目的评价胃癌术后调强放疗的剂量学优势及近期疗效。方法 32例胃癌患者术后采用调强技术行放疗,靶区包括肿瘤床、吻合口及淋巴引流区,处方剂量:计划靶区(PTV)DT45Gy/25次,高危计划靶区(PTV1)DT55Gy/25次。放疗同期口服卡培他滨625 mg/m~2,每天两次。评价毒副反应及近期疗效。最初10例患者均应用相同的CT图像做适形放疗、调强放疗计划,比较靶区及正常组织的照射剂量。结果调强放疗剂量分布优于适形技术。放化疗期间1例出现Ⅲ度骨髓抑制,1例出现大出血。放化疗前后患者体质量下降0～10%,中位值5.2%。2例在后续化疗期间出现肝功能异常,经保肝治疗后好转。调强放疗加同步化疗后2年总生存率、无复发生存率和局部区域控制率分别为70.3%、59.3%、89.8%。结论调强放疗具有明显的靶区剂量分布优势,可以减少肾脏、脊髓等正常组织器官的照射剂量。胃癌术后调强放疗加同期化疗是安全可行的,但其长期疗效有待于通过前瞻性随机研究来证实。 Objective To evaluate the dosimetric advantages and short-term efficacy of IMRT after gastric cancer surgery. Methods Twenty-two patients with gastric cancer underwent postoperative IMRT. The target area included tumor bed, anastomotic orifice and lymphatic drainage area. The prescription dose was: DT45Gy / 25 times PTV1, 25 times. Radiotherapy during the same period capecitabine 625 mg / m ~ 2, twice daily. Evaluation of toxicity and short-term efficacy. The first 10 patients were treated with the same CT images of conformal radiotherapy, intensity modulated radiotherapy plan to compare the target area and normal tissue irradiation dose. Results IMRT dose distribution better than conformal technique. One case of radiotherapy and chemotherapy during the emergence of Ⅲ degree myelosuppression, bleeding occurred in 1 case. Before and after radiotherapy and chemotherapy in patients with body mass decreased 0 ~ 10%, median 5.2%. 2 cases of liver dysfunction occurred during follow-up chemotherapy, after liver protection improved. The 2-year overall survival rate, recurrence-free survival rate and regional control rates after IMRT plus synchronous chemotherapy were 70.3%, 59.3% and 89.8% respectively. Conclusion IMRT has obvious advantage of target dose distribution, which can reduce the radiation dose of normal tissues and organs such as kidney and spinal cord. Postoperative IMRG plus concurrent chemotherapy is safe and feasible, but its long-term efficacy needs to be confirmed by prospective randomized studies.