宫颈癌调强放射治疗的临床研究

Clinical Study of Intensity-modulated Radiation Therapy for Cervical Cancer Patients

目的评价调强放射治疗(intensity-modulated radiation therapy,IMRT)在宫颈癌首程治疗中的临床疗效及放疗副反应。方法将2007年至2010年武汉协和医院收治的108例Ⅰ～Ⅱ期宫颈癌首程治疗患者,随机分为IMRT组及三维适形放射治疗(3dimensional conformal radiation therapy,3DCRT)组,同步给予铂类增敏放疗及后装放疗,观察两种治疗方法疗效和毒副反应的差异。结果两组治疗近期疗效相当(P>0.05),1年的总体生存率(overall survival,OS)、无局部复发生存率(local recurrence-free survival,LRFS)和无远处转移生存率(distance metastasis-free survival,DMFS)的差异无统计学意义(P>0.05);IMRT组肿瘤靶区平均剂量和3DCRT组无显著差异(P>0.05),危及器官如直肠、小肠、膀胱等平均剂量均低于3DCRT组(P<0.01);IMRT组急慢性直肠炎及慢性膀胱炎发病率均低于3DCRT组(P<0.05);IMRT组骨髓抑制发生率略低于3DCRT组,但差异无统计学意义(P>0.05)。结论 IMRT与3DCRT治疗宫颈癌近期疗效相同,但IMRT能更好地保护正常器官,有效降低放射损伤,值得推广。

Objective To evaluate the clinical efficacy and side effects of intensity-modulated radiation therapy（IMRT）on cervical cancer patients.Methods 108 patients who were admitted at the Union Cancer Center from 2007 to 2010 and were diagnosed with stage Ⅰ-Ⅱ cervical cancer,were randomized into IMRT group and 3-dimensional conformal radiation therapy（3DCRT）group.The patients all received once daily radiotherapy concurrent with chemotherapy of cisplatin and breech-loading intracavitary brachytherapy.The clinical efficacy and side effects were evaluated in both groups.Results The two groups had the same short-term efficacy.There was no significant difference between the two groups in the one-year overall survival（OS）,local recurrence-free survival（LRFS）and distance metastasis-free survival（DMFS）（P0.05）.The irradiated dose of tumor volume had no significant difference between two groups（P0.05）,but the irradiated doses of the rectum,bladder and small intestine in IMRT group were significantly less than in 3DCRT group（P0.01）.The incidence of acute and chronic radiation-induced enteritis as well as chronic radiation-induced cystitis in IMRT group was significantly lower than in 3DCRT group（P0.05）.The bone marrow toxicity seemed lower in IMRT group than in 3DCRT group but there was no significant difference between two groups.Conclusion IMRT is a better therapeutic option for cervical cancer patients as it can considerably minimize radiation-induced side effects without compromising on the end results.