直肠癌螺旋断层放疗与调强放疗急性不良反应比较  

Comparison between helical tomotberapy and intensity-modulated radiotherapy on acute toxicity in patients with rectal cancer

作　　者：姚波[1] 王雅棣[1] 路娜[1] 刘清智[1] 许卫东[1] 陈点点[1] 

机构地区：[1]北京军区总医院放疗科,100700

出　　处：《肿瘤研究与临床》2015年第11期736-739,共4页Cancer Research and Clinic

摘　　要：目的分析Ⅱ-Ⅲ期直肠癌患者螺旋断层放疗（HT）与5野调强放疗（5-IMRT）发生急性不良反应的差异。方法回顾性分析84例Ⅱ～Ⅲ期直肠癌放疗患者的临床资料，19例接受术前放疗，65例接受术后放疗，其中HT治疗43例，5-IMRT治疗41例。两种照射方式的肿瘤靶区（GTV）及临床靶区（CTV）勾画原则一致，计划靶区（PTV）5-IMRT外扩1,0cm，HT外扩0．5cn3。PTv剂量45．0—50．4Gy（1．8Gy／次），45例患者给予同步补量照射，肿瘤或瘤床总剂量55．0—60．0Gy（2．1—2．3Gy／次）。HT治疗患者每次治疗前在Prrv范围内进行CT扫描，据骨性标识和软组织与定位CT图像进行配准并校位。全部患者放疗第1天开始同步口服卡培他滨每天1600mg／m2，至放疗结束。结果HT组与5-IMRT组比较，≥2级急性膀胱炎发生率分别为7．0％（3例）、2．4％（1例）（P=0．616），≥3级急性腹泻发生率分别为4．7％（2例）、12．2％（5例）（P=0．259）。≥2级白细胞减少发生率分别为48．8％（21例）、19．5％（8例）（P=0．005）；≥1级贫血发生率分别为34．9％（15例）、14．6％（6例）（P=0．032）；≥1级血小板减少发生率分别为23．3％（10例）、14．6％（6例）（P=0．314）。结论Ⅱ-Ⅲ期直肠癌同步卡培他滨放化疗，采用HT放疗血液学不良反应发生率高于5-IMRT，急性腹泻和膀胱炎发生率两组相似。Objective To compare acute toxicity for stage Ⅱ-Ⅲ patients with rectal cancer irradiated with helical tomotherapy （HT） and conventional five-field intensity-modulated radiotherapy （5-IMRT）. Methods The data of 84 stage Ⅱ-Ⅲ patients with rectal adenocareinoma treated with concurrent chemoradiotherapy （CRT） were retrospectively analyzed. 19 patients underwent postoperative CRT, and 65 patients underwent preoperative CRT. 43 patients received radiotherapy with HT and 41 patients with 5-IMRT. The delineation on clinical target volume （CTV） and gross tumor target （GTV） was similar for two groups. The CTV to plan tumor volume （PTV） margins were 1.0 cm for patients with 5-IMRT and 0.5 cm for patients with HT. For all patients, a dose of 45.0-50.4 Gy, in daily fractions of 1.8 Gy, was delivered to PTV. For 45 patients with high risk factors, simultaneous integrated boost （SIB） was given to the tumor or tumor bed of a total dose of 55.0- 60.0 Gy, in daily fractions of 2.1-2.3 Gy. Before treatment, the patients treated with HT underwent scanning by the tomotherapy-integrated megavoltage computed tomography （MVCT） scan modality and were positioned by co-registration of these images to the original kilovohage planning CT image set. Concurrent capecitabine every day 1 600 mg/m2, twice daily on every day in the week. Results The rates of grade I〉 2 acute cystitis were 7.0 % （3 cases） in HT group and 2.4 % （1 case） in 5-IMRT group （P = 0.616）, and ≥3 grade acute diarrhea were 4.7 % （2 cases） and 12.2 % （5 cases）, respectively （P = 0.259）. 92 grade leukopenia were 48.8 % （21 cases） and 19.5 % （8 cases）, respectively （P = 0.005）, ≥ 1 grade anemia were 34.9 % （15 cases） and 14.6 % （6 cases）, respectively （P = 0.032）, and ≥ 1 grade thrombocytopenia were 23.3 % （10 cases） and 14.6 % （6 cases）, respectively （P = 0.314）. Conclusions There is no significant difference in acute diarrhea and cystitis for patients treated with HT an

关 键 词：直肠肿瘤 螺旋断层放疗 调强放疗 急性反应 

分 类 号：R735.37[医药卫生—肿瘤]