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目的探讨调强放射治疗(IMRT)用于宫颈癌术后提高靶区受照射剂量,减少并发症的价值。方法对2002年6月至2006年6月山东省肿瘤医院20例宫颈癌术后患者放疗前均给予2~3个周期化疗,并行全程IMRT,每日1次,每次1.8~2.2Gy,每周5次,给予处方剂量50~60Gy,中位剂量54.5Gy;同时拟设计该20例患者的普通2野放疗计划,拟给予相同的处方剂量,比较危险器官(OAR)受照射剂量;选取同期23例接受普通放疗的完整病例,比较调强放疗和普通放疗急、慢性毒副反应及近期存活率。结果20例患者均完成全程IMRT,放射治疗计划靶区(planning target volume,PTV)内的平均剂量为56.2Gy,90%的等剂量曲线(中位剂量54.5Gy)可以覆盖99%以上的肉眼靶区(gross target volume,GTV)体积。IMRT与拟行普通2野放疗计划比较,小肠、直肠、膀胱的受照射剂量均明显减小,P均<0.01;IMRT与普通放疗比较,急慢性毒副反应明显降低,但1、2、3年存活率比较差异无显著性意义,P>0.05。结论IMRT技术使宫颈癌术后患者的靶区获得理想的剂量分布,邻近危险器官得到很好的保护,毒副反应可以耐受,但未能提高患者近期存活率。
Objective To investigate the value of intensity modulated radiation therapy (IMRT) for cervical cancer patients after surgery to improve target dose and reduce complications. Methods Twenty patients with cervical cancer from Shandong Cancer Hospital from June 2002 to June 2006 were treated with 2 ~ 3 cycles of chemotherapy before radiotherapy. The total IMRT was performed once a day for 1.8 ~ 2.2 Gy each Week 5 times to give the prescribed dose of 50 ~ 60Gy, the median dose of 54.5Gy; Simultaneously intended to design the 20 cases of the general 2 field radiotherapy plan to be given the same prescription dose, compare the risk organs (OAR) by irradiation dose; select the same period Twenty-three patients underwent complete radiotherapy, comparing acute and chronic side effects of radiofrequency ablation and general radiotherapy, and recent survival rates. Results Totally IMRT was completed in all 20 patients. The average dose in planning target volume (PTV) was 56.2Gy, and the 90% isodose curve (median dose 54.5Gy) covered more than 99% Gross target volume (GTV) volume. IMRT compared with the planned 2-field radiotherapy program, the irradiation doses of small intestine, rectum and bladder decreased significantly (P <0.01); acute and chronic side effects of IMRT were significantly lower than those of general radiotherapy, but 1, 2, Annual survival rate was no significant difference, P> 0.05. Conclusion The IMRT technique can make the target dose of the postoperative patients with cervical cancer obtain the ideal dose distribution, the adjacent dangerous organs are well protected, the toxic reactions can be tolerated, but failed to improve the short-term survival rate of patients.