直肠癌术前IMRT同期化疗与VMAT同期化疗的急性不良反应比较  

Comparison of acute toxicities between IMRT and VMAT in preoperative concurrent chemoradiotherapy for rectal cancer

作　　者：任骅[1] 金晶[1] 肖琴[1] 冯燕茹[1] 房辉[1] 李宁[1] 王鑫[1] 王维虎[1] 王淑莲[1] 宋永文[1] 刘跃平[1] 余子豪[1] 刘新帆[1] 戴建荣[1] 李晔雄[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021

出　　处：《中华放射肿瘤学杂志》2014年第3期205-209,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 比较静态IMRT和VMAT用于直肠癌术前同期放化疗的急性不良反应及耐受性.方法 2006-2013年共242例患者接受IMRT或VMAT同期化疗,VMAT组61例,IMRT组181例（其中简化IMRT 137例,7个野IMRT 44例）.全组均予盆腔放疗50Gy分25次5周完成,同期化疗连用5周（卡培他滨每天1650 mg/m2,奥沙利铂每周50 mg/m2）.组间差异行x2检验.结果 全组因不良反应中断放疗者7.9％,VMAT和IMRT组相当（4.9％∶8.8％,P=0.325）,IMRT组中简化IMRT和7个野IMRT的也相近（8.0％∶11.4％,P=0.498）.全组最常见急性不良反应为白细胞下降（69.4％,≥3级5.8％）、腹泻（65.5％,≥3级20.7％）、放射性皮炎（62.0％,≥3级7.9％）,其中VMAT和IMRT组的相当（68.9％∶69.6％,P=0.911;63.9％∶ 67.4％,P=0.620;65.6％∶ 60.8,P=0.504）,只有VMAT组体重下降低于IMRT组（3.3％∶12.7％,P=0.036）.IMRT组中简化IMRT和7个野IMRT组的急性不良反应也相近（70.0％∶65.9％,P=0.539;68.66％∶63.6％,P=0.540;8.0％：9.1％,P =0.824）,但≥3级不良反应中简化IMRT组的呕吐明显好于7个野IMRT组（0∶6.8％,P=0.002）.结论 直肠癌术前同期放化疗采用不同调强技术的耐受性良好、急性不良反应基本相当,IMRT技术间的个别不良反应差别有待探索.Objective To compare the acute toxicities and tolerance between static intensitymodulated radiotherapy （IMRT） and volumetric modulated arc therapy （VMAT） in the preoperative concurrent chemoradiotherapy for rectal cancer.Methods From 2006 to 2013,242 rectal cancer patients received VMAT （n =61） or IMRT （n =181）.The IMRT group was further divided into 7-field IMRT subgroup （n =44） and simplified IMRT （sIMRT） subgroup （n =137）.All patients received preoperative radiotherapy to the pelvis at a dose of 50 Gy/25 fractions in 5 weeks,concurrently with capecitabine （1 650 mg/m2/day） and oxaliplatin （50 mg/m2/week） for 5 weeks.Comparison between groups was made by grouped t test.Results Nineteen （7.9%） of all patients discontinued radiotherapy due to toxicities,with 4.9% in VMAT group and 8.8% in IMRT group （P=0.325）;also,no significant difference in the incidence of toxicities was found between the 7-field IMRT and sIMRT subgroups （8.0% vs 11.4%,P =0.498）.The most common acute toxicities in all patients were leucopenia （69.4%,grade ≥ 3 5.8%）,diarrhea （65.5%,grade ≥3 20.7%）,and radiodermatitis （62.0%,grade ≥3 7.9%）.There were no significant differences in the incidence of most common acute toxicities between the VMAT and IMRT groups （68.9% vs 69.6%,P=0.911 ;63.9% vs 67.4%,P=0.620;65.6% vs 60.8%,P =0.504）,but the VMAT group had a significantly lower incidence of weight loss than the IMRT group （3.3% vs 12.7%,P =0.036）.The incidence of most common acute toxicities showed no significant differences between the 7-field IMRT and sIMRT subgroups （6 5.9 % vs7 0.8 %,P =0.5 3 9 ; 6 3.6 % vs 6 8.6 %,P =0.5 4 0 ; 5 9.1% vs 61.3%,P =0.793）.Among grade ≥3 toxicities,vomiting occurred less frequently in the sIMRT subgroup than in the 7-field IMRT subgroup （0 vs 6.8%,P =0.002）.Conclusions For patients with rectal cancer,IMRT and VMAT in preoperative concurrent chemoradiotherapy are well tolerable and lead to similar incidence of acute toxicities.The dif

关 键 词：直肠肿瘤 同期放化疗法 放射疗法 调强 放射疗法 调积 奥沙利铂 卡培他滨 

分 类 号：R735.37[医药卫生—肿瘤]