摘要
目的:探讨同步加量调强放射治疗(SMART)与常规三维适形放疗(3DCRT)治疗子宫颈癌术后腹膜后淋巴结转移的剂量学特点及其临床应用价值。方法:选取32例子宫颈癌术后腹膜后淋巴结转移接受全程SMART的患者为研究对象,给予肿瘤靶区(GTV)2.2～2.4 Gy/次,计划靶区(PTV)1.8～2.0 Gy/次。同时设计该32例患者的3DCRT计划,拟给予相同的处方剂量,比较危险器官受照射剂量。随机选取36例行3DCRT治疗的子宫颈癌术后复发患者,比较SMART和3DCRT的靶区剂量、治疗时间、近期疗效和急性毒副作用。结果:32例患者均完成全程SMART,照射靶区内GTV剂量为(64.5±4.4)Gy,PTV剂量为(50.0±2.0)Gy,95%的等剂量曲线可以覆盖99%的PTV体积,SMART与拟行3DCRT计划比较,SMART组小肠(t=5.045,P=0.000)、膀胱(t=16.76,P=0.000)、直肠(t=10.432,P=0.000)、股骨头(t=3.654,P=0.002)受照射剂量明显降低。SMART组与3DCRT组比较,治疗时间明显缩短,t=3.654,P=0.002;靶区剂量明显提高,GTV:t=13.997,P=0.000,PTV:t=6.785,P=0.000。SMART组的消化道反应(χ2=9.999,P=0.019)、泌尿系统(χ2=10.705,P=0.013)、骨髓抑制(χ2=9.321,P=0.025)的急性毒副作用均明显减少,差异均有统计学意义。两组完全缓解率比较差异无统计学意义,χ2=2.459,P=0.093;但有效率比较差异有统计学意义,χ2=6.477,P=0.011;1、2年生存率比较差异有统计学意义,χ2=4.449,P=0.035。结论:SMART对子宫颈癌术后腹膜后转移淋巴结可获得理想的剂量分布,靶区无需缩野可获得根治性剂量,缩短了治疗时间,邻近危险器官得到保护,临床近期疗效满意,毒副作用轻。
OBJECTIVE：To investigate the dosimetry and clinical outcomes of simultaneous modulated accelerated ra- diotherapy （SMART） versus three-dimensional conformal radiotherapy（3DCRT）for patients of cervical cancer with retro- peritoneal lymphnode metastasis after radical hysterectomy and pelvic lymphadenectomy. METHODS： All 32 patients com- pleted full course of SMART,2.2 to 2.4 Gy/fraction to the GTV, 1.8-2.0 Gy/fraction to the PTV. 3DCRT were de- signed for the 32 patients simultaneously and the same doses were prescriped to compare the dose of organs at risk. Thir- ty-six cases received 3DCRT with retroperitoneal lymphnode metastasis after radical hysterectomy and pelvic lymphade- nectomy were chosen to compare the target dose, treatment span, acute toxicity and efficacy with the 32 SMART cases. RESULTS：For SMART plan, the average dose delivered to the GTV was （64.5±4.4） Gy, 95 % of iso-dose curve covered more than 99% of PTV（50. 0±2.0） Cry. The dose of small intestine（t= 5. 045, P= 0. 000）, bladder（t= 16. 76, P= 0. 000）, rectum （t= 10. 432 ,P=0. 000） and femoral head（t= 3. 654, P= 0. 002） were significantly lower than that of 3DCRT plans. Compared with 3DCRT, the treatment span was significantly shortened （t = 3.654, P = 0. 002） and target dose significantly increased, GTV （t = 13.997, P = 0. 000）, PTV （t = 6. 785, P = 0. 000）. Patients experienced less acute toxicities, including gastrointestinal reation （X^2=9. 999, P = 0. 019）, urinary system （9（2 = 10. 705, P = 0. 013） and myelosuppression （X^2= 9. 321, P = 0. 025）.Also the complete remission rate showed not significantly difference （X^2= 2. 459, P= 0. 093）, a significantly higher overall response rate was observed in SMART group（x^2= 6. 477,P= 0. 011）. The survival rates of 1,2-year were significantly differeyt（X^2=4. 449 ,P= 0. 035）. CONCLUSIONS： SMART therapy provides a better dose distribution than 3DCRT for cervical cancer patients with retroperitoneal lymphnode metastasis after radical hysterectomy and pelvic lymphadenecto- my. The treatment time is short with satisfied field covering and radical dose distribution. The adjacent organs at risk can be well protected. SMART has statisfied short-term efficacy and tolerable toxicities.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2013年第3期226-230,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
宫颈肿瘤
放射疗法
淋巴转移
同步加量调强放射治疗
预后
cervix neoplasms/radiotherapy
lymphatic metastasis
simultaneous modulated accelerated radiotherapy
prognosis
