根治性放射治疗及术后放射治疗对妇科肿瘤调强放射治疗剂量和急性放射性肠炎的影响

Effect of radical radiotherapy and postoperative radiotherapy on intensity modulated radiotherapy dose and acute radiation enteritis in gynecological tumors

目的 探讨根治性放射治疗及术后放射治疗对妇科肿瘤调强放射治疗(IMRT)中危及器官剂量及放射性肠炎的影响,为IB、IIA期宫颈癌患者优化选择,优化正常器官剂量限制。方法 选取2021年1月~2022年1月就诊于华北理工大学附属医院接受IMRT的43例妇科肿瘤患者,分为根治性放射治疗组(19例)与术后放射治疗组(24例)。由同一位医师勾画靶区和危及器官,同一物理师进行治疗计划优化,比较两组患者危及器官剂量-体积关系,探讨两组患者急性放射性肠炎的发生状况。结果 术后放射治疗组小肠V15-V50(Vx系接受xGy处方剂量的体积所占的百分比)及Dmax(最大剂量Maximum Dose)均小于根治性放射治疗组,仅V45比较差异有统计学意义(P<0.05)。术后放射治疗组结肠V15-V50及Dmax均大于根治性放射治疗组,且V15、V20、V30、V40、V48、V50比较差异均有统计学意义(P<0.05)。术后放射治疗组直肠V15-V50均小于根治性放射治疗组,其中V30、V40、V45、V48比较差异均有统计学意义(P<0.05)。术后放射治疗组急性放射性肠炎的发生率高于根治性放射治疗组,但组间比较差异无统计学意义(P>0.05)。结论 妇科肿瘤根治性放射治疗会增加小肠V45及直肠V30、V40、V45、V48;术后放射治疗会增加结肠V15、V20、V30、V40、V48、V50。术后放射治疗较根治性放射治疗会增加急性放射性肠炎发生率。

Objective To investigate the effects of radical radiotherapy and postoperative radiotherapy on organ dose and radiation enteritis in intensity modulated radiotherapy(IMRT) for gynecological tumors, so as to optimize the selection of patients with operable and radical radiotherapy and the dose limit of normal organs. Methods A total of 43 gynecologic cancer patients treated in the Affiliated Hospital of North China University of Science and Technology from January 2021 to January 2022 with IMRT were divided into radical radiotherapy group(n= 19) and postoperative radiotherapy group(n= 24). The target area and organs at risk were delineated by the same physician, and the treatment plan was optimized by the same physicist. The dose-volume relationship of organs at risk was compared between the two groups, and the occurrence of acute radiation enteritis in the two groups was discussed.Results V15-V50(Vx: the percentage of the volume of the prescribed Dose of xGy) and Dmax(Maximum Dose) of the small intestine in the postoperative radiotherapy group were lower than those in the radical radiotherapy group, but only V45showed statistically significant difference(P<0.05). The V15-V50and Dmax of colon in postoperative radiotherapy group were higher than those in radical radiotherapy group, and the differences of V15, V20, V30, V40, V48and V50were statistically significant( P<0.05). The V15-V50and Dmax of rectum in postoperative radiotherapy group were lower than those in radical radiotherapy group, and the comparison of V30, V40, V45and V48showed statistically significant differences(P<0.05). The incidence of acute radiation enteritis in postoperative radiotherapy group was higher than that in radical radiotherapy group, but there was no significant difference between the two groups(P>0.05). Conclusion Radical radiotherapy for gynecological tumors can increase V45in small intestine and V30, V40, V45, V48in rectum. Postoperative radiotherapy increased colon V15, V20, V30, V40, V48, and V50. Postoperative radiotherapy can increase the incidence of acute radiation enteritis compared with radical radiotherapy.