中晚期宫颈癌适形调强放疗联合三维腔内后装放疗的剂量学初步研究
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摘要
目的:探讨适形调强放疗(IMRT)联合三维腔内后装放疗及顺铂(DDP)同步化疗在中晚期宫颈癌治疗中危及器官受照剂量及毒副反应。方法:回顾分析2015年3月至2017年10月安徽医科大学附属省立医院收治的中晚期宫颈癌患者86例的临床资料。根据治疗方式分组:二维后装组47例患者行IMRT联合二维腔内后装放疗及DDP同步化疗;三维后装组39例患者行IMRT联合三维腔内后装放疗及DDP同步化疗。分析评定两种治疗方式下对危及器官(小肠、膀胱、直肠)受照剂量、2cm3受照剂量(D2cc)及两组患者治疗期间的毒副反应。结果:三维后装组危及器官(小肠、膀胱及直肠)受照剂量Dmin、Dmax、Dmean、D2cc均明显少于二维后装组(P<0.05);三维后装组血小板减少23.09%(9/39)、消化道反应47.72%(19/39)、放射性膀胱炎71.79%(28/39)及放射性直肠炎56.41%(22/39)情况均明显低于二维后装组[70.21%(33/47)、65.96%(31/47)、82.98%(39/47)、80.85%(38/47)](均P<0.05)。结论:IMRT联合三维腔内后装放疗及DDP同步化疗治疗中晚期宫颈癌在剂量学角度可明显降低危及器官的受照剂量,且毒副反应较轻,值得推广应用。
Objective: To discuss the endanger organs irradiated dose and toxic and side effects of intensity modulated radiotherapy( IMRT) combined with three-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy in the treatment of advanced cervical cancer. Methods: A retrospective analysis of 86 advanced cervical cancer patients with complete medical records from Mar.2015 to Oct.2017 were included in this study,and divided according to the different ways of treatment,47 patients in the two-dimensional post loading group received IMRT combined with two-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy,39 patients in the three-dimensional post loading group received IMRT combined withthree-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy. Analyzed and evaluated the dose of the endanger organs( intestinum tenue,bladder and rectum),D2 cc under two therapy methodsand chemotherapies sideeffects of the two groups of patients. Results: The irradiated dose Dmin,Dmax,Dmean and D2 cc of endanger organs( intestinum tenue,bladder and rectum) of the three-dimensional post loading group were significantly less than the two-dimensional post loading group( P<0.05).The three-dimensional post loading group thrombocytopenia 23. 09%( 9/39),gastrointestinal reactions 47.72%( 19/39),radiation cystitis 71.79%( 28/39) and radiation proctitis 56.41%( 22/39) were significantly lower than the two-dimensional post loading group [70.21%( 33/47),65.96%( 31/47),82.98%( 39/47),80.85%( 38/47) ]( all P<0.05).Conclusion: IMRT combined with three-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy in the treatment of advanced cervical cancer can significantly reduce the irradiated doseof endanger organs at the dosimetric point of view,with mild toxic and side effects,which is worthy of popularization and Application.
Objective: To discuss the endanger organs irradiated dose and toxic and side effects of intensity modulated radiotherapy( IMRT) combined with three-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy in the treatment of advanced cervical cancer. Methods: A retrospective analysis of 86 advanced cervical cancer patients with complete medical records from Mar.2015 to Oct.2017 were included in this study,and divided according to the different ways of treatment,47 patients in the two-dimensional post loading group received IMRT combined with two-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy,39 patients in the three-dimensional post loading group received IMRT combined withthree-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy. Analyzed and evaluated the dose of the endanger organs( intestinum tenue,bladder and rectum),D2 cc under two therapy methodsand chemotherapies sideeffects of the two groups of patients. Results: The irradiated dose Dmin,Dmax,Dmean and D2 cc of endanger organs( intestinum tenue,bladder and rectum) of the three-dimensional post loading group were significantly less than the two-dimensional post loading group( P<0.05).The three-dimensional post loading group thrombocytopenia 23. 09%( 9/39),gastrointestinal reactions 47.72%( 19/39),radiation cystitis 71.79%( 28/39) and radiation proctitis 56.41%( 22/39) were significantly lower than the two-dimensional post loading group [70.21%( 33/47),65.96%( 31/47),82.98%( 39/47),80.85%( 38/47) ]( all P<0.05).Conclusion: IMRT combined with three-dimensional intracavitary post loading radiotherapy and DDP synchronous chemotherapy in the treatment of advanced cervical cancer can significantly reduce the irradiated doseof endanger organs at the dosimetric point of view,with mild toxic and side effects,which is worthy of popularization and Application.
