VMAT、IMRT和3DCRT放疗对局部晚期宫颈癌短期疗效、不良反应和剂量学差异  

Short-term efficacy,adverse reactions and dosimetric differences of volumetric modulated arc therapy,intensity-modulated radiotherapy and three-dimensional conformal radiotherapy modes for treating patients with locally advanced cervical cancer

作　　者：冉杰 钟萍[1] 蒋莎莎[1] 荣丽雯 赖琼 RAN Jie;ZHONG Ping;JIANG Shasha;RONG Liwen;LAI Qiong(The Third People's Hospital of Chengdu,Chengdu,Sichuan Province,610031)

机构地区：[1]四川省成都市第三人民医院,610031

出　　处：《中国计划生育学杂志》2025年第4期907-912,919,共7页Chinese Journal of Family Planning

基　　金：成都市科技项目(2022-YF05-02119-SN)。

摘　　要：目的:对比分析容积弧形调强放疗(VMAT)、调强适形放疗(IMRT)和三维适形放疗(3DCRT)3种模式对局部晚期宫颈癌短期疗效、不良反应和剂量学差异。方法:回顾性分析2019年10月-2022年7月本院收治的接受放疗的局部晚期(FIGO分期≥IIB期)宫颈癌患者113例临床资料,根据放疗方案的不同分为VMAT组(n=33)、IMRT组(n=51)和3DCRT组(n=29),比较3组近期实体瘤疗效,不同计划下的剂量学差异(靶区剂量分布、靶区的均匀性及适形性、危及器官受量、机器跳数),血清学指标[鳞状细胞癌相关抗原(SCCA)、肾上腺素样激酶1(DCLK1)、黏蛋白1(MUC1)],远期预后生存情况及放疗不良反应。结果:3组总有效率(RR)、病灶控制率(DCR)比较无差异(P>0.05);直肠、膀胱、小肠的V_(30)、V_(40)、V_(50)受量在VMAT组、IMRT组、3DCRT组依次升高,VMAT组、IMRT组的靶区剂量(D_(max)、D_(mean)、D_(min))分布及CI均高于3DCRT组,而HI及直肠、膀胱、小肠、左侧股骨头、右侧股骨头的V_(30)、V_(40)、V_(50)受量均低于3DCRT组(均P<0.05),VMAT组与IMRT组比较无差异(P>0.05);治疗后,3组血清SCCA水平VMAT组、IMRT组、3DCRT组依次升高(P<0.05);随访1年内3组总生存率和无进展生存率、总生存期、无进展生存期均无差异(P>0.05);治疗期间骨髓抑制、消化系统、生殖泌尿道、皮肤损伤发生率VMAT组低于另外两组(P<0.05)。结论:VMAT、IMRT和3DCRT对局部晚期宫颈癌的短期临床疗效相当,VMAT放射精密度更高,对危及器官有更好的保护作用,不良反应发生风险更低,SCCA水平显著下降,远期疗效略优于IMRT和3DCRT。Objective:To compare and analyze the short-term efficacy,adverse reactions and dosimetric differences of volumetric modulated arc therapy(VMAT),intensity-modulated radiotherapy(IMRT)and three-dimensional conformal radiotherapy(3DCRT)modes for treating patients with locally advanced cervical cancer.Methods:The clinical data of 113 patients with locally advanced cervical cancer(FIGO stage IIB and above)who received radiotherapy in the hospital from October 2019 to July 2022 were analyzed retrospectively.According to the different radiotherapy modes,these patients were divided into group A(33 patients with VMAT radiotherapy),group B(51 patients with IMRT radiotherapy)and group C(29 patients with 3DCRT radiotherapy).The short-term efficacy of solid tumor,the dosimetric differences under different plans(dose distribution of target area,homogeneity and conformity of target area,dose of organs at risk,number of monitor units),the levels of serological indicators,such as squamous cell carcinoma-associated antigen(SCCA),doublecortin-like kinase 1(DCLK1)and mucin 1(MUC1),the long-term prognosis survival and the adverse reactions of radiotherapy of the patients were compared among the three groups.Results:There were no significant differences in the values of RR and DCR of the patients among the three groups(P>0.05).The doses of V_(30),V_(40)and V_(50)in rectum,bladder and small intestine of the patients in group A,in group B and in group C had increased gradually.The dose distribution of target area(Dmax,Dmean,Dmin)and CI of the patients in group A and in group B were significantly higher than those of the patients in group C.The HI and doses of V_(30),V_(40)and V_(50)in rectum,bladder,small intestine,and left and right femoral head of the patients in group A were significantly lower than those of the patients in group C(all P<0.05),and which of the patients had no significant different between group A and group B(P>0.05).After treatment,the serum SCCA level of the patients in group A,in group B and in group C had increase

关 键 词：局部晚期宫颈癌 放疗模式 剂量差异 短期疗效 血清学指标 不良反应 

分 类 号：R737.33[医药卫生—肿瘤]