胸部肿瘤调强放疗与常规放疗心脏放射线受量及动态心电图改变的比较分析

Comparative analysis of dynamic electrocardiogram after intensity modulated radiation therapy or conventional radiotherapy for the thoracic tumor

目的比较胸部肿瘤调强放疗（IMRT）与常规放疗（CRT）心脏放射线受量及动态心电图（DCG）的改变。方法选择2006年1月～2013年8月广西壮族自治区肿瘤医院放疗中心及广西壮族自治区人民医院肿瘤中心住院的胸部肿瘤患者100例，分为IMRT组和CRT组，每组各50例，分别于治疗前、受照30、60Gv时进行24hDCG监测，分析两组心脏放射线受量及DCG改变。结果①IMRT组心脏V30、V40、V50[（31．9±13．6）％、（22．1±9．4）％、（11．7±5．3）％]均明显低于CRT组[（42．1±14．9）％、（33．2±10．1）％、（20．5±7．6）％]，差异有高度统计学意义（P〈0．01）；两组间心脏V10、V20、V60比较，差异无统计学意义（P〉0．05）。@IMRT组及CRT组治疗前、受照30、60Gv时DCG异常发生率比较，差异有高度统计学意义（P〈0．01）；治疗前两组DCG异常发生率比较，差异无统计学意义（P〉0．05），受照30、60Gy时IMRT组DCG异常发生率均低于CRT组，差异有统计学意义（P〈0．05）。结论两种疗法均可引起DCG改变，但IMRT在相同剂量照射时，心脏受照体积更少，DCG异常发生率更低。

Objective To compare volume histogram （DVH） parameters and dynamic electrocardiogram （DCG） changes after intensity modulated radiotherapy （IMRT） or conventional radiotherapy （CRT） for the thoracic tumor. Methods 100 patients with thoracic tumor in Tumor Hospital of Guangxi Zhuang Autonomous Region and the People＇s Hospital of Guangxi Zhuang Autonomous Region were selected and divided into IMRT group and CRT group, with 50 cases in each group. 24 hours DCG was performed in the two groups before treatment and 30, 60 Gy exposure; heart radiation amount and DCG changes were analyzed between the two groups. Results The V30, V40, V50 in IMRT group [（31.9±13.6）%, （22.1±9.4）%, （11.7±5.3）%] were all lower than those in CRT group [（42.1±14.9）%, （33.2±10.1）%, （20.5±7.6）%], the differences were statistically significant （P 〈 0.01）. The differences of V30 V40, V50 between the two groups were not sta- tistically significant （P 〉 0.05）. The differences of abnormal DCG incidence in IMRT group and CRT group before treatment and 30, 60 Gy exposure were statistically significant （P 〈 0.01）; the difference of abnormal DCG incidence between the two groups before treatment was not siatistically significant （P 〉 0.05）; the abnormal DCG incidence in IMRT group 30, 60 Gy exposure were all lower than those in CRT group, the differences were statistically significant （P 〈 0.05）. Conclusion Both treatments can cause DCG change, but at the same dose radiation, IMRT group has smaller heart illuminated volume, lower DCG change.