宫颈癌术后盆腔复发患者3D-CRT与IMRT剂量学比较及疗效分析

发布时间：2018-01-19 08:23

  本文关键词： 宫颈癌术后盆腔复发 三维适形放疗(3D-CRT) 调强放疗(IMRT)　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过回顾性分析宫颈癌术后盆腔复发患者三维适形放疗和调强放疗组的剂量学指标、放射治疗毒副反应及疗效,寻求较优的治疗方式,为三维适形及调强放疗技术在宫颈癌术后盆腔复发患者临床治疗中的应用提供数据支持。 方法和材料：收集2009年4月～2013年10月之间在中南大学湘雅医院放疗科治疗的宫颈癌术后单纯盆腔局部复发(不包括阴道残端复发),且均无盆腔以外部位复发和转移的患者,共32例,其中三维适形(3D-CRT)组14例,调强放疗(IMRT)组18例。放疗疗效评价标准依据RTOG和EORTC关于放射损伤分级标准,分为0-Ⅳ级。对计数资料以例和百分率(%)表示。对各项临床指标变量进行赋值,采用Kaplan-Meier方法估计生存率,并使用Log Rank法进行组间生存率比较,采用Fisher精确概率法进行3D-CRT组和IMRT组的疗效比较,采用秩转换的非参数检验方法比较急性和迟发性毒副反应,采用t检验或秩和检验比较两组的剂量学差异。 结果：1.全组患者随访时间24个月,平均生存时间为19.6个月；其中3D-CRT的平均生存时间为19.1个月,IMRT的平均生存时间为19.9个月。2.相同照射剂量下,(1) IMRT组与3D-CRT组相比,PGTVmax6346.98±168.81Gy和6198.47±54.12Gy,两组有统计学差异(P=0.023); CIpgtv0.56±0.21和0.26±0.13(P=0.002), CIptv0.77±0.13和0.59±0.07(P=0.004)。HIptv1.12±0.11和1.24±0.11(P=0.039)IMRT组CIpgtv、CIptv、HIptv优于3D-CRT组。(2) IMRT和3D-CRT组相比,小肠V4512.61±9.57和24.58±13.31,有统计学差异(P=0.044)；V4016.66±11.98和30.40±12.80,有统计学差异(P=0.032)；膀胱V4057.22±17.52和76.00±13.18,有统计学差异(P=0.021)； V4542.72±16.98和64.79±18.71,有统计学差异(P=0.019)；V5030.43±11.50和57.93±19.68,有统计学差异(P=0.003); IMRT组小肠V45、V40、膀胱V40、V45、V50受照射百分体积均低于3D-CRT组。(3)其余指标,PGTVmax、PGTVmean、PTVmean直肠Dmax、直肠Dmean、直肠V50、直肠V60、左股骨头Dmax、右股骨头Dmax、 HIpgtv均无统计学差异(P0.05)。3.近期疗效：IMRT组与3D-CRT组相比,疼痛缓解率93.8%和83.3%,无统计学差异(P0.05)；肿瘤消退有效率43.8%和50%,无统计学差异(P0.05)。4.放疗急慢性毒副反应：(1)急性肠道毒副反应,IMRT组与3D-CRT组相比,0度25%和8.3%,Ⅰ度68.8%和50%,Ⅱ度6.3%和33.3%,IMRT无Ⅲ度以上肠道反应,两组有统计学差异(P=0.03)；急性膀胱毒副反应,IMRT组与3D-CRT组相比,0度81.3%和50%,Ⅰ度18.8%和16.7%,Ⅱ度6.3%和33.3%,IMRT无Ⅱ度以上膀胱反应,3D-CRT组Ⅱ度和Ⅲ度反应为25%和8.3%,两组有统计学差异(P=0.043)；(急性肠道及膀胱的毒副反应IMRT均明显低于3D-CRT组,(2)慢性膀胱毒副反应,]MRT组与3D-CRT组相比,0度43.8%和16.7%,Ⅰ度37.5%和25%,Ⅱ度12.5%和41.7%,Ⅲ度6.3%和8.3%,IMRT无Ⅳ度以上膀胱反应,两组有统计学差异(P=0.04)；慢性肠道毒副反应,IMRT组与3D-CRT组相比,0度18.8%和0,Ⅰ度50%和41.7%,Ⅱ度25%和41.7%,Ⅲ度6.3%和8.3%,IMRT组无Ⅳ度毒副反应,两组无统计学差异(P=0.077)；5.生存分析3D-CRT组和IMRT组的1年总生存率分别为73.3%和80.4%(χ2=0.170,P=0.680),2年总生存率分别为51.3%和55.7%(χ2=0.068,P=0.794),认为接受两种放疗方法的患者的总生存率无统计学差异。 结论：(1)宫颈癌术后盆腔局部复发患者在同一放疗剂量下,IMRT相较于3D-CRT组适形性、均匀性更好,同时膀胱及肠道的受照射剂量低、体积小。 (2)宫颈癌术后盆腔局部复发患者在毒副反应方面,IMRT组的急性肠道、膀胱及慢性膀胱的毒副反应均明显低于3D-CRT组,IMRT在降低急慢性膀胱及肠道毒副反应并发症方面具有显著优势。 (3) IMRT及3D-CRT治疗患者在1、2年总生存率上无显著差异,近期疗效无显著差异。
