子宫颈癌术后调强放疗和三维适形放疗的临床疗效观察

目的 探讨子宫颈癌术后调强放疗（IMRT）与三维适形放疗（3DCRT）的临床疗效及安全性。方法 选取我院2012年9月至2013年3月60例宫颈癌术后患者，均制定IMRT和3DCRT两种放疗计划，随机分为IMRT组和3DCRT组进行放疗， IMRT组行5野6MV X射线放疗， 3DCRT组行4野6MV-X射线盒式照射，处方剂量均为95％计划靶区体积（PTV）为45 Gy／25 f／5 W。评价PTV和危及器官（OAR）的剂量分布特点；随访两组OAR的急慢性放射性损伤，计算两组3年生存率。结果IMRT组PTV的适形度指数（CI）、均匀性指数（HI）分别为0.80±0.03、1.10±0.01，3DCRT组分别为0.58±0.19、1.09±0.01，差异有统计学意义（P＜0.05）；IMRT组膀胱前壁的V10、V20、V30、V40和V45均低于3DCRT组，差异有统计学意义（P＜0.05）；IMRT组直肠后壁的V20、V30、V40和V45均低于3DCRT组，差异有统计学意义（P＜0.05）；IMRT组直肠和膀胱的急性和慢性放射性损伤发生率低于3DCRT组，差异有统计学意义（P＜0.05）。IMRT组3年生存率为83.3％，3DCRT组为80.0％，差异无统计学意义（P＞0.05）。结论 在PTV的CI、HI及保护OAR如膀胱前壁、直肠后壁上，IMRT优于3DCRT。

Clinical observation of intensity modulated radiotherapy or three dimensional conformal radiotherapy in cervical cancer patients treated with surgery

Objective To explore the efficacy and safety of intensity modulated radiotherapy（IMRT） and three dimensional conformal radiotherapy（3DCRT） in cervical cancer patients after the surgery. Methods IMRT and 3DCRT plans were designed for 60 cervical cancer patients after the surgery. Patients were randomly assigned to IMRT group and 3DCRT group. The dose distribution of planning target volume（PTV） and organ at risk （OAR） were evaluated. And the acute and chronic radiation injury， 3 years overall survival （OS） were compared between two groups. Results The conformation index （CI）， relative dose homogeneity index （HI） of PTV were significant different between two groups （P＜0.05）. Compared with 3DCRT group， V10， V20， V30， V40 and V45of anterior bladder wall and the V20， V30， V40 and V45of posterior rectal wall were significant lower in IMRT group （P＜0.05）. And the acute and chronic radiation injury of rectal and bladder were significant slighter in IMRT group. There was no difference in 3-year survival rates between two groups. Conclusion IMRT was superior to 3DCRT in CI， HI of PTV and the protection of the anterior bladder wall and the posterior rectal wall.