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目的:探讨中晚期宫颈癌患者应用调强放射治疗(IMRT)技术在提高靶区剂量与减少正常组织受量方面的价值。方法:40例中晚期宫颈癌患者均给予全程IMRT1.8～2.2Gy/次,每周4次外照射和1次内照射,外照射的处方剂量为50～55Gy,中位剂量为53.5Gy,内照射共给6次,每次5Gy。同时拟设计该40例患者2野和4野的放疗计划,拟给予相同的处方剂量,比较危险器官(OAR)直肠、小肠、膀胱和骨髓的受照射剂量和体积。结果:40例患者均完成全程的IMRT,放射治疗计划靶区(PTV)的平均剂量为54.5Gy,90%的等剂量曲线(中位剂量53.5Gy)可以覆盖99%以上的肉眼靶区(GTV)体积。IMRT与普通2野和4野放疗组比较,小肠、直肠、膀胱和骨髓的受照射剂量和体积均明显减少(P<0.05)。急慢性放射反应明显减轻。1,2年生存率比较,差异无统计学意义。结论:IMRT放疗技术可以使患者的放疗靶区获得较为理想的剂量分布,邻近危险器官得到很好的保护,从而减小了急慢性放疗反应,毒副反应可以耐受,但未能提高近期生存率。
Objective: To investigate the application of IMRT in patients with advanced cervical cancer to increase the target dose and reduce the amount of normal tissue. Methods: Forty patients with advanced cervical cancer underwent IMRT 1.8 ~ 2.2Gy / time, 4 times per week external irradiation and 1 internal irradiation. The prescription dose of external irradiation was 50 ~ 55Gy and the median dose was 53.5Gy. A total of 6 times within the irradiation, each 5Gy. At the same time, we planned to design two and four radiotherapy plans for the 40 patients. The same prescribed dose was proposed to compare the dose and volume of rectal, small intestine, bladder and bone marrow of dangerous organs (OAR). RESULTS: All 40 patients achieved a full IMRT with an average dose of 54.5 Gy for the target of the PTT and 90% of the isodose dose (median dose of 53.5 Gy) covering more than 99% of the gross target (GTV )volume. The IMRT dose and volume in the small intestine, rectum, bladder and bone marrow were significantly decreased (P <0.05) compared with those in the general 2 field and 4 field radiotherapy groups. Acute and chronic radiation response was significantly reduced. 1, 2 year survival rate, the difference was not statistically significant. Conclusion: The IMRT radiotherapy can make the patient’s target area for radiotherapy achieve an ideal dose distribution, and the adjacent dangerous organs are well protected, thereby reducing the acute and chronic radiotherapy response, the side effects can be tolerated, but failed to improve the short-term survival rate.