引文
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[10]Jodda A,Urbanski B,Piotrowski T,et al.Dosimetric study of the protection level of the bone marrow in patients with cervical or endometrial cancer for three radiotherapy techniques-3D CRT,IMRT and VMAT.Study protocol[J].Pol J Med Phys Eng,2016,22(1):11-15
[11]龚唯,徐晓婷,李莉,等.影像引导宫颈癌三维腔内放疗的临床初步观察[J].中国癌症杂志,2015,25(11):906-910
[12]王嘉琪,李静,宋海涛.调强放疗与三维适形放疗联合腔内后装放疗治疗中晚期宫颈癌的对比研究[J].实用临床医药杂志,2015,19(17):67-70
[2]王绿化,朱广迎,郎锦义,等.肿瘤放射治疗学[M].北京:人民卫生出版社,2016:424-426
[3]Chang YU,Yang ZY,Li GL,et al.Correlations between radiation dose in bone marrow and hematological toxicity in patients with cervical cancer a comparison of 3DCRT,IM-RT,and Rapid ARC[J].Int J Gynecol Cancer,2016,26(4):770-776
[4]Mabuchi S,Isohashi F,Yokoi T,et al.A phase II study of postoperative concurrent carboplatin and paclitaxel combined with intensity-modulated pelvic radiotherapy followed by consolidation chemotherapy in surgically treated cervical cancer patients with positive pelvic lymph nodes[J].Gynecol Oncol,2016,141(2):240-246
[5]Bae HS,Kim YJ,Lim MC,et al.Predictors of radiation field failure after definitive chemoradiation in patients with locally advanced cervical cancer[J].J Clin Oncol,2015,33(15S):4284-4294
[6]Kim H,Rajagopalan MS,Beriwal S,et al.Cost-effectiveness analysis of 3D image-guided brachytherapy compared with 2D brachytherapy in the treatment of locally advanced cervical cancer[J].Brachyther,2015,14(1):29-36
[7]朱丽红,姜伟娟,田素青,等.每周紫杉醇和顺铂同步三维适形盆腔放疗原发宫颈癌的Ⅰ期临床研究[J].中华肿瘤防治杂志,2016,23(15):1034-1037
[8]Kohler C,Mustea A,Marnitz S,et al.Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer:results of a prospective randomized trial[J].Am J Obstet Gynecol,2015,213(4):503.e1-503.e7
[9]鲁文力,李英,姜庆丰,等.宫颈癌三维后装放射治疗计划中剂量归一基于参考点和参考体积的剂量学参数比较[J].肿瘤,2016,36(3):340-344
[10]Jodda A,Urbanski B,Piotrowski T,et al.Dosimetric study of the protection level of the bone marrow in patients with cervical or endometrial cancer for three radiotherapy techniques-3D CRT,IMRT and VMAT.Study protocol[J].Pol J Med Phys Eng,2016,22(1):11-15
[11]龚唯,徐晓婷,李莉,等.影像引导宫颈癌三维腔内放疗的临床初步观察[J].中国癌症杂志,2015,25(11):906-910
[12]王嘉琪,李静,宋海涛.调强放疗与三维适形放疗联合腔内后装放疗治疗中晚期宫颈癌的对比研究[J].实用临床医药杂志,2015,19(17):67-70