宫颈癌术后静态调强放疗与容积旋转调强放疗的比较  

Comparison of IMRT and VMAT strategies for postoperative cervical cancer patients

作　　者：朱必清[1] 武雅琴[1] 韩晶晶[1] 李倩[1] 徐寒子[1] 陆谔梅[1] 

机构地区：[1]南京医科大学附属肿瘤医院(江苏省肿瘤医院)放疗科江苏省肿瘤防治研究所,江苏南京210009

出　　处：《南京医科大学学报（自然科学版）》2018年第1期88-91,98,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省妇幼健康科研项目(F201762)

摘　　要：目的:比较宫颈癌术后静态调强放疗(intensity modulated radiotherapy,IMRT)与容积旋转调强放疗(volumetric modulated arc therapy,VMAT)近期不良反应发生率以及剂量学参数,为早期宫颈癌根治术后放疗的选择提供参考依据。方法:收集整理接受IMRT或VMAT治疗的宫颈癌根治术后患者各50例,观察所有患者放疗期间急性不良反应的发生率,比较两组放疗计划危及器官的受照剂量,计划靶区的适形度指数(conformity index,CI)、均匀性指数(homogeneity index,HI)、照射时间及跳数(the number of monitor unit,MU)。结果:VMAT组急性放射性肠炎的发生率明显低于IMRT组,两者差异有统计学意义(38%vs.64%,P<0.05);与IMRT组相比,上消化道反应发生率明显降低(20%vs.6%,P<0.05);VMAT组直肠V40、小肠V40均低于IMRT组(P<0.01),而直肠和小肠的V20、V30在两组中均无统计学差异(P>0.05);两组中膀胱V20、V30、V40均无统计学差异(P>0.05);VMAT计划CI优于IMRT计划(P<0.05);HI在两组中无统计学差异(P>0.05);与IMRT计划比较,VMAT计划的MU值和治疗时间分别减少了50%和54%(P<0.01)。结论:宫颈癌根治术后患者选择VMAT治疗,可在一定程度上减少患者急性放射性肠炎和上消化道反应的发生率,减轻正常器官的受照剂量,缩短放疗时间,从而提高患者术后放疗的耐受性。Objective：The primary aim of this study was to compare the incidence of acute adverse reactions and dosimetricparameters of postoperative cervical cancer patients with intensity modulated radiotherapy（IMRT）and volumetric modulated arctherapy（VMAT）,and to provide the reasonable selection of the cervical cancer patients who had needed postoperative radiotherapy.Methods：In our study,a total of 100 cervical cancer patients who needed postoperative radiotherapy were respectively treated withIMRT or VMAT,including 50 patients in the IMRT group and 50 patients in the VMAT group. The acute radioactive adverse reactions,dose of organ at risk（OAR）,homogeneity index（HI）,conformity index（CI）,the number of monitor units（MUs）and treatment timeswere compared between the two groups. Results：The incidence of acute radioactive enteritis in the VMAT group was obviously lowerthan the IMRT group（38% vs. 64%,P〈0.05）. Compared with the IMRT group,the incidence of upper gastrointestinal tract reactionsignificantly decreased in the VMAT group（20% vs. 6%,P〈0.05）. The small intestine V40 and rectum V40 of the VMAT group wasmarkedly lower than those of the IMRT group（P〈0.01）. However,rectum and small intestine V20 and V30,as well as bladder V20,V30,and V40 showed no statistical difference between the two groups（P〈0.05）. Compared with the IMRT group,the CI of VMATgroup was significantly improved（P〈0.05）,while there were no statistical differences of the HI between the two techniques（P〈0.05）. The MUs and treatment times of the VMAT group compared with those of the IMRT group were significantly decreased by 50%and 54%,respectively（P〈0.01）. Conclusion：VMAT is superior to IMRT in many aspects. Cervical cancer postoperative patientschoose VMAT treatment could reduce the acute radioactive adverse reactions,decrease the dose of OAR,and shorten the treatmenttime of radiotherapy to improve the tolerance of patients with postoperative radiotherapy.

关 键 词：宫颈癌术后 放射治疗 静态调强放疗 容积旋转调强放疗 

分 类 号：R730.55[医药卫生—肿瘤]