子宫颈癌术后辅助性放疗不同照射技术临床比较研究
发布时间：2018-10-18 09:01
【摘要】：目的子宫颈癌术后病理存在高危因素的患者,术后辅助放疗可提高疗效,改善预后。常用的放疗技术有调强放射治疗(intensity modulated radiotherapy,IMRT)、三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)和常规放疗(conventional radiotherapy,CRT),本研究旨在比较这3种放疗技术的剂量学、毒副作用、疗效及生存情况的差异,从而找出一种更佳的放疗方案。方法选取2009-01-10-2015-07-10临沂市肿瘤医院接受放疗的341例宫颈癌术后存在高危因素患者,分为IMRT组患者128例、3D-CRT组患者77例和CRT组患者136例。IMRT组PTV 50.4~54Gy,3D-CRT组PTV45~50.4Gy,CRT组处方剂量DT41.4~45Gy。体外放疗同时给予化疗。随机选取10例患者重新制定IMRT计划、3D-CRT计划和CRT计划。采用SPSS 22.0统计软进行数据分析,比较危及器官(organ at risk,OAR)受照射剂量、靶区剂量、急慢性毒副作用、疗效及生存情况。结果 IMRT计划、3D-CRT计划和CRT计划的OAR受照射剂量差异有统计学意义(脊髓F=1 070.038,P0.001;股骨头F=103.277,P0.001;小肠F=208.677,V=13.776,P0.001;膀胱F=303.481,V=13.330,P0.001;直肠F=230.452,V=13.272,P0.001。3组患者的靶区剂量差异有统计学意义,χ~2=293.059,P0.001。IMRT组与3D-CRT组比较,Z=-11.096,P0.001;IMRT组与CRT组比较,Z=-14.281,P0.001;3D-CRT组与CRT组比较,Z=-12.401,P0.001,差异均有统计学意义。3组的急性消化道反应(χ~2=11.848,P=0.003)、泌尿系统反应(χ~2=10.390,P=0.006)、骨髓抑制(χ~2=14.154,P=0.001)、慢性消化道反应(χ~2=19.242,P0.001)、泌尿系统反应(χ~2=15.670,P0.001)差异均有统计学意义。3组靶区内外转移率比较显示,IMRT组靶区内复发率有降低趋势,但无统计学意义(χ~2=5.327,P=0.070),靶区外转移率差异无统计学意义,χ~2=1.370,P=0.504。3组无瘤生存期(disease-free survival,DFS)差异无统计学意义(P=0.054),其中IMRT组较CRT组明显提高(P=0.013),IMRT组较3D-CRT组差异无统计学意义(P=0.123),3D-CRT组较CRT组差异无统计学意义(P=0.532)。3组总生存期(overall survival,OS)差异有统计学意义(P=0.024),其中IMRT组OS较CRT组明显提高(P=0.008),IMRT组较3D-CRT组差异无统计学意义(P=0.259),3D-CRT组较CRT组差异无统计学意义,P=0.213。将宫旁受侵、淋巴转移、深肌层受侵、脉管癌栓、靶区内外转移进行多因素分析,深肌层受侵是患者独立预后不良因素,P=0.047,HR=2.362,95%CI为1.013~5.508。结论对宫颈癌术后具有不良预后因素患者,IMRT可获得理想的剂量分布,IMRT技术与其他技术相比具有明显剂量学优势,OAR受照射剂量降低,靶区剂量明显提高,毒副作用减少,靶区内复发率有降低趋势,总生存率提高。
[Abstract]:Objective: postoperative adjuvant radiotherapy can improve the curative effect and prognosis of patients with cervical cancer with high risk factors. The commonly used radiotherapy techniques include intensity modulated radiotherapy (intensity modulated radiotherapy,IMRT), three-dimensional conformal radiotherapy (three-dimensional conformal radiotherapy,3D-CRT) and conventional radiotherapy (conventional radiotherapy,CRT). The purpose of this study was to compare the dosimetry, side effects, efficacy and survival of these three radiotherapy techniques. In order to find a better radiotherapy program. Methods 341 patients who received radiotherapy in Linyi Cancer Hospital from 2009-01-10 to 2015-10 were divided into IMRT group (128 cases), 3D-CRT group (77 cases) and CRT group (136 cases). The prescription dose of DT41.4~45Gy. in PTV 50.4 Gy 3D-CRT group, PTV45~50.4Gy,CRT group, IMRT group was 50.4 GY3D-CRT. External radiotherapy was given at the same time as chemotherapy. Ten patients were randomly selected to reformulate IMRT plan, 3D-CRT plan and CRT plan. SPSS 22.0 statistical software was used to analyze the data, to compare the radiation dose, target dose, acute and chronic toxicity, curative effect and survival status of (organ at risk,OAR. Results there were statistically significant differences in the dose of OAR exposure between IMRT, 3D-CRT and CRT (spinal cord 10 070.038 渭 P 0.001; femoral head 103.277U P 