中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2013年
12期
925-931
,共7页
杜雪莲%盛修贵%王聪%于浩%宋趣清%潘春霞
杜雪蓮%盛脩貴%王聰%于浩%宋趣清%潘春霞
두설련%성수귀%왕총%우호%송취청%반춘하
官颈肿瘤%放射治疗剂量%调强放射治疗%治疗结果
官頸腫瘤%放射治療劑量%調彊放射治療%治療結果
관경종류%방사치료제량%조강방사치료%치료결과
Uterine cervical neoplasms%Radiotherapy dosage%Intensity modulated radiation therapy%Treatment outcome
目的 探讨缩野调强放射治疗(RF-IMRT)用于中晚期子宫颈癌的临床疗效和价值.方法 对2005年8月至2011年8月山东省肿瘤医院收治的71例ⅡB～ⅢB期子宫颈癌患者行RF-IMRT(RF-IMRT组),具体放疗计划为先行全盆IMRT,给予处方剂量30 Gy,然后缩野照射淋巴引流区、宫颈旁及宫旁组织,再给予处方剂量30 Gy.同时对该组患者采用ADAC Pinnacle3计划系统拟设常规二野放疗计划,拟给予相同的处方剂量,比较危及器官的受照射剂量.选取同期收治的72例接受常规二野放疗计划患者作为对照(c-RT组),拟给予相同的处方剂量.两组患者均同时行后装治疗和同步化疗.比较两组患者的临床疗效、不良反应及危及器官的受照射剂量.结果 全部患者均完成放疗计划,66例RF-IMRT组患者和65例c-RT组患者完成随访.RF-IMRT与拟行常规放疗计划比较,靶区更精确,剂量适形度明显增加(0.711±0.057和0.525±0.062,P=0.032),危及器官的受照射剂量明显减少[直肠:(41.6±6.8)Gy和(50.8±3.2) Gy,P=0.016;膀胱:(40.2±2.9)Gy和(51.4±1.8)Gy,P=0.007;小肠:(22.3±2.6) Gy和(35.8±3.9) Gy,P=0.004].RF-IMRT组放射治疗计划靶区(PTV)内的平均剂量为60.8 Gy,明显高于c-RT组(51.2 Gy,P=0.006).RF-IMRT组与c-RT组比较,急、慢性放疗不良反应的发生率明显降低(均P＜0.05),但有效率的差异无统计学意义(P＞0.05).RF-IMRT组与c-RT组患者的1、3、5年生存率差异无统计学意义(P＞0.05),但RF-IMRT组患者的5年无进展生存率为65.2％,明显高于c-RT组(46.2％,P=0.039).结论 RF-IMRT技术可使中晚期子宫颈癌患者的靶区获得理想的剂量分布,肿瘤靶区及盆腔淋巴引流区均获得根治性剂量,邻近危及器官得到较好的保护,不良反应可以耐受,且可提高患者的5年无进展生存率.
目的 探討縮野調彊放射治療(RF-IMRT)用于中晚期子宮頸癌的臨床療效和價值.方法 對2005年8月至2011年8月山東省腫瘤醫院收治的71例ⅡB～ⅢB期子宮頸癌患者行RF-IMRT(RF-IMRT組),具體放療計劃為先行全盆IMRT,給予處方劑量30 Gy,然後縮野照射淋巴引流區、宮頸徬及宮徬組織,再給予處方劑量30 Gy.同時對該組患者採用ADAC Pinnacle3計劃繫統擬設常規二野放療計劃,擬給予相同的處方劑量,比較危及器官的受照射劑量.選取同期收治的72例接受常規二野放療計劃患者作為對照(c-RT組),擬給予相同的處方劑量.兩組患者均同時行後裝治療和同步化療.比較兩組患者的臨床療效、不良反應及危及器官的受照射劑量.結果 全部患者均完成放療計劃,66例RF-IMRT組患者和65例c-RT組患者完成隨訪.RF-IMRT與擬行常規放療計劃比較,靶區更精確,劑量適形度明顯增加(0.711±0.057和0.525±0.062,P=0.032),危及器官的受照射劑量明顯減少[直腸:(41.6±6.8)Gy和(50.8±3.2) Gy,P=0.016;膀胱:(40.2±2.9)Gy和(51.4±1.8)Gy,P=0.007;小腸:(22.3±2.6) Gy和(35.8±3.9) Gy,P=0.004].RF-IMRT組放射治療計劃靶區(PTV)內的平均劑量為60.8 Gy,明顯高于c-RT組(51.2 Gy,P=0.006).RF-IMRT組與c-RT組比較,急、慢性放療不良反應的髮生率明顯降低(均P＜0.05),但有效率的差異無統計學意義(P＞0.05).RF-IMRT組與c-RT組患者的1、3、5年生存率差異無統計學意義(P＞0.05),但RF-IMRT組患者的5年無進展生存率為65.2％,明顯高于c-RT組(46.2％,P=0.039).結論 RF-IMRT技術可使中晚期子宮頸癌患者的靶區穫得理想的劑量分佈,腫瘤靶區及盆腔淋巴引流區均穫得根治性劑量,鄰近危及器官得到較好的保護,不良反應可以耐受,且可提高患者的5年無進展生存率.
