盒式放疗与调强放射治疗对中晚期宫颈癌的临床疗效及不良反应
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摘要
目的探讨盒式放疗与调强放射治疗(IMRT)对中晚期宫颈癌的临床疗效及不良反应。方法选择68例中晚期宫颈癌患者,根据患者病情及意愿将患者分为盒式放疗组和IMRT组,每组34例。盒式放疗组患者采用盆腔外照射并腔内后装放疗进行根治性放疗,IMRT组患者进行IMRT。比较两组患者的放疗参数、临床疗效及不良反应。结果 IMRT组中计划靶区(PTV)的均匀指数(HI)和适形指数(CI)均优于盒式放疗组(P﹤0.05)。IMRT组中膀胱、小肠和直肠的V30、V40和V50均低于盒式放疗组(P﹤0.05),且随着靶区体积的增加,两组患者膀胱、小肠和直肠的受照剂量均呈下降趋势。盒式放疗组和IMRT组患者均出现了不同程度的急性放射性膀胱炎、急性放射性肠炎及骨髓抑制,其中IMRT组患者的急性放射性膀胱炎和急性放射性肠炎均轻于盒式放疗组(P﹤0.05)。盒式放疗组和IMRT组患者的有效率分别为52.94%(18/34)和67.65%(23/34),差异无统计学意义(P﹥0.05)。盒式放疗组和IMRT组患者的1年和3年生存率、局部复发率和远处转移率比较,差异均无统计学意义(P﹥0.05)。结论与盒式放疗相比,IMRT体现了显著的保护危及器官的优势,且可降低不良反应发生率。
Objective To investigate the clinical efficacy of box technique whole pelvic radiotherapy(WPRT) and intensity modulated radiation therapy(IMRT) and the adverse reactions in the treatment of advanced cervical cancer.Method A total of 68 cases with advanced cervical cancer were included in the research as box technique WPRT group and IMRT group according to their medical conditions and willing for treatment, with 34 cases in each group. The box technique WPRT group was administered with external pelvic radiation followed by pelvic radiation, while the IMRT group was given IMRT accordingly. The radiotherapy parameters, clinical efficacy and adverse reactions in both groups were compared. Result The homogeneity index(HI) and conformity index(CI) in IMRT group were better than those in box technique WPRT group(P<0.05). The V30, V40 and V50 of bladder, small intestine, and rectum in IMRT group were all lower compared to those in box technique WPRT group(P<0.05), and the irradiation doses of bladder, small intestine and rectum in both groups declined as the target volume increased. The box technique WPRT group and IMRT group all developed acute radiation cystitis, acute radiation proctitis, and bone marrow suppression, besides, the incidence of acute radiation cystitis and acute radiation proctitis in IMRT group was generally lower compared with that in box technique WPRT group(P<0.05). The response rate in box technique WPRT and IMRT group was 52.94%(18/34) and 67.65%(23/34),with no statistically significant difference observed(P>0.05). There were no evident difference in regard to the 1-and 3-year survival rate, local recurrence rate and distant metastasis rate in box technique WPRT group and IMRT group(P>0.05). Conclusion Compared with box technique WPRT, IMRT plan demonstrates the advantages in protecting organs at risk, with less adverse reactions.
Objective To investigate the clinical efficacy of box technique whole pelvic radiotherapy(WPRT) and intensity modulated radiation therapy(IMRT) and the adverse reactions in the treatment of advanced cervical cancer.Method A total of 68 cases with advanced cervical cancer were included in the research as box technique WPRT group and IMRT group according to their medical conditions and willing for treatment, with 34 cases in each group. The box technique WPRT group was administered with external pelvic radiation followed by pelvic radiation, while the IMRT group was given IMRT accordingly. The radiotherapy parameters, clinical efficacy and adverse reactions in both groups were compared. Result The homogeneity index(HI) and conformity index(CI) in IMRT group were better than those in box technique WPRT group(P<0.05). The V30, V40 and V50 of bladder, small intestine, and rectum in IMRT group were all lower compared to those in box technique WPRT group(P<0.05), and the irradiation doses of bladder, small intestine and rectum in both groups declined as the target volume increased. The box technique WPRT group and IMRT group all developed acute radiation cystitis, acute radiation proctitis, and bone marrow suppression, besides, the incidence of acute radiation cystitis and acute radiation proctitis in IMRT group was generally lower compared with that in box technique WPRT group(P<0.05). The response rate in box technique WPRT and IMRT group was 52.94%(18/34) and 67.65%(23/34),with no statistically significant difference observed(P>0.05). There were no evident difference in regard to the 1-and 3-year survival rate, local recurrence rate and distant metastasis rate in box technique WPRT group and IMRT group(P>0.05). Conclusion Compared with box technique WPRT, IMRT plan demonstrates the advantages in protecting organs at risk, with less adverse reactions.
引文
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[2]Therasse P,Arbuck SG,Eisenhauer EA,et al.New guidelines to evaluate the response to treatment in solid tumors[J].J Natl Cancer Inst,2000,92(3):205-216.
[3]Roszak A,Warenczak-Florczak Z,Bratos K,et al.Incidence of radiation toxicity in cervical cancer and endometrial cancer patients treated with radiotherapy alone versus adjuvant radiotherapy[J].Rep Pract Oncol Radiother,2012,17(6):332-338.
[4]de Freitas AC,Gurgel AP,Chagas BS,et al.Susceptibility to cervical cancer:an overview[J].Gynecol Oncol,2012,126(2):304-311.
[5]Izmajlowicz B,Rusiecka M,Sztuder A,et al.Tolerance of combined radiochemotherapy in cervical cancer patients[J].Adv Clin Exp Med,2017,26(4):587-594.
[6]Fernandez-Ots A,Crook J.The role of intensity modulated radiotherapy in gynecological radiotherapy:present and future[J].Rep Pract Oncol Radiother,2013,18(6):363-370.
[7]Chera BS,Rodriguez C,Morris CG,et al.Dosimetric comparison of three different involved nodal irradiation techniques for stage II Hodgkin's lymphoma patients:conventional radiotherapy,intensity-modulated radiotherapy,and three-dimensional proton radiotherapy[J].Int J Radiat Oncol Biol Phys,2009,75(4):1173-1180.
[8]Lu JY,Cheung ML,Huang BT,et al.Improving target coverage and organ-at-risk sparing in intensity-modulated radiotherapy for cervical oesophageal cancer using a simple optimisation method[J].PLo S One,2015,10(3):e0121679.
[9]van de Bunt L,van der Heide UA,Ketelaars M,et al.Conventional,conformal,and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer:the impact of tumor regression[J].Int JRadiat Oncol Biol Phys,2006,64(1):189-196.