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目的:探讨食管癌三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)与调强放疗(intensity modulated radiotherapy,IMRT)技术间的剂量参数差异,为临床提供有价值的循证医学证据。方法:计算机检索Cochrane、PubMed、Embase及中国知网(CNKI)、万方数据库中所有比较食管癌三维适形放疗及调强放疗的文章,应用RevMan 5.2软件对所有满足条件的数据进行Meta分析。结果:17篇文献纳入本次研究。食管癌调强放疗与适形放疗比,能显著降低双肺的V_(20)(MD=4.63,95%CI:1.69~7.56,P<0.01)及V_(30)。(MD=4.21,95%CI:1.48~6.94,P<0.01),且有更好的适形指数(MD=-0.14,95%CI:-0.2~-0.07,P<0.01)及均匀指数(MD=0.04,95%CI:-0.01~0.07,P<0.01);双肺V_5、V_(10)、心脏V_(40)及脊髓最大受量D_(max)两种放疗技术间无统计学差异。结论:食管癌IMRT与3D—CRT比较能明显降低肺的V_(20)及V_(30),具有更好的靶区适形度。
Objective: To investigate the difference of dose parameters between three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) in esophageal cancer, so as to provide evidence-based evidence for clinical practice. Methods: All articles of three-dimensional conformal radiotherapy and intensity modulated radiotherapy of esophageal cancer in Cochrane, PubMed, Embase, CNKI and Wanfang database were searched by computer. Meta-analysis was performed on all the data satisfying the conditions by RevMan 5.2 software. Results: 17 articles were included in this study. Compared with CRT, esophageal carcinoma could significantly reduce the V_ (20) of lung (MD = 4.63, 95% CI: 1.69 ~ 7.56, P <0.01) and V_ (30). (MD = 4.21, 95% CI: 1.48-6.94, P <0.01), and had better conformal index (MD = -0.14,95% CI -0.2-0.07, P <0.01) and evenness index MD = 0.04, 95% CI: -0.01 ~ 0.07, P <0.01). There was no significant difference between the two radiotherapy techniques of V_5, V_ (10), V_ (40) . Conclusion: Compared with 3D-CRT, the IMRT of esophageal cancer can significantly reduce the V_ (20) and V_ (30) of the lung and has better target conformality.