固定野调强放疗与容积旋转调强放疗治疗宫颈癌的临床比较

Clinical Comparison of Fixed Field Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Cervical Cancer

目的:比较固定野调强放疗(ff-IMRT)与容积旋转调强放疗(VMAT)治疗宫颈癌的临床剂量差异。方法:选取2017年1月—2020年1月宁乡市人民医院收治的102例宫颈癌患者作为研究对象,根据放疗治疗的不同分为ff-IMRT组和VMAT组。ff-IMRT组实施ff-IMRT,VMAT组实施VMAT。比较两组盆腔骨剂量分布情况、计划剂量梯度指数(GI)值、血液毒性分级情况。结果:ff-IMRT组在V_(5~45)盆腔骨组织受照射剂量体积均高于VMAT组,差异有统计学意义(P<0.05);两组在V_(50~55)盆腔骨组织受照射剂量体积比较,差异无统计学意义(P>0.05)。ff-IMRT组放疗计划剂量的GI值高于VMAT组,差异有统计学意义(P=0.013);ff-IMRT组白细胞下降≥1级与中性粒细胞计数下降≥3级发生率高于VMAT组,差异有统计学意义(P<0.05);ff-IMRT组急性血液毒性发生率高于VMAT组,差异有统计学意义(P=0.034)。结论:VMAT相对于ff-IMRT能有效降低宫颈癌患者血液毒性发生率,剂量体积参数V_(5~15)更低,在降低盆腔骨组织剂量方面具有明显优势。

Objective:To compare the clinical dose difference of fixed field intensity-modulated radiotherapy(ff-IMRT)and volumetric modulated arc therapy(VMAT)for cervical cancer.Methods:A total of 102 patients with cervical caner in Ningxiang Municipal People's Hospital from January 2017 to January 2020 were selected as the study subjects.According to the difference of radiotherapy,they were divided into ff-IMRT group and VMAT group.The ff-IMRT group received ff-IMRT and the VMAT group received VMAT.The pelvic bone dose distribution,planned dose gradient index(GI)value,and hematotoxicity grade were compared between the two groups.Results:The irradiation dose volume of pelvic bone tissue in the ff-IMRT group was higher than that in the VMAT group,and the difference was statistically significant(P<0.05).There was no significant difference in the irradiation dose volume V_(50~55) of pelvic bone tissue between the two groups(P>0.05).The planned dose GI value of the radiotherapy in the ff-IMRT group was higher than that in the VMAT group,and the difference was statistically significant(P=0.013).The incidence of white blood cell count decreased≥grade 1 and neutrophil count decreased≥grade 3 in the ff-IMRT group was higher than that in the VMAT group,and the difference was statistically significant(P<0.05).The incidence of acute hematotoxicity in the ff-IMRT group was higher than that in the VMAT group,and the difference was statistically significant(P=0.034).Conclusion:Compared with ff-IMRT,VMAT can effectively reduce the incidence of hematotoxicity in patients,and the dose volume parameter V_(5~15) is lower.VMAT has obvious advantages in reducing the dose of pelvic bone tissue.