목적 탐토축야조강방사치료(RF-IMRT)용우중만기자궁경암적림상료효화개치.방법 대2005년8월지2011년8월산동성종류의원수치적71례ⅡB～ⅢB기자궁경암환자행RF-IMRT(RF-IMRT조),구체방료계화위선행전분IMRT,급여처방제량30 Gy,연후축야조사림파인류구、궁경방급궁방조직,재급여처방제량30 Gy.동시대해조환자채용ADAC Pinnacle3계화계통의설상규이야방료계화,의급여상동적처방제량,비교위급기관적수조사제량.선취동기수치적72례접수상규이야방료계화환자작위대조(c-RT조),의급여상동적처방제량.량조환자균동시행후장치료화동보화료.비교량조환자적림상료효、불량반응급위급기관적수조사제량.결과 전부환자균완성방료계화,66례RF-IMRT조환자화65례c-RT조환자완성수방.RF-IMRT여의행상규방료계화비교,파구경정학,제량괄형도명현증가(0.711±0.057화0.525±0.062,P=0.032),위급기관적수조사제량명현감소[직장:(41.6±6.8)Gy화(50.8±3.2) Gy,P=0.016;방광:(40.2±2.9)Gy화(51.4±1.8)Gy,P=0.007;소장:(22.3±2.6) Gy화(35.8±3.9) Gy,P=0.004].RF-IMRT조방사치료계화파구(PTV)내적평균제량위60.8 Gy,명현고우c-RT조(51.2 Gy,P=0.006).RF-IMRT조여c-RT조비교,급、만성방료불량반응적발생솔명현강저(균P＜0.05),단유효솔적차이무통계학의의(P＞0.05).RF-IMRT조여c-RT조환자적1、3、5년생존솔차이무통계학의의(P＞0.05),단RF-IMRT조환자적5년무진전생존솔위65.2％,명현고우c-RT조(46.2％,P=0.039).결론 RF-IMRT기술가사중만기자궁경암환자적파구획득이상적제량분포,종류파구급분강림파인류구균획득근치성제량,린근위급기관득도교호적보호,불량반응가이내수,차가제고환자적5년무진전생존솔.
Objective To explore the clinical value and efficacy of reduced field intensity modulated radiation therapy (RF-IMRT) for patients with advanced cervical cancer.Methods Seventy-one patients with stage IIB-IIIB cervical cancer,who underwent reduced field IMRT (RF-IMRT group) and 72 patients treated with conventional radiotherapy (c-RT group) in Shandong Cancer Hospital between 2005 August and 2011 August,were enrolled in this study.The RF-IMRT plans were as follows:whole pelvic IMRT plan was performed to deliver an initial dose of 30 Gy,then the irradiated volume was reduced to lymphatic drainage region as well as paracervix and parametrium for an additional 30 Gy boost.Conventional 2-field RT plan was performed in these patients using ADAC Pinnacle 3 planning system,to be given the same prescription dose,and to compare the irradiation dose of organs at risk (OARs).At the same time,conventional 2-field RT was performed in 72 patients of the c-RT group.Concurrent chemotherapy and intracavitary brachytherapy were also performed in the two groups.The treatment response,toxicities,normal tissue avoidance,and survival were assessed.Results Sixty-six patients of the RF-IMRT group and 65 patients of the c-RT group fulfilled the treatment plan.IMRT plans yielded better dose conformity to the target (0.711 ± 0.057 vs.0.525 ± 0.062,P =0.032) and better sparing of the rectum,bladder and small intestine (rectum:41.6 ± 6.8 vs.50.8 ± 3.2,P =0.016 ; bladder:40.2 ± 2.9 vs.51.4 ± 1.8,P =0.007 ; small intestine:22.3 ± 2.6 vs.35.8 ± 3.9,P =0.004).The mean dose delivered to the planning target volume (PTV) was significantly higher in the RF-IMRT group than that in the c-RT group (60.8 vs.51.2 Gy,P =0.006).The RF-IMRT patients experienced significantly lower acute and chronic toxicities with comparable short-term effects than did those treated with conventional RT (P ＞ 0.05).No significant differences were found between the two groups for 1-,3-,and 5-year overall survival (OS) rates,while a significantly higher progression-free survival (PFS,65.2％ vs.46.2％,P =0.031) rate was observed in the RF-IMRT group.Conclusions RF-IMRT yields higher dose distributions and lower toxicities compared with conventional RT,and both the tumor target volume and pelvic lymphatic drainage region achieve curative dose irradiation,the adjacent organs at risk are well protected,and with tolerable adverse reactions.Yet,RF-IMRT provides comparable clinical outcomes and higher PFS.
