肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2012年
5期
300-303
,共4页
傅芳芳%王霞%马晓捷%麻富卯
傅芳芳%王霞%馬曉捷%痳富卯
부방방%왕하%마효첩%마부묘
子宫颈肿瘤%复发%肿瘤转移%放射疗法,调强适形%放射疗法,适形
子宮頸腫瘤%複髮%腫瘤轉移%放射療法,調彊適形%放射療法,適形
자궁경종류%복발%종류전이%방사요법,조강괄형%방사요법,괄형
Uterine cervical neoplasms%Recurrence%Neoplasm metastasis%Radiotherapy,intensity-modulated%Radiotherapy,conformal
目的 比较调强放疗(IMRT)和三维适形放疗(3DCRT)治疗复发、转移子宫颈癌的疗效、剂量学及毒副作用.方法 回顾性分析治疗后复发转移子宫颈癌62例,其中IMRT组29例,3DCRT组33例,均行直线加速器6MVX线放疗,单次剂量1.8 ～ 2.2 Gy,每周5次,共18 ～33次,处方剂量40～60 Gy,中位剂量52.8 Gy.同时对IMRT组的患者设计行3DCRT,给予相同的处方剂量,比较危及器官(OAR)受照射剂量.结果 IMRT组膀胱和小肠的最高剂量分别为(4642.71±805.53 )cGy和(4240.36±572.51)cGy,低于3DCRT组的(5057.53±1998.03) cGy和(5953.99±1180.81 )cGy(P＜0.05)；IMRT计划中PTV的最高剂量(5245.68±365.26)cGy高于3DCRT的最高剂量(4801.27±346.25)cGy,差异具有统计学意义(P＜0.05).IMRT组1、2、3年生存率分别为65.5 ％(19/29)、42.1％(8/19)、25.0％(2/8),中位生存时间为19个月,28例死亡病例中,21例死于肿瘤进展,7例死于远处转移；3DCRT组:1、2、3年生存率分别为60.6％(20/33)、35.0％(7/20)、14.3 ％(1/7),中位生存时间为17个月,32例死亡病例中,24例死于肿瘤进展,8例死于远处转移.IMRT组和3DCRT组比较,1、2、3年生存率差异无统计学意义(均P＞ 0.05).IMRT组的不良反应的发生率明显低于3DCRT组,尤其是Ⅰ级和Ⅱ级,IMRT组为24.1％(7/29),3DCRT组为33.5％(11/33).结论 IMRI对于复发转移子宫颈癌疗效较3DCRT更好,可以在提高肿瘤剂量的同时减少正常组织的受照体积和剂量,减少不良反应的发生.
目的 比較調彊放療(IMRT)和三維適形放療(3DCRT)治療複髮、轉移子宮頸癌的療效、劑量學及毒副作用.方法 迴顧性分析治療後複髮轉移子宮頸癌62例,其中IMRT組29例,3DCRT組33例,均行直線加速器6MVX線放療,單次劑量1.8 ～ 2.2 Gy,每週5次,共18 ～33次,處方劑量40～60 Gy,中位劑量52.8 Gy.同時對IMRT組的患者設計行3DCRT,給予相同的處方劑量,比較危及器官(OAR)受照射劑量.結果 IMRT組膀胱和小腸的最高劑量分彆為(4642.71±805.53 )cGy和(4240.36±572.51)cGy,低于3DCRT組的(5057.53±1998.03) cGy和(5953.99±1180.81 )cGy(P＜0.05)；IMRT計劃中PTV的最高劑量(5245.68±365.26)cGy高于3DCRT的最高劑量(4801.27±346.25)cGy,差異具有統計學意義(P＜0.05).IMRT組1、2、3年生存率分彆為65.5 ％(19/29)、42.1％(8/19)、25.0％(2/8),中位生存時間為19箇月,28例死亡病例中,21例死于腫瘤進展,7例死于遠處轉移；3DCRT組:1、2、3年生存率分彆為60.6％(20/33)、35.0％(7/20)、14.3 ％(1/7),中位生存時間為17箇月,32例死亡病例中,24例死于腫瘤進展,8例死于遠處轉移.IMRT組和3DCRT組比較,1、2、3年生存率差異無統計學意義(均P＞ 0.05).IMRT組的不良反應的髮生率明顯低于3DCRT組,尤其是Ⅰ級和Ⅱ級,IMRT組為24.1％(7/29),3DCRT組為33.5％(11/33).結論 IMRI對于複髮轉移子宮頸癌療效較3DCRT更好,可以在提高腫瘤劑量的同時減少正常組織的受照體積和劑量,減少不良反應的髮生.
