宫颈癌调强放射治疗的临床研究

目的评价调强放射治疗(intensity-modulated radiation therapy,IMRT)在宫颈癌首程治疗中的临床疗效及放疗副反应。方法将2007年至2010年武汉协和医院收治的108例Ⅰ～Ⅱ期宫颈癌首程治疗患者,随机分为IMRT组及三维适形放射治疗(3dimensional conformal radiation therapy,3DCRT)组,同步给予铂类增敏放疗及后装放疗,观察两种治疗方法疗效和毒副反应的差异。结果两组治疗近期疗效相当(P>0.05),1年的总体生存率(overall survival,OS)、无局部复发生存率(local recurrence-free survival,LRFS)和无远处转移生存率(distance metastasis-free survival,DMFS)的差异无统计学意义(P>0.05);IMRT组肿瘤靶区平均剂量和3DCRT组无显著差异(P>0.05),危及器官如直肠、小肠、膀胱等平均剂量均低于3DCRT组(P<0.01);IMRT组急慢性直肠炎及慢性膀胱炎发病率均低于3DCRT组(P<0.05);IMRT组骨髓抑制发生率略低于3DCRT组,但差异无统计学意义(P>0.05)。结论 IMRT与3DCRT治疗宫颈癌近期疗效相同,但IMRT能更好地保护正常器官,有效降低放射损伤,值得推广。

Clinical Study of Intensity-modulated Radiation Therapy for Cervical Cancer Patients

Objective To evaluate the clinical efficacy and side effects of intensity-modulated radiation therapy(IMRT)on cervical cancer patients.Methods 108 patients who were admitted at the Union Cancer Center from 2007 to 2010 and were diagnosed with stage Ⅰ-Ⅱ cervical cancer,were randomized into IMRT group and 3-dimensional conformal radiation therapy(3DCRT)group.The patients all received once daily radiotherapy concurrent with chemotherapy of cisplatin and breech-loading intracavitary brachytherapy.The clinical efficacy and side effects were evaluated in both groups.Results The two groups had the same short-term efficacy.There was no significant difference between the two groups in the one-year overall survival(OS),local recurrence-free survival(LRFS)and distance metastasis-free survival(DMFS)(P>0.05).The irradiated dose of tumor volume had no significant difference between two groups(P>0.05),but the irradiated doses of the rectum,bladder and small intestine in IMRT group were significantly less than in 3DCRT group(P<0.01).The incidence of acute and chronic radiation-induced enteritis as well as chronic radiation-induced cystitis in IMRT group was significantly lower than in 3DCRT group(P<0.05).The bone marrow toxicity seemed lower in IMRT group than in 3DCRT group but there was no significant difference between two groups.Conclusion IMRT is a better therapeutic option for cervical cancer patients as it can considerably minimize radiation-induced side effects without compromising on the end results.