摘要
目的:探讨后装逆向调强放射治疗在妇科肿瘤治疗中的应用价值,为临床治疗的技术选择提供依据。方法:选取20例Ⅰ~Ⅲ期宫颈癌患者,随机分为A、B两组,各10例。Ⅰb期2例,Ⅱa期4例,Ⅱb期12例,Ⅲa期2例。病理分型:鳞癌16例,腺癌4例。以上诊断均经过病理学证实。平均年龄55.67岁(32岁~65岁)。A组病例行后装逆向调强放射治疗,采用Inverse Planning Simulated Annealing(IPSA)技术进行剂量优化设计,B组病例行三维适形后装放射治疗。A、B组患者均采用3根施源器,进行腔内照射并同步箱式四野等中心外照射,剂量为46 Gy/23次。依据曼彻斯特剂量学系统,给予A点(宫口上2 cm,宫腔中轴线左右旁开2 cm处为A点位置)处方剂量6 Gy/次,照射次数5次,2次/周。对比分析A、B两组患者的靶区剂量分布,危及器官(直肠、膀胱)受量,放射性并发症及近期疗效。结果:A组患者的靶区剂量适形度和均匀性均好于B组患者。患者0.5年~1.0年的肿瘤局部和区域控制率:A组患者分别为96%(95%CI,85%~99%)和95%(95%CI,81%~99%)。B组患者局分别为93%(95%CI,85%~99%)和92%(95%CI,81%~99%)。危及器官(直肠、膀胱)受量:A组患者的直肠、膀胱最大受量比B组患者小约35%。A组患者的直肠、膀胱75%处方剂量受照体积V75约只为B组患者的二分之一。放射性并发症:RTOG 1级反应:A组患者为1例,B组患者为6例。RTOG 2级反应:A组患者为0例,B组患者为3例。RTOG 3级反应:A组患者为0例,B组患者为1例。近期疗效:在A、B组患者放疗期间及治疗结束后,几乎所有患者的肿瘤均有不同程度的缩小,有效率(CR+PR)均为92%以上。结论:后装逆向调强放射治疗技术具有近期疗效明显,靶区剂量适形度、均匀性好,危及器官受量低,放射性并发症少等优点,值得在妇科肿瘤治疗中广泛应用。
Objective: To investigate the application value of the Afterloading Brachytherapy Inverse Intensity-Modulated Ra- diotherapy of Gynecological Tumor. Methods: 20 patients with cervical cancer, were randomly divided into A, B two groups, 10 cases in each. Stage I b 2 cases, stage Ⅱa 4 cases, stage Ⅱb 12 cases, stage Ⅲa 2 cases. Pathological types: Squamous Cell carcinoma 16 cases, Adenocarcinoma 4 cases. The average age was 55.67 years (32 years- 65 years old). Group A patients re- ceived the Afterloading Brachytherapy Inverse Intensity-Modulated Radiotherapy. The dose optimization technology was the In- verse Planning Simulated Annealing (IPSA) .Group B patients received the Three-Dimensional Comformal Atlerloading Brachytherapy. Group A and B patients were treated with 3 applicator for intracavitary irradiation and synchronous box around 4 fields isocenter external irradiation, prescription dose 46 Gy/23F. According to the Manchester system ,the prescription dose of A points (2 cm above the cervix, 2 cm both in the left and right sides of the axis of uterine cavity ) was 30 Gy in 5 fi:actions, 2 times each week. Analysed groups A and B patients about the target volume dose distribution, organs at risk (rectum, bladder), short-term curative effect and radioactive complications. Results: The dose conformal and homogeneity index of the target vol- ume of group A were better than group B. The 0.5 year~ 1.0 year tumor local and regional control rate :group A patients were 96% (95% CI,85%-99%) and 95% (95% CI,81%-99%), group A patients were 93% (95% CI,85%-99%)and 92% (95% CI, 81%-99%).Organs at risk (rectum, bladder): the maximum dose ~f rectum and bladder of group A patients were about 35% less than group B, The 75% prescription dose irradiated volume of rectum and bladder of group A patients were about only 1/2 ofgroup B. Radioactive complications:RTOG grade 1 reaction : group A: lcase, group B: 6 cases. RTOG grade 2 reaction : group A: 0 ease, group B: 3cases. RTOG grade 3 reaction : group A: 0 case, group B: leases. Short-term efficacy : the tumors size of group A and B patients had both reduced during and after the radiotherapy, efficiency (CR+PR) was more than 92%. Conclu- sions: Afterloading Brachytherapy Inverse Intensity-Modulated Radiotherapy technique have obvious short-term efficacy, bet- ter dose conformal and homogeneity index of the target volume, lower dose of organs at risk, fewer radioactive complications. It's worthy of widely applicated in the gynecological cancer therapy.
出处
《中国医学物理学杂志》
CSCD
2013年第6期4487-4490,共4页
Chinese Journal of Medical Physics