本文關(guān)鍵詞： 宮頸癌術(shù)后盆腔復(fù)發(fā) 三維適形放療(3D-CRT) 調(diào)強(qiáng)放療(IMRT)　出處：《中南大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：通過(guò)回顧性分析宮頸癌術(shù)后盆腔復(fù)發(fā)患者三維適形放療和調(diào)強(qiáng)放療組的劑量學(xué)指標(biāo)、放射治療毒副反應(yīng)及療效,尋求較優(yōu)的治療方式,為三維適形及調(diào)強(qiáng)放療技術(shù)在宮頸癌術(shù)后盆腔復(fù)發(fā)患者臨床治療中的應(yīng)用提供數(shù)據(jù)支持。 方法和材料：收集2009年4月～2013年10月之間在中南大學(xué)湘雅醫(yī)院放療科治療的宮頸癌術(shù)后單純盆腔局部復(fù)發(fā)(不包括陰道殘端復(fù)發(fā)),且均無(wú)盆腔以外部位復(fù)發(fā)和轉(zhuǎn)移的患者,共32例,其中三維適形(3D-CRT)組14例,調(diào)強(qiáng)放療(IMRT)組18例。放療療效評(píng)價(jià)標(biāo)準(zhǔn)依據(jù)RTOG和EORTC關(guān)于放射損傷分級(jí)標(biāo)準(zhǔn),分為0-Ⅳ級(jí)。對(duì)計(jì)數(shù)資料以例和百分率(%)表示。對(duì)各項(xiàng)臨床指標(biāo)變量進(jìn)行賦值,采用Kaplan-Meier方法估計(jì)生存率,并使用Log Rank法進(jìn)行組間生存率比較,采用Fisher精確概率法進(jìn)行3D-CRT組和IMRT組的療效比較,采用秩轉(zhuǎn)換的非參數(shù)檢驗(yàn)方法比較急性和遲發(fā)性毒副反應(yīng),采用t檢驗(yàn)或秩和檢驗(yàn)比較兩組的劑量學(xué)差異。 結(jié)果：1.全組患者隨訪時(shí)間24個(gè)月,平均生存時(shí)間為19.6個(gè)月；其中3D-CRT的平均生存時(shí)間為19.1個(gè)月,IMRT的平均生存時(shí)間為19.9個(gè)月。2.相同照射劑量下,(1) IMRT組與3D-CRT組相比,PGTVmax6346.98±168.81Gy和6198.47±54.12Gy,兩組有統(tǒng)計(jì)學(xué)差異(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組CIpgtv、CIptv、HIptv優(yōu)于3D-CRT組。(2) IMRT和3D-CRT組相比,小腸V4512.61±9.57和24.58±13.31,有統(tǒng)計(jì)學(xué)差異(P=0.044)；V4016.66±11.98和30.40±12.80,有統(tǒng)計(jì)學(xué)差異(P=0.032)；膀胱V4057.22±17.52和76.00±13.18,有統(tǒng)計(jì)學(xué)差異(P=0.021)； V4542.72±16.98和64.79±18.71,有統(tǒng)計(jì)學(xué)差異(P=0.019)；V5030.43±11.50和57.93±19.68,有統(tǒng)計(jì)學(xué)差異(P=0.003); IMRT組小腸V45、V40、膀胱V40、V45、V50受照射百分體積均低于3D-CRT組。(3)其余指標(biāo),PGTVmax、PGTVmean、PTVmean直腸Dmax、直腸Dmean、直腸V50、直腸V60、左股骨頭Dmax、右股骨頭Dmax、 HIpgtv均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。3.近期療效：IMRT組與3D-CRT組相比,疼痛緩解率93.8%和83.3%,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；腫瘤消退有效率43.8%和50%,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。4.放療急慢性毒副反應(yīng)：(1)急性腸道毒副反應(yīng),IMRT組與3D-CRT組相比,0度25%和8.3%,Ⅰ度68.8%和50%,Ⅱ度6.3%和33.3%,IMRT無(wú)Ⅲ度以上腸道反應(yīng),兩組有統(tǒng)計(jì)學(xué)差異(P=0.03)；急性膀胱毒副反應(yīng),IMRT組與3D-CRT組相比,0度81.3%和50%,Ⅰ度18.8%和16.7%,Ⅱ度6.3%和33.3%,IMRT無(wú)Ⅱ度以上膀胱反應(yīng),3D-CRT組Ⅱ度和Ⅲ度反應(yīng)為25%和8.3%,兩組有統(tǒng)計(jì)學(xué)差異(P=0.043)；(急性腸道及膀胱的毒副反應(yīng)IMRT均明顯低于3D-CRT組,(2)慢性膀胱毒副反應(yīng),]MRT組與3D-CRT組相比,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無(wú)Ⅳ度以上膀胱反應(yīng),兩組有統(tǒng)計(jì)學(xué)差異(P=0.04)；慢性腸道毒副反應(yīng),IMRT組與3D-CRT組相比,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組無(wú)Ⅳ度毒副反應(yīng),兩組無(wú)統(tǒng)計(jì)學(xué)差異(P=0.077)；5.生存分析3D-CRT組和IMRT組的1年總生存率分別為73.3%和80.4%(χ2=0.170,P=0.680),2年總生存率分別為51.3%和55.7%(χ2=0.068,P=0.794),認(rèn)為接受兩種放療方法的患者的總生存率無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論：(1)宮頸癌術(shù)后盆腔局部復(fù)發(fā)患者在同一放療劑量下,IMRT相較于3D-CRT組適形性、均勻性更好,同時(shí)膀胱及腸道的受照射劑量低、體積小。 (2)宮頸癌術(shù)后盆腔局部復(fù)發(fā)患者在毒副反應(yīng)方面,IMRT組的急性腸道、膀胱及慢性膀胱的毒副反應(yīng)均明顯低于3D-CRT組,IMRT在降低急慢性膀胱及腸道毒副反應(yīng)并發(fā)癥方面具有顯著優(yōu)勢(shì)。 (3) IMRT及3D-CRT治療患者在1、2年總生存率上無(wú)顯著差異,近期療效無(wú)顯著差異。
[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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