中晚期宫颈癌适形调强放疗与容积旋转调强技术临床效果比较

Clinical efficacy of intensity-modulated radiotherapy and volumetric modulated arc therapy for advanced cervical cancer

目的：比较中晚期宫颈癌适形调强放疗（IMRT）和容积旋转调强（VMAT）两种放疗技术的临床效果。方法：分析本院2011年10月至2015年5月收治的35例分别行IMRT和VMAT中晚期宫颈癌患者,其中IMRT组18例,VMAT组17例;比较两组患者的近期和远期临床效果及不良反应。结果：除血液毒性外,两组不良反应没有显著性差异。IMRT和VMAT组有效率分别为94.4%和100.0%,总生存率时间分别为25.6月（95%CI：22.2~26.9）和25.8月（95%CI：22.5~29.2）;无进展生存率时间分别为25.1月（95%CI：21.8~28.4）和23.5月（95%CI：20.3~26.7）;局部复发率时间分别为27.1月（95%CI：23.6~30.5）和23.1月（95%CI：19.9~26.4）;远处转移率时间分别为18.9月（95%CI：15.3~22.5）和18.2月（95%CI：15.7~20.7）,差异均无统计学意义（P〉0.05）。结论：VMAT能够获得与IMRT相同的临床疗效,VMAT计划可以降低急性血液毒性,没有增加其它放化疗的毒副反应,是一种安全有效的治疗方式。

Objective To compare the clinical efficacy of intensity-modulated radiotherapy（IMRT） and volumetric modulated arc therapy（VMAT） for advanced cervical cancer. Methods Admitted from October 2011 to May 2015, 35 patients with advanced cervical cancer were respectively treated with IMRT and VMAT, including 18 patients in IMRT group and 17 patients in VMAT group. The short-term and long-term clinical efficacy and adverse reactions were compared between two groups. Results Except for hematologic toxicity, no significant differences were found between the two groups. The effective rates of two groups were respectively 94.4% and 100.0%. Respectively, IMRT group and VMAT group have the overall survival time of 25.6 months（95%CI： 22.2-26.9） and 25.8 months（95%CI： 22.5-29.2）, the progression-free survival time of 25.1 months（95%CI： 21.8-28.4） and23.5 months（95%CI： 20.3-26.7）, the median time to local recurrence of 27.1 months（95%CI： 23.6-30.5） and 23.1 months（95%CI： 19.9-26.4）, the median time to distant metastases of 18.9 months（95%CI： 15.3-22.5） and 18.2 months（95%CI： 15.7-20.7）.No statistical differences were found in the four indexes between two groups（P0.05）. Conclusion VMAT achieves the same clinical efficacy as IMRT, significantly reducing the incidence of acute hematologic toxicity without increasing other toxic and adverse effects. VMAT is a safe and effective treatment method.