0.001; small intestine F208.677V 13.776U P 0.001; bladder F303.481V13.330P0.001; F230.452V 13.272 P 0.001.3; 蠂 ~ 2293.059P 0.001.Compared with 3D-CRT group, Z-11.096m P 0.001IMRT was significantly different from that of 3D-CRT group.) there was significant difference in the dose of the target area between the two groups (蠂 ~ 2293.0599P 0.001.ImRT group), compared with the 3D-CRT group (P 0.001). The dose difference was statistically significant in the patients with F303.481V13.330P0.001.The dose difference between the two groups was statistically significant (蠂 ~ 2293.0599P 0.001.Compared with that of the 3D-CRT group). Compared with CRT group, there were significant differences in acute digestive tract reaction (蠂 ~ 2), urinary system reaction (蠂 ~ 210.390P ~ 0.006), bone marrow suppression (蠂 ~ 2n 14.154 P ~ 0.001), chronic digestive tract reaction (蠂 ~ 2n 19.242P ~ 0.001) and urinary system reaction (蠂 ~ 215.670 P ~ 0.001) between Z-14.281P 0.001D CRT group and CRT group (P 0.001), and there were significant differences between the three groups in acute digestive tract reaction (蠂 ~ 215.670p ~ 0.003), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001) and urinary system response (蠂 ~ 215.670p ~ 0.001) in the three groups (蠂 ~ 210.390P 0.006), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001), urinary system response (蠂 ~ 215.670p 0.001). The recurrence rate of target area in IMRT group was lower than that in other three groups. However, there was no statistical significance (蠂 ~ 2 ~ 2 ~ (5.327) P ~ (0. 070), there was no significant difference in the rate of metastasis outside the target area, and there was no significant difference in tumor-free survival (disease-free survival,DFS) in 蠂 ~ 2 ~ (1.370) P ~ (0.504.3) group (P0. 054). Among them, IMRT group was significantly higher than CRT group (P 0. 013), IMRT group vs 3D-CRT group) (P0. 123), and 3D-CRT group was worse than CRT group (P < 0. 123). The total survival time (overall survival,OS) of the three groups was significantly higher than that of the CRT group (P0. 024). The OS of the IMRT group was significantly higher than that of the CRT group (P0. 008), IMRT group compared with the 3D-CRT group (P0. 259), and the 3D-CRT group had no statistical significance compared with the CRT group (P0. 213). Multivariate analysis was carried out on periuterine invasion, lymphatic metastasis, deep myometrial invasion, vascular tumor embolus, external and internal metastasis of target area. The invasion of deep muscular layer was an independent prognostic factor. The CI of 2.36295 CI was 1.0131355.508. Conclusion IMRT can obtain ideal dose distribution in patients with adverse prognostic factors after cervical cancer surgery. Compared with other techniques, IMRT technique has obvious dosimetric advantages. The dose of OAR is decreased, the dose of target area is increased, and the side effects of OAR are decreased. The recurrence rate in target area decreased and the overall survival rate increased.