목적 비교조강방료(IMRT)화삼유괄형방료(3DCRT)치료복발、전이자궁경암적료효、제량학급독부작용.방법 회고성분석치료후복발전이자궁경암62례,기중IMRT조29례,3DCRT조33례,균행직선가속기6MVX선방료,단차제량1.8 ～ 2.2 Gy,매주5차,공18 ～33차,처방제량40～60 Gy,중위제량52.8 Gy.동시대IMRT조적환자설계행3DCRT,급여상동적처방제량,비교위급기관(OAR)수조사제량.결과 IMRT조방광화소장적최고제량분별위(4642.71±805.53 )cGy화(4240.36±572.51)cGy,저우3DCRT조적(5057.53±1998.03) cGy화(5953.99±1180.81 )cGy(P＜0.05)；IMRT계화중PTV적최고제량(5245.68±365.26)cGy고우3DCRT적최고제량(4801.27±346.25)cGy,차이구유통계학의의(P＜0.05).IMRT조1、2、3년생존솔분별위65.5 ％(19/29)、42.1％(8/19)、25.0％(2/8),중위생존시간위19개월,28례사망병례중,21례사우종류진전,7례사우원처전이；3DCRT조:1、2、3년생존솔분별위60.6％(20/33)、35.0％(7/20)、14.3 ％(1/7),중위생존시간위17개월,32례사망병례중,24례사우종류진전,8례사우원처전이.IMRT조화3DCRT조비교,1、2、3년생존솔차이무통계학의의(균P＞ 0.05).IMRT조적불량반응적발생솔명현저우3DCRT조,우기시Ⅰ급화Ⅱ급,IMRT조위24.1％(7/29),3DCRT조위33.5％(11/33).결론 IMRI대우복발전이자궁경암료효교3DCRT경호,가이재제고종류제량적동시감소정상조직적수조체적화제량,감소불량반응적발생.
Objective To compare the treatment effects,dosimetry,and toxicities to organs at risk of intensity-modulated radiation therapy (IMRT) and 3-dimentional conformal radiotherapy (3DCRT) plans for cervical carcinoma patients with recurrence and metastasis. Methods 62 cervical carcinoma patients with recurrence and metastasis were analyzed retrospectively, and divided into two groups including intensitymodulated radiation therapy group (n=29) and 3-dimentional conformal radiotherapy group (n=32).Patients were performed with 6 MV-X ray.The regimen was 1.8-2.2 Gy/f,1 f/d,18-33 times in total.Prescribed dose was 40-60 Gy and median dose was 52.8 Gy. At the same time for the IMRT group 29 cases were performed with 3DCRT, which was designed using the same prescribed dose to compare radiation dose distributed in organs at risk (OAR).Results The maximum dose of the two plans showed that bladder and small intestine in IMRT plans were lower than that in 3DCRT (P＜0.05), showing the IMRT's protective advantage. The maximum dose of PTV in IMRT plans were significantly higher than 3DCRT (P＜0.05). In the group of IMRT plans, the overall 1-,2-,and 3-year survival rates were 65.5 ％(19/29), 42.1％(8/19), and 25.0 ％(2/8),respectively,the median survival time was 19 months,of 28 deaths,21 patients died of tumor progression,7 patients died of distant metastases.In the group of 3DCRT plans,the overall 1-,2-,and 3-year survival rates were 60.6 ％(20/33),35.0 ％(7/20),and 14.3 ％(1/7),respectively,the median survival time was 17 months,of 32 deaths, 24 patients died of tumor progression, 8 patients died of distant metastasis. There were no significant differences in overall 1-, 2-, and 3-year survival rates between the two groups (P＞0.05). The incidence rate of toxicity in the IMRT plans was significantly lower than that in the 3DCRT plans, especially for patients with Ⅰ level and Ⅱ level.Conclusion The treatment effects of the IMRT plans are better than the 3DCRT plans for cervical carcinoma patients with recurrence and metastasis. IMRT plans can improve radiation dose in tumors and reduce the dose distributed in normal issue and reduce the incidence of the side effect.
