局部晚期胃癌患者术后调强放疗的临床观察

目的]比较局部晚期胃癌患者术后调强放疗（IMRT）与三维适形放疗（3D-CRT）计划,观察术后IMRT的不良反应及临床疗效。方法]对46例局部晚期胃癌患者术后同时作IMRT及3D-CRT计划,处方剂量4500cGy,分割剂量180cGy。结果]与3D-CRT相比,IMRT靶区剂量分布更好,平均剂量更高（P〈0.05）,肝脏平均受照剂量明显降低（P〈0.05）,左肾V12.5、V22.5亦显著降低（P〈0.05）。46例患者1年及2年生存率分别为98.0%、80.0%,死亡的6例患者中有5例发生了远处转移。结论]对局部晚期胃癌患者,相对3D-CRT,术后IMRT靶区剂量分布更好,临床不良反应可耐受。

Postoperative Intensity Modulated Radiotherapy for Locally Advanced Gastric Cancer

Purpose] To compare the radiotherapy plan between intensity modulated radiation therapy（IMRT） and 3-dimensional conformal radiation therapy（3D-CRT） and to determine the efficacy and toxicity of postoperative IMRT for locally advanced gastric cancer. Methods] Fortysix patients with locally advanced gastric cancer were included in this study. For each patient IMRT and 3D-CRT radiotherapy plan were generated. The median radiation dose delivered was4 500cGy,with 180cGy per fraction. Results] IMRT had better target dosimetric distribution and higher average dose compared with 3D-CRT（P〈0.05）. IMRT plan significantly reduced the mean dose of liver（P〈0.05） and V12.5and V22.5of left kidney（P〈0.05）. The 1-year and 2-year overall survival were 98.0% and 80.0% respectively. Of the six death patients,five developed distant metastasis. Conclusion] Compared to 3D-CRT,IMRT has advantages in target dosimetric distribution,with tolerable toxicities.