宫颈癌术后适形调强放疗与三维适形放疗同步化疗的对比研究

背景与目的:适形调强放疗(intensity-modulated radiotherapy,IMRT)是一项很有前景的技术,不仅能提高靶区的照射剂量及适形度,而且减少了周围正常组织受照剂量。本文旨在评估IMRT联合化疗作为宫颈癌术后辅助治疗的局部控制及急性不良反应。方法:2005年7月—2010年11月在我科治疗的61例早期宫颈癌术后高危和中危患者行术后辅助放疗联合化疗,每周顺铂25 mg/m2同步化疗,26例行三维适形放疗(three dimensional conformal radiotherapy,3D-CRT),35例行IMRT,放疗剂量45～50.4 Gy。两组患者的病理类型和FIGO分期差异无统计学意义(P>0.05)。结果:所有患者1、3年的总生存率分别为100%和95.1%。1年的的局控率IMRT与3D-CRT分别为94%和92%(P=0.01),急性消化系统不良反应,IMRT与3D-CRT发生率分别为42.9%和80.9%(P=0.005),泌尿道系统不良反应IMRT与3D-CRT发生率分别为28.6%和57.7%(P=0.034)。在血液系统不良反应的发生率方面,IMRT较3D-CRT有明显的优势(P=0.006)。结论:IMRT与3D-CRT相比,虽然局部控制率相似,但急性不良反应发生率较低。

To investigate the local control and side effects of IMRT with 3D-CRT with concurrent chemotherapy in posthysterectomy cervical cancer patients treated with concurrent chemotherapy

Background and purpose:Intensity-modulated radiotherapy(IMRT) is a promising technology that can deliver a high dose of radiation in a more conformal manner,with relative spring of adjacent normal tissues.The purpose of this study was to assess local control and acute toxicity of IMRT and three dimensional conformal radiotherapy(3D-CRT) as adjuvant treatment of posthysterectomy cervical cancer.Methods:Between Jul.2005 and Nov.2010,61 patients at high risk or intermediate risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy.Adjuvant chemotherapy consisted of cisplatin(25 mg/m2) per week.Twenty-six patients received adjuvant radiotherapy by 3D-CRT,35 patients by IMRT.All the patients received 45-50.4 Gy of external beam radiotherapy.The clinical data of the 2 groups were similar to each other.Results:The 1-and 3-year overall survival rates were 100% and 95.1% of all patients.Compared with 3D-CRT,IMRT provided compatible local tumor control.1-year locoregional control of IMRT and 3D-CRT groups were 94% and 92%,respectively.IMRT can be tolerated,and significant reduction the acute gastrointestinal(GI) and genitourinary(GU) toxicities(GI: 42.9% vs 80.9%,P=0.005;GU: 28.6% vs 57.7%,P=0.0034).And also less influence in the hematologic toxicities(P=0.006).Conclusion:Our results suggest that adjuvant treatment IMRT in early stage cervical cancer has similar local control but low acute toxicity.However,the true benefits of IMRT are needed longer follow-up and more patients.