宫颈癌术后调强放疗与三维适形放疗的对比研究  

A comparative study on three-dimensional conformal radiotherapy and intensity modulated radiotherapy in the treatment of postoperative cervical cancer

作　　者：穆鹏[1] 李联崑[1] 贾海清[1] 

机构地区：[1]辽宁省肿瘤医院,辽宁沈阳110042

出　　处：《实用医院临床杂志》2015年第2期49-52,共4页Practical Journal of Clinical Medicine

摘　　要：目的比较宫颈癌术后行调强放疗（IMRT）与辅助性三维适形放疗（3DCRT）的有效性、安全性及远期疗效,优化临床治疗措施。方法 2009年1月至2010年10月收治的宫颈癌术后行辅助性放疗患者90例,据随机数字表法分为IMRT组与3DCRT组。IMRT组患者行5野6 MVX射线放疗,计划靶区（PTV）内剂量梯度〈10%;3DCRT组行4野6MV X射线盒式照射。两组处方剂量、总剂量分别为1.8 Gy/次和45-48.6 Gy。对比两组PTV剂量分布、危及器官照射体积、副反应及3年复发率。结果 IMRT组PTV最小照射剂量（Dmin）、平均照射剂量（Dmean）显著低于3DCRT组,差异均有统计学意义（P〈0.001,P=0.014）,适形指数（CI 95%）明显高于3DCRT组（P〈0.001）。经归一化处理后,IMRT组小肠、直肠、膀胱、骨髓、双侧股骨头受照体积在V45处方水平均明显低于3DCRT组（P〈0.05）,骨髓抑制、消化系统反应、放射性膀胱炎发生率亦明显低于3DCRT组,差异有统计学意义（P〈0.05）。随访期内均无死亡病例,两组复发率、平均复发时间差异无统计学意义（P〉0.05）。结论宫颈癌术后IMRT放疗相对于3DCRT放疗可以达到更好的靶区剂量分布,明显降低危及器官的受照射体积,减少放射性损伤,但患者的远期预后无明显获益。Objective To compare the clinical effectiveness,safety and long-term efficacy of adjuvant three-dimensional conformal radiotherapy（ 3DCRT） and intensity modulated radiation therapy（ IMRT） in the treatment of postoperative cervical cancer in order to optimize the clinical treatment measures. Methods Ninety postoperative patients with cervical cancer received an adjuvant radiotherapy from Jan. 2009 to Oct. 2010 were selected as study objects,and randomly divided into IMRT group and 3DCRT group. The IMRT group underwent the 5 fields of 6 MV X-ray radiotherapy with a planning target volume（ PTV） dose gradient 10% while the3 DCRT group underwent the 4 fields of 6MV X-ray cassette radiotherapy. The prescription dose and total dose were 1. 8 gy / time and 45- 48. 6 gy in the both groups. The PTV-dose distributions,irradiation volume of organs of risk（ OAR）,side effects,and recurrence rate during 3 years were compared between the two groups. The PTV minimum dose（ Dmin） and average dose（ Dmean） in the IMRT group were significantly lower than that in the 3DCRT group（ P〈0. 001 and P = 0. 014,respectively） while the conformal index（ CI 95%）in the IMRT group was significantly higher than that in the 3DCRT group（ P〈0. 001）. Results After normalization,the irradiated volumes of small intestine,rectum,bladder,bone marrow and bilateral femoral head at V45 prescription level in the IMRT group were significantly lower than that in the 3DCRT group（ P〈0. 05）. The incidence of bone marrow depression,digestive system reactions and radiation cystitis in the IMRT group were also statistically lower than that in the 3DCRT group（ P〈0. 05）. During the follow-up period,there was no death case and there was no significant difference in recurrence rate and mean recurrence time between the two groups.Conclusion Compared with 3DCRT radiotherapy,IMRT radiotherapy can archive a better target dose distribution in treatment of postoperative cervical cancer that will significantly reduce the OAR＇s

关 键 词：宫颈癌 三维适形放疗 调强放疗 辅助性放疗 适形指数 复发率 

分 类 号：R737.33[医药卫生—肿瘤]