早期宫颈癌术后VMAT与IMRT的临床效果对比及对放疗剂量血清DCLK1 miR-15b水平的影响  

Comparison of Clinical Effects of VMAT and IMRT After Surgery for Early Cervical Cancer and Their Influence on Radiotherapy Dose Serum DCLK1 and MiR-15b Levels

作　　者：陈晶美 宋鹏慧 王威威[1] 郭明芳 孟亚超 CHEN Jingmei;SONG Penghui;WANG Weiwei(Heping Hospital Affiliated to Changzhi Medical College,Shanxi Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院放射治疗科,山西长治046000

出　　处：《河北医学》2025年第1期150-155,共6页Hebei Medicine

基　　金：山西省科学技术研究与开发项目,(编号:202012D782032)。

摘　　要：目的:探究早期宫颈癌术后容积弧形调强放疗(VMAT)与固定野静态调强放疗(IMRT)的临床效果及对放疗剂量、血清双皮质素样激酶1(DCLK1)、微小RNA-15b(miR-15b)水平的影响。方法:选取2021年1月至2023年1月长治医学院附属和平医院收治的早期宫颈癌术后行放射治疗的宫颈癌(CC)患者130例,采用随机数字表法分为VMAT组(n=65)、IMRT组(n=65),开展前瞻性研究。VMAT组采用VMAT治疗,IMRT组采用IMRT治疗。比较两组计划实施效率、靶区放疗剂量、危及器官受照剂量、血清DCLK1、miR-15b水平、肠道及阴道微生态、不良反应、复发率。结果:VMAT组机器跳数少于IMRT组,治疗时间短于IMRT组(P<0.05);两组HI、CI、Dmean、Dmin、Dmax比较,差异无统计学意义(P>0.05);VMAT组直肠Dmean、右股骨头Dmean、左股骨头Dmean、小肠Dmax、膀胱Dmean、骨盆Dmean均小于IMRT组(P<0.05);放疗后两组间血清DCLK1、miR-15b水平比较差异无统计学意义(P>0.05);放疗后VMAT组肠道菌群丰富度、肠道菌群多样性指数、阴道菌群多样性评分、阴道菌群密集度评分均高于IMRT组(P<0.05);VMAT组骨髓抑制、放射性肠炎、消化道反应、细菌性阴道炎发生率低于IMRT组(P<0.05);术后12个月两组复发率比较差异无统计学意义(P>0.05)。结论:VMAT靶区放疗剂量参数与IMRT相当,但能减少机器跳数和治疗时间,降低对周围器官受照剂量,改善肠道及阴道微生态,降低不良反应发生风险,且不会增加复发风险。Objective:To investigate the clinical effects of volumetric arc intensity-modulated radiotherapy(VMAT)and fixed-field static intensity-modulated radiotherapy(IMRT)after surgery for early-stage cervical cancer,as well as their effects on radiotherapy dose,serum levels of doublecortin-like kinase 1(DCLK1),and microRNA-15b(miR-15b).Methods:A total of 130 patients with early-stage cervical cancer who underwent postoperative radiotherapy at Heping Hospital Affiliated to Changzhi Medical College from January 2021 to January 2023 were selected and randomly divided into a VMAT group(n=65)and an IMRT group(n=65)using a random number table method for a prospective study.The VMAT group received VMAT,while the IMRT group received IMRT.The planned implementation efficiency,target radiotherapy dose,exposure dose to organs at risk,serum DCLK1 and miR-15b levels,intestinal and vaginal microecology,adverse reactions,and recurrence rate were compared between the two groups.Results:The number of machine jumps in the VMAT group was fewer than in the IMRT group,and the treatment time was shorter(P<0.05).There were no significant differences in homogeneity index(HI),conformity index(CI),mean dose(Dmean),minimum dose(Dmin),and maximum dose(Dmax)between the two groups(P>0.05).The rectal Dmean,right femoral head Dmean,left femoral head Dmean,small intestine Dmax,bladder Dmean,and pelvic Dmean in the VMAT group were all lower than those in the IMRT group(P<0.05).There were no significant differences in serum DCLK1 and miR-15b levels between the two groups after radiotherapy(P>0.05).After radiotherapy,the intestinal flora richness,intestinal flora diversity index,vaginal flora diversity score,and vaginal flora density score in the VMAT group were higher than those in the IMRT group(P<0.05).The incidence of myelosuppression,radiation enteritis,gastrointestinal reactions,and bacterial vaginitis in the VMAT group was lower than in the IMRT group(P<0.05).There was no significant difference in the recurrence rate between the two groups(P>0.05).

关 键 词：宫颈癌 容积弧形调强放疗 固定野静态调强放疗 双皮质素样激酶1 阴道微生态 

分 类 号：R737.33[医药卫生—肿瘤]