不同放疗模式治疗局部晚期宫颈癌的临床疗效、急性不良反应及剂量学研究

Comparative study of clinical efficacy,acute adverse effects and dosimetry of different radiotherapy modalities for locally advanced cervical cancer

目的观察及评估局部晚期宫颈癌在容积旋转调强放疗(VMAT)、调强适形放疗(IMRT)、三维适形放疗(3DCRT)不同放疗模式下的临床短期疗效、急性不良反应及剂量学差异。方法回顾性分析2018年1月—2022年12月就诊于徐州医科大学附属淮安医院的局部晚期宫颈癌患者138例,按照放疗方案的不同分为VMAT组(n=43)、IMRT组(n=64)和3DCRT组(n=31),比较3组患者临床短期疗效、急性不良反应发生情况及不同计划下的剂量学差异。结果3组患者疾病缓解率(RR)无明显差异。VMAT组与IMRT组胃肠道急性不良反应、生殖泌尿道急性不良反应及血小板降低的发生率明显低于3DCRT组(P<0.05),VMAT组胃肠道急性不良反应、生殖泌尿道急性不良反应发生率明显低于IMRT组(P<0.05)。VMAT在降低不良反应发生率方面更占优势,IMRT次之,3DCRT相对较差。VMAT组与IMRT组在计划靶区体积(PTV)平均剂量、适形性指数(CI)、均匀性指数(HI)、危及器官受量(OARs受量)方面显著优于3DCRT组(P<0.05)。对比VMAT组和IMRT组,2组间PTV平均剂量、CI、HI无明显差异,但VMAT组膀胱、小肠受量低于IMRT组(P<0.05),直肠V_(30)较IMRT组更低(P<0.05),但V_(40)、V_(50)高于IMRT组(P<0.05)。VMAT组双侧股骨头受量略低于IMRT组,但差异无统计学意义。VMAT组和IMRT组较3DCRT组机器跳数(MU)显著增加(P<0.05),而VMAT组较IMRT组MU显著减少(P<0.05)。结论局部晚期宫颈癌患者采取容积旋转调强放疗、调强适形放疗、三维适形放疗均可获得较为满意的临床短期疗效,但容积旋转调强放疗在靶区危及器官保护、降低急性不良反应发生率、提高治疗效率方面具有一定的优势,在临床治疗中值得进一步推广。

Objective To observe and evaluate the clinical short-term efficacy,acute adverse effects and dosimetric difference and of volumetric rotational intensity-modulated radiotherapy(VMAT),intensity-modulated conformal radiotherapy(IMRT),and three-dimensional conformal radiotherapy(3DCRT)in advanced cervical cancer patients.Methods A total of 138 patients with locally advanced cervical cancer who were admitted to Huai’an Hospital Affiliated to Xuzhou Medical University from January 2018 to December 2022 were enrolled and their clinical data were retrospectively analyzed.According to the corresponding radiotherapy regimens,the patients were divided into three groups:a VMAT group(n=43),an IMRT group(n=64),and a 3DCRT group(n=31).The three groups were compared for clinical short-term outcomes,acute adverse reaction,and dosimetric differences.Results There was no statistical difference in response rate(RR)among the three groups.The VMAT group and the IMRT group showed remarkable decreases in the incidence of acute gastrointestinal injury,acute urinary tract injury and platelet decline,compared with the 3DCRT group(P<0.05),whereas the VMAT group presented decreases in the incidence of acute gastrointestinal injury and acute urinary tract injury,compared with the IMRT group(P<0.05).In contrast,VMAT was superior in reducing the incidence of adverse reactions compared with IMRT,and 3DCRT was relatively worse.Furthermore,both the VMAT group and the IMRT group showed remarkable improvement in the average dose of PTV,conformal index(CI),uniformity index(HI)and doses to organs at risk(OARs),compared with the 3DCRT group(P<0.05).There was no statistical difference in the average dose of PTV,CI,and HI between the VMAT group and the IMRT group.However,the VMAT group showed decreases in the does to the small intestine and bladder(P<0.05),decreases in the V_(30) of the rectum(P<0.05),but increases in the V_(40) and V_(50) of the rectum,compared with the IMRT group(P<0.05).The does to the bilateral femoral head in the VMAT group was lower than that to the IMRT group,without statistical difference.The monitor units(MUs)in the VMAT group and the IMRT group were significantly higher than that in the 3DCRT group,where the VMAT group showed significantly lower MU the IMRT group(P<0.05).Conclusions VMAT,IMRT and 3DCRT can be applied for the treatment of locally advanced cervical cancer,with satisfactory short-term outcomes.However,VMAT had advantages of protecting OARs in targeted area,reducing the incidence of acute reactions and improving therapeutic effect,which is worthy promoting in clinical practice.