[Abstract]:Objective: through retrospective analysis of postoperative cervical cancer patients with pelvic recurrence of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy group and radiotherapy dosimetry indicators, toxicity and efficacy, to seek better treatment methods for three-dimensional conformal and intensity-modulated radiotherapy in postoperative cervical cancer patients with pelvic recurrence in clinical application provide data support.
Materials and methods: from April 2009 to October 2013 at the Central South University between Radiotherapy Department of Xiangya Hospital for treatment of cervical carcinoma after operation simple pelvic recurrence (not including vaginal stump recurrence), and there were no pelvic recurrence and metastasis in areas other than the patients, a total of 32 cases, including three-dimensional conformal (3D-CRT) group (14 cases, radiotherapy IMRT) group of 18 cases. The curative effect of radiotherapy on the basis of RTOG and EORTC on the evaluation standard of grading standards of radiation injury, divided into 0- grade. The count data in cases and percentage (%). Assignment of the clinical variables, Kaplan-Meier method is used to estimate the survival rate, and survival rate between groups using Log Rank method comparison of curative effect, 3D-CRT group and IMRT group by using Fisher's exact probability method, using non parametric test method of rank transformation of acute and delayed toxicity, using t test or rank sum test between the two groups. Difference.
Results: all 1. patients were followed up for 24 months, the average survival time was 19.6 months; the average survival time of 3D-CRT for 19.1 months, the average survival time of IMRT for the same dose 19.9 months.2., (1) in IMRT group compared with 3D-CRT group, PGTVmax6346.98 + 168.81Gy and 6198.47 + 54.12Gy. The two groups had significant difference (P=0.023); CIpgtv0.56 + 0.21 and 0.26 + 0.13 (P=0.002), CIptv0.77 + 0.13 and 0.59 + 0.07 (P=0.004).HIptv1.12 + 0.11 and 1.24 + 0.11 (P=0.039) IMRT group CIpgtv, CIptv, HIptv is better than 3D-CRT group. (2) compared to IMRT and 3D-CRT group, intestinal V4512.61 + 9.57 and 24.58 + 13.31, there was significant difference (P=0.044); V4016.66 + 11.98 and 30.40 + 12.80, there was significant difference (P=0.032); bladder V4057.22 + 17.52 and 76 + 13.18, there was significant difference (P=0.021); V4542.72 + 16.98 and 64.79 + 18.71, there was significant difference (P=0.019); V5030.43 + 11. 50鍜，

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