【作者单位】： 临沂市肿瘤医院妇一科;山东大学附属山东省肿瘤医院妇瘤科;山东大学附属山东省肿瘤医院放疗科;
【基金】：山东省医药卫生科技发展计划(2016WS0246)
【分类号】：R737.33
，
本文编号：2278642
[Abstract]:Objective: postoperative adjuvant radiotherapy can improve the curative effect and prognosis of patients with cervical cancer with high risk factors. The commonly used radiotherapy techniques include intensity modulated radiotherapy (intensity modulated radiotherapy,IMRT), three-dimensional conformal radiotherapy (three-dimensional conformal radiotherapy,3D-CRT) and conventional radiotherapy (conventional radiotherapy,CRT). The purpose of this study was to compare the dosimetry, side effects, efficacy and survival of these three radiotherapy techniques. In order to find a better radiotherapy program. Methods 341 patients who received radiotherapy in Linyi Cancer Hospital from 2009-01-10 to 2015-10 were divided into IMRT group (128 cases), 3D-CRT group (77 cases) and CRT group (136 cases). The prescription dose of DT41.4~45Gy. in PTV 50.4 Gy 3D-CRT group, PTV45~50.4Gy,CRT group, IMRT group was 50.4 GY3D-CRT. External radiotherapy was given at the same time as chemotherapy. Ten patients were randomly selected to reformulate IMRT plan, 3D-CRT plan and CRT plan. SPSS 22.0 statistical software was used to analyze the data, to compare the radiation dose, target dose, acute and chronic toxicity, curative effect and survival status of (organ at risk,OAR. Results there were statistically significant differences in the dose of OAR exposure between IMRT, 3D-CRT and CRT (spinal cord 10 070.038 渭 P 0.001; femoral head 103.277U P 0.001; small intestine F208.677V 13.776U P 0.001; bladder F303.481V13.330P0.001; F230.452V 13.272 P 0.001.3; 蠂 ~ 2293.059P 0.001.Compared with 3D-CRT group, Z-11.096m P 0.001IMRT was significantly different from that of 3D-CRT group.) there was significant difference in the dose of the target area between the two groups (蠂 ~ 2293.0599P 0.001.ImRT group), compared with the 3D-CRT group (P 0.001). The dose difference was statistically significant in the patients with F303.481V13.330P0.001.The dose difference between the two groups was statistically significant (蠂 ~ 2293.0599P 0.001.Compared with that of the 3D-CRT group). Compared with CRT group, there were significant differences in acute digestive tract reaction (蠂 ~ 2), urinary system reaction (蠂 ~ 210.390P ~ 0.006), bone marrow suppression (蠂 ~ 2n 14.154 P ~ 0.001), chronic digestive tract reaction (蠂 ~ 2n 19.242P ~ 0.001) and urinary system reaction (蠂 ~ 215.670 P ~ 0.001) between Z-14.281P 0.001D CRT group and CRT group (P 0.001), and there were significant differences between the three groups in acute digestive tract reaction (蠂 ~ 215.670p ~ 0.003), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001) and urinary system response (蠂 ~ 215.670p ~ 0.001) in the three groups (蠂 ~ 210.390P 0.006), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001), urinary system response (蠂 ~ 215.670p 0.001). The recurrence rate of target area in IMRT group was lower than that in other three groups. However, there was no statistical significance (蠂 ~ 2 ~ 2 ~ (5.327) P ~ (0. 070), there was no significant difference in the rate of metastasis outside the target area, and there was no significant difference in tumor-free survival (disease-free survival,DFS) in 蠂 ~ 2 ~ (1.370) P ~ (0.504.3) group (P0. 054). Among them, IMRT group was significantly higher than CRT group (P 0. 013), IMRT group vs 3D-CRT group) (P0. 123), and 3D-CRT group was worse than CRT group (P < 0. 123). The total survival time (overall survival,OS) of the three groups was significantly higher than that of the CRT group (P0. 024). The OS of the IMRT group was significantly higher than that of the CRT group (P0. 008), IMRT group compared with the 3D-CRT group (P0. 259), and the 3D-CRT group had no statistical significance compared with the CRT group (P0. 213). Multivariate analysis was carried out on periuterine invasion, lymphatic metastasis, deep myometrial invasion, vascular tumor embolus, external and internal metastasis of target area. The invasion of deep muscular layer was an independent prognostic factor. The CI of 2.36295 CI was 1.0131355.508. Conclusion IMRT can obtain ideal dose distribution in patients with adverse prognostic factors after cervical cancer surgery. Compared with other techniques, IMRT technique has obvious dosimetric advantages. The dose of OAR is decreased, the dose of target area is increased, and the side effects of OAR are decreased. The recurrence rate in target area decreased and the overall survival rate increased.
【作者单位】： 临沂市肿瘤医院妇一科;山东大学附属山东省肿瘤医院妇瘤科;山东大学附属山东省肿瘤医院放疗科;
【基金】：山东省医药卫生科技发展计划(2016WS0246)
【分类号】：R737.33
，
本文编号：2278642
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