摘要
目的:探讨调强放射治疗(intensity modulated radiation therapy,IMRT)用于宫颈癌放疗后主动脉旁淋巴结转移患者的治疗效果、减少并发症的价值。方法:28例宫颈癌放疗后主动脉旁淋巴结转移患者(KPS≥70)放疗前均行1~3个周期化疗,然后给予全程IMRT,1,8~2.3Gy/次,1次/日,5次/周,总处方剂量58~68Gy,中位剂量63.5Gy,同时设计28例患者的普通主动脉旁2野照射计划,拟给予相同的处方剂量,比较危险器官(organs at risk,OAR)受照射剂量。随机选择32例接受普通放疗的病例,比较IMRT和普通放疗的急慢性毒副反应及近期疗效。结果:28例患者均完成全程IMRT,照射靶区内计划靶区体积(planning target volume,PTV)的平均剂量为67.5Gy,90%的等剂量曲线(中位剂量63.5Gy)可以覆盖99%以上的肉眼肿瘤靶区体积(gross tumor volume,GTV)。IMRT与普通主动脉旁两野比较,肾、脊髓、小肠的受照射剂量明显减小(P均<0.05),急、慢性毒副反应明显减少。两组完全缓解率和有效率比较均有统计学意义(P<0.05)。1、2年生存率IMRT组较普通放疗组明显提高(P<0.05),但3年生存率比较无统计学意义(P>0.05)。结论:IMRT技术用于治疗宫颈癌放疗后主动脉旁淋巴结转移,可获得理想的剂量分布,靶区可以获得根治性剂量,临近危险器官得到很好的保护,临床近期疗效满意,毒副反应可以耐受。
Objective: To investigate the significence of intensity modulated radiation therapy (IMRT) for cervical cancer patients with paraaortic lymph node metastasis to maximize tumor control with minimizing complications. Methods: Twenty eight cervical cancer patients with paraaortic lymph node metastasis after radiotherapy were selected whose Karnofsky performance status(KPS)≥70. They received full course IMRT after 1 to 3 cycles of chemotherapy. The prescription dose was 1.8 to 2.3Gy/ fraction, once daily, 5 fractions per week. The total dose was from 58.0-68.0 Gy and the median dose was 63.5 Gy. Simultaneously conventional paraaortic lymph node radiation plan(2-field plan) was designed for the 28 patients with the same prescription dose. The dose delivered to the organs at risk (OAR) was compared. Thirty-two cases with paraaortic lymph node metastasis were randomly selected and given conventional radiotherapy. The acute and chronic toxicities and short-term efficacy of IMRT and conventional radiotherapy were compared. Results: All the 28 patients completed the full course of IMRT. The average dose delivered to the planning target volume (PTV) was 67.5 Gy, and 90% of iso-dose curve (median dose of 63.5 Gy) covered more than 99 % gross tumor volume (GTV). The doses delivered to small intestine, kidney and spinal cord were significantly lower by IMRT than conventional 2-field plans (P〈0.05). Compared with conventional radiotherapy the acute and chronic toxicity of IMRT was significantly decreased. The complete response rate and overall response rate (complete response+partial response) had significant difference between the two groups (P〈0.05). One- and two-year survival rate were significantly higher in IMRT group than conventional radiotherapy group (P〈0.05). But the difference in the 3-year survival rate between the two groups was not significant (P〉0.05). Conclusion: Compared with conventional radiotherapy for paraaortic lymph node metastasis of cervical cancer, IMRT achieved a better dose distribution. The tumor target volume receives radical dose and the adjacent organs at risk gets better protection. IMRT has statisfying short-term efficacy and tolerable toxicities.
出处
《肿瘤》
CAS
CSCD
北大核心
2007年第3期218-222,共5页
Tumor
关键词
宫颈肿瘤
淋巴转移
主动脉
放射疗法
调强适形
治疗结果
Uterine cervical neoplasms
Lymphatic metastasis
Aorta
Radiotherapy,intensity-modulated~ Treatment outcomes