3D-CRT、IMRT和VMAT放疗技术在早期宫颈癌根治术后辅助放疗中的应用  

Application of 3D-CRT,IMRT and VMAT radiotherapy techniques in adjuvant radiotherapy after radical resection of early cervical cancer

作　　者：王瑜 康婉英 王光明 闫朱敏 任慧荣 Wang Yu;Kang Wanying;Wang Guangming;Yan Zhumin;Ren Huirong(Department of Radiotherapy,Fuyang Cancer Hospital,Fuyang Anhui 236000,China;Department of Radiotherapy,The First Affiliated Hospital of University of Science and Technology of China,Hefei 236000,China)

机构地区：[1]安徽省阜阳市肿瘤医院放疗科,安徽阜阳236000 [2]中国科学技术大学附属第一医院放疗科,合肥236000

出　　处：《保健医学研究与实践》2023年第6期56-60,共5页Health Medicine Research and Practice

基　　金：安徽省自然科学基金项目(2108085MH02159)。

摘　　要：目的探讨三维适形放疗(3D-CRT)、固定野静态调强放疗(IMRT)、容积弧形调强放疗(VMAT)技术在早期宫颈癌根治术后辅助放疗中的应用效果。方法选取2017年5月—2019年5月安徽省阜阳市肿瘤医院收治的96例宫颈癌根治术后患者,采用随机数字表法分为3D-CRT组、IMRT组及VMAT组,每组32例,分别采用3D-CRT、IMRT和VMAT放疗技术进行术后辅助放疗。比较3组患者的放疗靶区剂量学指标、短期生存情况及不良反应发生情况。结果3组患者放疗靶区最大剂量(Dmax)、最小剂量(D_(min))、平均剂量(D_(mean))及不均匀性指数(HI)比较,差异无统计学意义(P>0.05);3组患者的适形度指数(CI)比较,差异有统计学意义(P<0.05);IMRT及VMAT组患者的CI均高于3D-CRT组,差异均有统计学意义(P<0.05)。IMRT、VMAT组患者治疗期间的机器跳数多于3D-CRT组,治疗时间均长于3D-CRT组,但VMAT组患者治疗时间短于IMRT组,差异均有统计学意义(P<0.05)。IMRT、VMAT组患者骨盆、直肠、膀胱、小肠及股骨头对应剂量的受照体积小于3D-CRT组,差异均有统计学意义(P<0.05)。3组患者术后1年、2年及3年生存率比较,差异均无统计学意义(P>0.05)。3组患者治疗期间白细胞减少、放射性肠炎及放射性膀胱炎发生率比较,差异均无统计学意义(P>0.05);3D-CRT组患者治疗期间消化道反应及膀胱反应Ⅰ~Ⅱ级发生率均高于IMRT及VMAT组,差异均有统计学意义(P<0.05)。结论早期宫颈癌术后采用3D-CRT、IMRT、VMAT技术辅助放疗,患者短期生存情况差异不大,但与3D-CRT相比,IMRT及VMAT适形度更高,更有利于保护邻近正常组织,安全性更高。Objective This paper aims to investigate the effect of three-dimensional conformal radiotherapy(3D-CRT),fixed-field static intensity-modulated radiotherapy(IMRT),and volumetric modulated arc therapy(VMAT)in adjuvant radio-therapy after radical resection of early cervical cancer.Methods Ninety-six patients with radical resection of cervical carci-noma admitted to Fuyang Cancer Hospital from May 2017 to May 2019 were randomly allocated to 3D-CRT,IMRT and VMAT groups,with 32 cases for each group.3D-CRT,IMRT and VMAT radiotherapy techniques were used for postoper-ative adjuvant radiotherapy.The dosimetric parameters,short-term survival and adverse reactions of radiotherapy target volume were compared among the three groups.Results There was no significant difference in the maximum dose(Dmax),minimum dose(D_(min)),mean dose(D_(mean)),and homogeneity index(HI)of radiotherapy target volume among the three groups(P>0.05).A significant difference was observed in the conformity index(CI)among the three groups(P<0.05).The CI of the IMRT and VMAT groups was significantly higher than that of the 3D-CRT group(P<0.05).Patients in the IMRT and VMAT groups had more number of monitor units during treatment than those in the 3D-CRT group,and the treatment time was longer than that in the 3D-CRT group;patients in the VMAT group had a shorter treatment time than those in the IMRT group,with statistical significance(P<0.05).Patients in the IMRT and VMAT groups were irradiated significantly less than those in the 3D-CRT group for the corresponding doses to the pelvis,rectum,bladder,small intes-tine,and femoral head(P<0.05).No significant difference was observed in the 1-year,2-year and 3-year survival rates a-mong the three groups(P>0.05).There were no significant differences in the incidence of leukopenia,radiation enteritis,and radiation cystitis during treatment among the three groups(P>0.05).The incidence of gastrointestinal reactions and bladder reactions grade I-II during treatment in the 3D-CRT group was significantly higher tha

关 键 词：三维适形放疗 固定野静态调强放疗 容积弧形调强放疗 早期宫颈癌 临床价值 

分 类 号：R737.33[医药卫生—肿瘤]