宫颈癌患者术后三维适形与调强放疗临床疗效比较

Clinical curative effect of three - dimensional conformal radiotherapy and intensity modulated radiation therapy on postoperative patients with cervical cancer

目的回顾性对比分析宫颈癌患者术后三维适形与调强放疗的临床疗效。方法选取78例宫颈癌患者，均行宫颈癌根治术，根据术后放疗方案分为观察组与对照组，每组39例。观察组术后进行调强放疗，对照组术后进行三维适形放疗。对比两组计划靶区（PTV）剂量学指标[最小照射剂量（Dmin）、最大照射剂量（Dmax）、平均照射剂量（Dmean）、适形指数（95%CI）、均匀性指数（HI）]、危及器官（OAR）处方剂量V45水平下受照射体积百分比、化疗期间不良反应发生率、随访期间宫颈癌复发率。结果①PTV剂量学指标：观察组Dmin、Dmean低于对照组，95%CI高于对照组（P〈0.05），Dmax、HI与对照组比较差异未见统计学意义（P〉0.05）；②OAR处方剂量V45水平下受照射体积百分比：处方剂量V45水平下，观察组膀胱、直肠、小肠、骨髓、股骨头受照射体积百分比均低于对照组（P〈0.05）；③不良反应：两组放疗期间均未发生Ⅳ级不良反应，观察组消化系统反应、放射性膀胱炎及骨髓抑制发生率均低于对照组（P〈0.05），放射性阴道炎、盆腔纤维化发生率与对照组比较差异未见统计学意义（P〉0.05）；④预后：观察组与对照组1年复发率[2.56%（1/39）比7.69%（3/39）]、2年复发率[7.69%（3/39）比12.82%（5/39）]比较差异均未见统计学意义（P〉0.05）。结论调强放疗较三维适形放疗可达到更好的靶区剂量分布，且一定程度上能够减小危及器官受照射体积，有利于降低骨髓抑制等不良反应发生率，但对宫颈癌复发率的影响无显著优势。

Objective To retrospectively analyze the clinical efficacy of three dimensional con- formal radiotherapy and intensity modulated radiation therapy on postoperative patients with cervical canc- er. Methods Seventy-eight cases of cervical cancer patients were treated with radical hysterectomy. Ac- cording to the postoperative radiotherapy plan, the patients were divided into the observation group and the control group, with 39 cases in each group. The observation group received intensity modulatedradiation therapy, and the control group received three -dimensional conformal radiotherapy after opera- tion. The planning target volume （PTV） indexes [ minimum radiation dose （Dmin） , maximum irradia- tion dose （Dmax）, mean radiation dose （Dmean）, conformal index （95% CI）, uniformity index （HI） ], the percentage of irradiated volume under the organs at risk （OAR） prescription dose V45 lev- el, the incidence of adverse reaction during chemotherapy and the recurrence rate of cervical cancer dur- ing the period of follow-up between the two groups were compared. Results （1）PTV dosimetric indica- tors： the Dmin and Dmean in the observation group were lower than those in the control group, and 95% CI was higher than that in the control group （ P 〈 0. 05 ）. There were no significant difference in Dmax and Hx between the two groups（P 〉 0. 05 ）. （2）The percentage of irradiated volume under the OAR pre- scription dose V45 level： at the prescribed dose of V45, the percentage of radiation volume in the blad- der, rectum, small intestine, bone marrow and femoral head of the observation group was lower than that of the control group（ P 〈 0.05 ）. （3）Adverse reaction： there were no grade IV toxicity was found in the two groups during the radiotherapy. The digestive system reaction, the incidence of radiation cystitis and bone marrow suppression in the observation group were lower than those in the control group （P 〈 0. 05 ）. There was no significant difference in the incidence of radiation vaginitis or pelvic fibrosis between the ob- servation group and the control group （ P 〉 0. 05 ）. （4）Prognosis ： there was no significant difference in the 1-year recurrence rate [2. 56% （1/39） vs. 7.69% （3/39） ] or 2-year recurrence rate [7.69% （3/39） vs. 12.82% （5/39）] between the observation group and the control group （P〉 0.05 ）. Conclusions Compared with the three dimensional conformal radiotherapy, IMRT can achieve better target dose distribution, and to some extent, it can reduce the volume of irradiated organs at risk. It is helpful to reduce the incidence of adverse reaction such as bone marrow suppression, but it has no signifi- cant advantage on the recurrence rate of cervical cancer.