherapy and one fraction of internal radiotherapy per week,the prescription dose of planned target volume（PTV） for IMRT was 50 Gy,2.0 Gy/fraction;5 Gy/fraction of internal radiotherapy（dose of A point）.Total dose of A point was 30-35 Gy.Simultaneously CRT plans were designed with the same prescription dose in order to compare the dose delivered to the targets and the organs at risk（OAR）,including rectum,small intestine,bladder and bone marror.The internal radiotherapy was started when external radiation dose reached 24 Gy,and was given one fraction per week,with the same prescription dose and dose fraction as IMRT group.The rate of tumor response,one-and two-year survival rates,incidences of acute and chronic toxicity,complication,period of treament were compared between the two groups.Results Compared with CRT group,the target dose of IMRT plan was increased envidently（P0.01）,the doses and volume of small intestine,rectum,bladder,bone marror irradiated were significantly decreased（P0.05）,the rate of tumor response was higher（P0.05）,the incidence of some of the acute and chronic toxicity was significantly decreased（P0.05） in IMRT group,while the difference of the 1-or 2-year survival rates was not significant（P0.05）.Conclusions In cervical cancer patients treated with IMRT,the dose of target was increased,perfect dose distribution was got,the OAR was well protected,the incidence of acute and chronic toxic reactions was decreased,but the short-term survival rate was not improved.

关 键 词：宫颈肿瘤/放射疗法 危险器官 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]