摘要
目的探讨三种外照射放疗方案在中晚期宫颈癌治疗上的优劣势,并对计划靶区(Planning target volume,PTV)和各个危及器官进行剂量学比较。方法选取辽宁省肿瘤医院2015年9月—2019年10月收治的90例宫颈癌(Ⅱ期b以上)患者,随机分成A、B和C三组,每组30人,分别做三维适形放疗(3D-CRT)、固定野静态调强放疗(IMRT)和容积旋转调强放疗计划(VMAT)放疗计划并进行剂量学对比,结合三维后装等效生物剂量讨论三种宫颈癌放疗优劣势。结果外照射靶区方面,三组计划的PTV平均剂量、适形度指数(CI)和均匀性指数(HI)在总体上均有统计学差异(P<0.05),A组PTV平均剂量、HI和CI显著低于B和C组(P<0.05)。外照射危及器官方面,三组计划的膀胱、结直肠和小肠平均剂量在总体上均有统计学差异(P<0.05),进一步比较发现A组小肠平均剂量和B、C组比较分别高了13.7%和28%(P<0.05),膀胱平均剂量比B、C组分别降低19.8%和15.2%(P<0.05);结直肠平均剂量则比B、C组分别降低26.1%和19.4%(P<0.05)。B组和C组之间比较,发现两者小肠平均剂量相近,差异无统计学意义(P>0.05),B组的膀胱和结直肠的平均剂量分别高了5.7%和9.1%,差异有统计学意义(P<0.05)。A组治疗时间为(135.5±27.6)s,B组治疗时间是A组的7.6倍,是C组的4.8倍。三组外照射联合腔内照射的靶区剂量和危及器官剂量均能满足临床要求。结论中晚期宫颈癌患者采用容积旋转调强放疗在靶区剂量适形度和保护危及器官方面较其他两种方案具有一定优势。而“半野”适形放疗结合三维近距离放疗靶区同样满足临床要求。“半野”三维适形放疗具有治疗时间短,计划执行效率高等优势,与调强放疗相比具有明显价格优势,值得临床推广。
Objective The objectives of this study were to investigate the advantages and disadvantages of three external radiation radiotherapy regimens in the treatment of advanced cervical cancer,and to compare dosimetry of the planning target volume(PTV)with various crisis organs.Methods A total of 90 patients with cervical cancer(stage II B or above)who were treated in our hospital from September 2015 to October 2019 were randomly divided into three ABC groups(30 patients/group).The radiotherapy plans of three-dimensional conformal radiotherapy(3D-CRT),the fixed field static intensity modulated radiotherapy(IMRT)and volume rotation intensity modulated radiotherapy(VMAT)were compared in the dosimetry.The advantages and disadvantages of three types of cervical cancer radiotherapy were discussed in combination with three-dimensional after loading equivalent biological doses.Results In terms of external irradiation target area,the average dose of PTV,conformity index CI and uniformity index HI of planned targets in overall three groups were statistically different(P<0.05).The average dose,index HI and conformity index CI in the group A were significantly lower than those in the other two groups(P<0.05).In terms of crisis organs by external exposure,the bladder,colorectal and small intestine of three plans of ABC were significant different(P<0.05).Further comparison showed that the average dose of small intestine in the group A was higher over 13.7%than that in the group B,and higher over 28%than that in the group C(P<0.05).The average dose of bladder was lower less 19.8%and 15.2%lower than that in the group B and C,respectively(P<0.05).The average dose of colorectal was lower less 26.1%and 19.4%than that in the group B and C,respectively(P<0.05).The average dose of small intestine in the group B was similar with the group C,there was no statistical difference(P>0.05).The average doses of bladder and colorectal in the group B were higher over 5.7%and 9.1%than those in the group C,respectively(P<0.05).The treatment time of group A was(135.5±27.6)s.the treatment time of group B was 7.6 times than that of group A and 4.8 times than that of group C.The target dose and organ-endangered dose of external irradiation combined with intracavitary irradiation in the three groups of ABC could meet the clinical requirements.Conclusion Volume-modulated intensity-modulated radiotherapy for patients with intermediate and advanced cervical cancer has certain advantages over other two schemes in terms of dose conformation at the target area and protection of endangered organs.“Half-field”conformal radiotherapy combined with three-dimensional brachytherapy at the target area also meets the clinical requirements."Half-field"three-dimensional conformal radiotherapy has the advantages of short treatment time and high plan execution efficiency.It has a significant price advantage compared with IMRT and is worthy of clinical promotion.
作者
杨东明
卢庆刚
YANG Dongming;LU Qinggang(Cancer Hospital of China Medical University,Liaoning Cancer Hospital & Institute,Shenyang 110042,China)
出处
《实用肿瘤学杂志》
CAS
2020年第3期244-248,共5页
Practical Oncology Journal
关键词
宫颈癌
三维适形
固定野静态调强
容积旋转调强
Cervical cancer
Three-dimensional conformal
Static field intensity modulation in fixed field
Volume rotation intensity modulation
